PS Form 3541 - USPS.com® - About
PS Form 3541 - USPS.com® - About
PS Form 3541 - USPS.com® - About
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
United States Postal Service<br />
Postage Statement - Periodicals<br />
One Issue or One Edition Unless Used as a Consolidated Statement<br />
Mailer<br />
Mailing<br />
Postage<br />
Certification<br />
Publication Title and Owner or News Agent's Name Mailing Agent's (Printer or Consolidator) Name, Address, Telephone Number, Entry Post Office Name, State, and ZIP+4<br />
and Email Address if Any<br />
CA<strong>PS</strong> Customer Ref. No.<br />
CRID<br />
Applicable Parts Completed Statement for bundles/ Price Category<br />
(select all that apply) containers only<br />
A B - E F (If Applicable)<br />
Classroom<br />
Regular Nonprofit<br />
Science-of-Agriculture<br />
Combined Mailing<br />
Mixed Class<br />
Single Class<br />
Publication No.<br />
Edition/Code Mailer's Mailing Date Processing Category No. of Addressed Pieces<br />
Letters Excluding Addressed<br />
Issue Date<br />
Issue Frequency Statement Sequence No.<br />
Flats<br />
Parcels<br />
Supplements<br />
Weight of a Single<br />
Ride-Along piece<br />
0 . ___ ___ ___ ___ lb.<br />
For Automation Pieces, Enter Date<br />
of Address Matching and Coding<br />
Part A - In-County Prices Total Part A (page 2) (Postmaster: Report total Part A postage in AIC 224)<br />
Owner or Agent's Name<br />
Owner or Agent's Signature<br />
Name and Telephone Number of Contact<br />
Person in Publisher's Office<br />
Weight per Copy for Issue (Round off to 4 decimal Advertising Percentage in This<br />
places if necessary)<br />
Issue<br />
____ ____ . ____ ____ ____ ____ pounds ____ ____ . ____ ____ %<br />
For Carrier Route Pieces, Enter Date<br />
of Address Matching and Coding<br />
US<strong>PS</strong> Use Only<br />
To be completed in<br />
non-PostalOne! sites<br />
Post Office Computed Weight per Copy<br />
(Round off to 4 decimal places if necessary)<br />
____ ____ . ____ ____ ____ ____ pounds<br />
Time AM PM<br />
US<strong>PS</strong> Employee's Signature<br />
Print US<strong>PS</strong> Employee's Name<br />
For Carrier Route Pieces, Enter<br />
Date of Carrier Route Sequencing<br />
____ ____ / ____ ____ / ___ ___ ___ ___ ____ ____ / ____ ____ / ___ ___ ___ ___ ____ ____ / ___ ___ / ___ ___ ___ ___<br />
Part B - Outside-County Pound Prices<br />
Part C - Outside-County Piece Prices<br />
Part D - Outside-County Bundle Prices<br />
Part E - Outside-County Sack/Tray/Pallet Prices<br />
Outside-County Postage<br />
Printer/Consolidator Imprint Permit No.<br />
CRID<br />
Total Part B (Page 3)<br />
Total Part C (Page 4)<br />
Total Part D (Page 5)<br />
Total Part E (Page 6 &7)<br />
Subtotal Parts B, C, D, and E<br />
Preferred Price Discount - Nonprofit, Classroom, Limited Circulation, Limited Circulation Science of<br />
Agriculture (Add line B16, and parts C, D, and E Totals) _____ X .05 (all others enter zero)<br />
Subtract the Preferred Price Discount from the Outside-County Postage<br />
Part F - Outside-County Ride-Along and Repositionable Notes (Page 7)<br />
Total Outside-County Postage (Postmaster: Report total Outside-County postage in AIC 135)<br />
Add Total In-County Postage and Total Outside-County Postage<br />
-<br />
=<br />
+<br />
Post Office: Note Mail Arrival Date & Time<br />
(Do Not Round-Stamp)<br />
Consolidated Postage Statement<br />
Yes No<br />
Number of Addressed Supplements<br />
