Completing PS Form 3500
Overview
PS Form 3500, Application For Periodicals Mailing Privileges, has a section
to indicate your type of publication ("Filing Status") and different parts to be
completed for different types of publications. Not all parts apply to all
publication categories. A copy of PS Form 3500 is shown in Exhibit I.
• Part A - Must be completed for all publications.
• Part B - Must be completed for General (Paid) publications or
for Foreign publications.
• Part C - Must be completed for Requester publications.
• Part D - Must be completed for all publications of Institutions
and Societies.
• Part E - Must be completed for publications of Institutions and
Societies that are authorized to contain general advertising.
• Part F - Must be completed for publications applying for
nonprofit rate eligibility.
Complete the worksheets in Appendixes A and B to determine the accuracy
of your identification statement and whether or not the publication is entitled
to In-County rates of postage.
Filing Status
Check the box that best fits your publication and, if you wish (except if you
check Requester), the box for requesting special Periodicals rates.
Part A
All applicants must complete Part A, items 1 through 19.
1. Title of Publication
Print the title of the publication as it appears on the publication.
2. Name of Publisher, Agent (for Foreign publications), or Organization
Print the name of the publisher or publishing company or, for foreign
publications, the name of the agent or broker.
3. ISSN (If assigned)
Place the eight-digit ISSN (International Standard Serial Number) here
if one is already assigned to the publication by the Library of Congress
Serials Data Division. Leave blank if no number has been assigned.
4. Frequency of Issue
List the frequency as called for by the statement of frequency. (See the
examples under "Basic Criteria" noted previously in this handbook.)
5. Number of Issues
List the number of issues published annually as called for by the
statement of frequency.
6. Annual Subscription Price
Indicate the basic annual subscription price if the publication has one.
7. Full Name of Owner
Enter the name of the owner of the publication. This could be one or
more individuals, a partnership, or a corporation.
8. Location of Known Office of Publication
Enter the physical address of the known office of publication where
regular business is conducted and circulation records are kept or made
available for review. For Foreign publications, this is the physical
address of the mailing agent. Be sure to include the county when
completing this item.
9. Corporate Stockholders
List the names of all stockholders owning 1 percent or more of stock in
the company. Use a separate sheet if needed.
10. Financial Interest
Check the appropriate box. If "Yes," describe the interest in the box to
the right of item 10.
11. Advertising Interest
Check the appropriate box. If "Yes," describe the interest in the box to
the right of item 11.
12. Copies to Advertisers
Check the appropriate box. If "Yes," state the number of copies and the
reasons for this extra distribution in the box to the right of item 12. Each
advertiser may receive one proof copy that is counted as a valid
subscriber or requester copy.
13. Issue Date
List the issue date. You may not file an application for Periodicals
mailing privileges for publications not meeting Periodicals requirements.
Therefore, the date of issue on which the application is based should
be the date of the first issue meeting all Periodicals requirements.
14. Total Copies Printed
Print the total number of copies produced from your press run or print
order for the issue listed in item 13. If there are multiple runs to complete
an issue, indicate the total of all press runs or production orders.
15. Contact's Name
Print the name of the individual responsible for completing this form.
16. Contact's Address
Print the contact person's business address.
17. Contact's Phone Number
Print the contact person's business phone number.
18. Signature
After the rest of the form is completed, have the publisher or publisher's
representative sign the application after reading the certification
statement.
19. Date
After the rest of the form is completed, enter the date you sign and
submit the application.
Items 20 through 26 must be completed by the postmaster or
postmaster's designee.
20. Date of First Mailing
Enter the date of the first mailing made under the deposit arrangements
after the application was filed. This coincides with the establishment of
the pending account for the publication.
21. Amount of Fee Paid
Enter the amount of the fee collected for the application.
22. Date Fee Paid
Enter the date the fee was paid.
23. Name of Postal Contact
Print your name.
24. Signature
Sign your name.
25. Date Signed
Print the date the application fee was paid and the application was
accepted. Also, round-date the application in this area.
26. Post Office Address
Enter the address of the Post Office accepting the application.
27. Telephone Number
Enter the telephone number of the Post Office accepting the
application.
This completes Part A.
Part B
Complete Part B if you are applying for either a General publication or a
Foreign publication.
1. Basic Annual Subscription Price
Record the basic annual subscription price, which is the same as the
amount in Part A, item 6.
2. Subscriptions Received at the Basic Price
Record the number of subscriptions for which the basic price was paid by
individuals wishing to receive the publication. Copies to be billed (also
called "promised to be paid") may count toward these subscriptions.
3. Subscriptions Received Under a Premium Offer or Discount
Record all subscriptions paid at a discounted price or with the
understanding that a premium item will be included with the subscription.
In the box below item 3, describe the discount or premium and its cost to
the publisher, retail value, and value represented, if any. Subscriptions for
which premium offers or discounts (or a combination of the two) exceed
50 percent of the basic subscription price are nominal rate subscriptions
and disqualify that individual as a subscriber.
4. Subscriptions Paid With Dues or Contributions
Record the number of subscriptions paid for as part of dues or contributions
to the organization. Attach a copy of the form used to obtain payments of
dues or contributions and subscriptions. Such forms must show the amount of
dues or contributions that are set aside for a subscription.
5. Copies Purchased by Others
List all subscriptions purchased by others (e.g., gift subscriptions). Attach
a separate sheet showing who purchased these subscriptions, the price
paid