In-County Outside-County<br />
Number and Type of Containers. (Enter total number of<br />
containers)<br />
_____ Trays _____ Sacks _____ Pallets<br />
For pieces bearing a simplified address enter date of<br />
delivery statistics file or alternative method<br />
____ ____ / ___ ___ / ___ ___ ___ ___<br />
Total Postage<br />
(AIC 224 + AIC 135)<br />
The signature of the owner of the publication certifies acceptance of liability for and agreement to pay any revenue deficiencies assessed on this mailing,<br />
subject to appeal. If an agent signs this form, the agent certifies that he or she is authorized to sign on behalf of the owner of the publication and that the<br />
owner of the publication is bound by the certification and agrees to pay any deficiencies. In addition, agents may be liable for any deficiencies resulting from<br />
matters within their responsibility, knowledge, or control. The owner of the publication hereby certifies that all information furnished on this form is accurate,<br />
truthful, and complete; that the mail and the supporting documentation comply with all postal standards and the mailing qualifies for the prices and fees<br />
claimed; and that the mailing does not contain any matter prohibited by law or postal regulation. I understand that anyone who furnishes false or misleading<br />
information on this form or who omits information requested on this form, may be subject to criminal and/or civil penalties, including fines and imprisonment.<br />
Privacy Notice: For information regarding our Privacy Policy visit www.usps.com.<br />
Round Stamp (Required)<br />
Payment Date<br />
<strong>PS</strong> <strong>Form</strong> <strong>3541</strong>-1, January 2013 (Page 1 of 7) <strong>PS</strong>N 7530-07-000-6222 This form and mailing standards are available on Postal Explorer at pe.usps.com.<br />
US<strong>PS</strong> Use Only<br />
To be completed in<br />
non-PostalOne! sites
Periodicals - One Issue or One Edition - In-County<br />
Part A<br />
In-County<br />
Pound Price<br />
Entry<br />
Subscriber or<br />
Requester<br />
Copies<br />
Nonsubscriber or<br />
Nonrequester<br />
Copies<br />
Total<br />
Copies<br />
Check box at left if prices are populated in this section.<br />
Total<br />
Pounds<br />
A1 DDU $0.149<br />
A2 None 0.194<br />
A3 Total Pound Price Postage (Add lines A1 and A2)<br />
Piece Price (Presort)<br />
Entry / Zone Presort Discount<br />
Total<br />
Copies<br />
Addressed<br />
Pieces<br />
Price<br />
A4 Nonautomation $0.136<br />
A5 Basic Automation Letters 0.062<br />
A6 Automation Flats 0.120<br />
A7 Nonautomation 0.124<br />
A8 3-Digit Automation Letters 0.051<br />
A9 Automation Flats 0.112<br />
A10 Nonautomation 0.111<br />
A11 5-Digit Automation Letters 0.049<br />
A12 Automation Flats 0.105<br />
A13 Basic 0.063<br />
A14 Carrier Route High Density 0.046<br />
A15 Saturation 0.032<br />
A16 Presort Subtotal (Add lines A4-A15)<br />
A17 Number of Addressed Pieces at DDU Prices 0.008<br />
A18 Piece Price Subtotal (A16 minus A17)<br />
Full Service Intelligent Mail Option<br />
A19 Number of pieces that comply ____________ x $0.001 =<br />
A20 Periodicals In-County Subtotal (Line A18 minus A19)<br />
Ride-Along Price<br />
(Must equal the number of copies in line A16,<br />
not number of addressed pieces)<br />
A21<br />
Ride-Along Pieces<br />
Repositionable Notes<br />
(Must equal the number of copies in line A16,<br />
not number of addressed pieces)<br />
A22<br />
A23<br />
Repositionable Notes<br />
<strong>PS</strong> <strong>Form</strong> <strong>3541</strong>, January 2013 (Page 2 of 7)<br />
Total<br />
Copies<br />
Addressed<br />
Pieces<br />
Price<br />
Price<br />
Total Addressed<br />
Copies Pieces<br />
Price<br />
Other Subtotal(Add lines A21 and A22)<br />
Part A Total (Add lines A3, A20, and A23) Postmaster: Report in AIC 224<br />
$0.169<br />
$0.00<br />
Total<br />
Postage<br />
Total<br />
Postage<br />
Total<br />
Postage<br />
Total<br />
Postage
Periodicals - One Issue or One Edition - Outside-County<br />
Part B<br />
Outside-County - Pound Prices<br />
For Nonprofit & Classroom: All commingled nonsubscriber or nonrequester copies over the 10% limit must pay regular prices & use a separate <strong>PS</strong> <strong>Form</strong> <strong>3541</strong>.<br />
Advertising Pound Prices<br />
Entry Zone<br />
Subscriber or<br />
Requester<br />
Copies<br />
Nonsubsc. or<br />
Nonreq.<br />
Copies<br />
Total Copies Total Pounds Advertising<br />
Pounds<br />
Check box at left if prices are populated in this section.<br />
Price<br />
Reg Sci/Ag<br />
B1 DDU $0.138 $0.104<br />
B2 DSCF 0.211 0.158<br />
B3 DADC 0.225 0.169<br />
B4 1 & 2 0.247 0.185<br />
B5 3 0.271<br />
B6 4 0.333<br />
B7 5 0.426<br />
B8 6 0.524<br />
B9 7 0.645<br />
B10 8 0.749<br />
B11 Subtotal (Add lines B1-B10)<br />
Nonadvertising Pound Prices<br />
Total<br />
Pounds<br />
minus<br />
Advertising<br />
Pounds<br />
equals Nonadvertising<br />
Pounds<br />
Price<br />
Total<br />
Postage<br />
X Reg Sci/Ag Total Postage<br />
B12 DDU (From B1) (From B1) $0.116 $0.116<br />
B13 DSCF (From B2) (From B2) 0.175 0.175<br />
B14 DADC (From B3) (From B3) 0.187 0.187<br />
B15 All Others (From B4-B10) (From B4-B10) 0.208 0.208<br />
B16 Subtotal (Add lines B12-B15)<br />
<strong>PS</strong> <strong>Form</strong> <strong>3541</strong>-3, January 2013 (Page 3 of 7) <strong>PS</strong>N 7530-07-000-6223<br />
Pound Price Postage Total (Add lines B11 and B16)<br />
Nonadvertising Pound Prices - Alternate (Nonprofit and Classroom publications with 10% or less advertising, or other publications with 0%<br />
advertising.)<br />
Price<br />
Entry Zone<br />
Subscriber or<br />
Requester<br />
Copies<br />
Nonsubsc. or<br />
Nonreq. Copies<br />
Total Copies Total Pounds Reg Sci/Ag Total Postage<br />
B12 DDU $0.116 $0.116<br />
B13 DSCF 0.175 0.175<br />
B14 DADC 0.187 0.187<br />
B15 All Others 0.208 0.208<br />
B16 Subtotal (Add lines B12-B15)<br />
Part B Total - Pound Price Total (Add lines B11 and B16)
Periodicals - One Issue or One Edition - Outside-County<br />
Part C<br />
Outside-County - Piece Prices<br />
Machinable Flats<br />
Level Price Level Total Copies Addressed Pieces Price<br />
C1 Mixed ADC Barcoded $0.424<br />
C2 Nonbarcoded 0.457<br />
C3 ADC Barcoded 0.397<br />
C4 Nonbarcoded 0.421<br />
C5 3-Digit Barcoded 0.381<br />
C6 Nonbarcoded 0.404<br />
C7 5-Digit Barcoded 0.291<br />
C8 Nonbarcoded 0.301<br />
Nonmachinable Flats<br />
C9 Mixed ADC Barcoded $0.594<br />
C10 Nonbarcoded 0.641<br />
C11 ADC Barcoded 0.494<br />
C12 Nonbarcoded 0.520<br />
C13 3-Digit Barcoded 0.430<br />
C14 Nonbarcoded 0.442<br />
C15 5-Digit Barcoded 0.318<br />
C16 Nonbarcoded 0.319<br />
Parcels<br />
C17 Mixed ADC $0.641<br />
C18 ADC 0.520<br />
C19 3-Digit 0.442<br />
C20 5-Digit 0.319<br />
Letters<br />
C21 Mixed ADC Barcoded $0.331<br />
C22 Nonbarcoded 0.457<br />
C23 ADC Barcoded 0.290<br />
C24 Nonbarcoded 0.421<br />
C25 3-Digit Barcoded 0.269<br />
C26 Nonbarcoded 0.404<br />
C27 5-Digit Barcoded 0.205<br />
C28 Nonbarcoded 0.301<br />
Carrier Route & Firm Bundles<br />
C29 Basic $0.193<br />
C30 High-Density 0.160<br />
C31 Saturation 0.139<br />
C32<br />
Firm Bundle (Use "Addressed Pieces" to<br />
calculate postage)<br />
0.189<br />
C33 Subtotal (Add lines C1 through C32)<br />
C34 Nonadv. % (100 minus adv.%) _____ X # of Addressed Pieces (C33) X $0.00104<br />
C35 Subtotal Outside County Piece Prices (Line C33 minus C34)<br />
Full Service Intelligent Mail Option<br />
C36 Number of pieces that comply ______ x $0.001 =<br />
<strong>PS</strong> <strong>Form</strong> <strong>3541</strong>, January 2013 (Page 4 of 7)<br />
Check box at left if prices are populated in this section.<br />
Part C Total (Line C35 minus C36)<br />
Total<br />
Postage
Periodicals - One Issue or One Edition - Outside-County<br />
Part D<br />
Outside County - Bundle Prices<br />
Container Level Bundle Level Bundles Price<br />
D1 Mixed ADC $0.081<br />
D2 ADC 0.213<br />
D3 Mixed ADC 3-Digit/SCF 0.283<br />
D4 5-Digit 0.292<br />
D5 Carrier Route<br />
D6 Firm 0.190<br />
D7 ADC 0.118<br />
D8 3-Digit/SCF 0.195<br />
D9 ADC 5-Digit 0.211<br />
D10 Carrier Route 0.333<br />
D11 Firm 0.158<br />
D12 3-Digit/SCF 0.132<br />
D13 SCF/ 3-Digit 5-Digit 0.154<br />
D14 Carrier Route 0.295<br />
D15 Firm 0.146<br />
D16 5-Digit 0.149<br />
D17 CR/ 5-Digit Carrier Route 0.156<br />
D18 Firm 0.081<br />
<strong>PS</strong> <strong>Form</strong> <strong>3541</strong>-5, January 2013 (Page 5 of 7) <strong>PS</strong>N 7530-10-000-0501<br />
Part D Total (Add lines D1-D18)<br />
Check box at left if prices are populated in this section.<br />
Total<br />
Postage
Periodicals - One Issue or One Edition - Outside-County<br />
Part E<br />
Outside-County - Sack and Tray Prices<br />
Outside-County - Sack/Tray Prices<br />
Container Level Entry Sacks/Trays Price<br />
E1 Origin NDC $0.449<br />
E2 Mixed ADC Origin ADC 0.449<br />
E3 Sack/Tray Origin SCF 0.449<br />
E4 Origin Post Office/DMU 0.449<br />
E5 Origin NDC 2.134<br />
E6 Origin ADC 2.134<br />
E7 ADC Sack/Tray Origin SCF 2.134<br />
E8 Origin Post Office/DMU 2.134<br />
E9 Destination NDC 1.492<br />
E10 Destination ADC 0.853<br />
E11 Origin NDC 2.238<br />
E12 Origin ADC 2.238<br />
E13 3-Digit / Origin SCF 2.238<br />
E14 SCF Sack/ Origin Post Office/DMU 2.238<br />
E15 Tray Destination NDC 1.599<br />
E16 Destination ADC 1.279<br />
E17 Destination SCF 0.853<br />
E18 Origin NDC 2.877<br />
E19 Origin ADC 2.877<br />
E20 5-Digit/ Origin SCF 2.877<br />
E21 Carrier Route Origin Post Office/DMU 2.877<br />
E22 Sack/Tray Destination NDC 2.132<br />
E23 Destination ADC 1.812<br />
E24 Destination SCF 1.385<br />
E25 DDU 0.959<br />
E26 Part E Sack and Tray Total (Add lines E1-E25)<br />
<strong>PS</strong> <strong>Form</strong> <strong>3541</strong>, January 2013 (Page 6 of 7)<br />
Check box at left if prices are populated in this section.<br />
Total<br />
Postage
Periodicals - One Issue or One Edition - Outside-County<br />
Part E - Continued<br />
Outside-County - Pallet Prices<br />
Outside-County - Pallet Prices<br />
Container Level Entry Pallets Price<br />
E27 Origin NDC $3.560<br />
E28 Mixed ADC Pallet Origin ADC 3.560<br />
E29 Origin SCF 3.560<br />
E30 Origin Post Office/DMU 3.560<br />
E31 Origin NDC 34.375<br />
E32 Origin ADC 34.375<br />
E33 ADC Pallet Origin SCF 34.375<br />
E34 Origin Post Office/DMU 34.375<br />
E35 Destination NDC 23.717<br />
E36 Destination ADC 13.129<br />
E37 Origin NDC 40.719<br />
E38 Origin ADC 40.719<br />
E39 3-Digit / Origin SCF 40.719<br />
E40 SCF Pallet Origin Post Office/DMU 40.719<br />
E41 Destination NDC 25.199<br />
E42 Destination ADC 21.917<br />
E43 Destination SCF 11.752<br />
E44 Origin NDC 53.370<br />
E45 Origin ADC 53.370<br />
E46 Origin SCF 53.370<br />
E47 5-Digit / Origin Post Office/DMU 53.370<br />
E48 Carrier Route Pallet Destination NDC 33.776<br />
E49 Destination ADC 31.975<br />
E50 Destination SCF 21.599<br />
E51 DDU 1.694<br />
E52<br />
F1<br />
Ride-Along Pieces<br />
Part E Pallet Total (Add lines E27-E51)<br />
<strong>PS</strong> <strong>Form</strong> <strong>3541</strong>-7, January 2013 (Page 7 of 7) <strong>PS</strong>N: 7530-10-000-0502<br />
Part E Total (add lines E26 and E52)<br />
Part F Total (Add lines F1 and F2)<br />
Check box at left if prices are populated in this section.<br />
$0.169<br />
Total<br />
Postage<br />
Part F<br />
Ride-Along Price and Repositionable Notes (Outside-County Only) Check box at left if prices are populated in this section.<br />
Ride-Along Price<br />
(Must equal the number of copies, not number of addressed pieces)<br />
Total<br />
Copies<br />
Addressed<br />
Pieces<br />
Price<br />
Total<br />
Postage<br />
Repositionable Notes<br />
(Must equal the number of copies, not number of addressed pieces)<br />
F2<br />
Repositionable Notes<br />
Total<br />
Copies<br />
Addressed<br />
Pieces<br />
Price<br />
$0.000<br />
Total<br />
Postage
Instructions<br />
Use this form for Periodicals mailings.<br />
Step 1: Complete Mailer and Mailing sections on page 1. List all containers in the Number and Type of Containers field.<br />
You must select either Yes or No under Consolidated Postage Statement.<br />
Step 2: Before you complete the Postage section, go to parts A through E and complete the part(s) that pertain to your<br />
mailing. Pieces that comply with the Full-Service Intelligent Mail option requirements are additionally reported on the line<br />
provided.The following information will help you determine which parts to complete:<br />
Parts A - In-County piece and pound prices.<br />
Parts B - Outside-County pound prices.<br />
Parts C - Outside-County piece prices.<br />
Parts D - Outside-County bundle prices.<br />
Parts E - Outside-County sack/tray/pallet prices.<br />
Parts F - Outside-County Ride-along and Repositionable Notes prices.<br />
Step 3: Complete only applicable part(s), as follows:<br />
1. For In-County mailings, complete only part A.<br />
2. For Outside-County mailings, complete applicable parts B through F.<br />
Step 4: Go to the Postage Section on page 1. Add postage from Part Total box for each completed part. Bring these totals<br />
forward to front page and insert in appropriate box. For outside-county sack/tray/pallet prices, complete distribution section<br />
in order to determine Part E total. Add all parts together to get Total Postage.<br />
Step 5: Read and sign the Certification section, including your telephone number. Attach all completed pages together to<br />
submit with the mailing. (Do not include blank pages.)<br />
Information: For more information on mailing standards, prices, and fees please go to Postal Explorer at pe.usps.com.<br />
<strong>PS</strong> <strong>Form</strong> <strong>3541</strong>, January 2013 (Instructions)
Change language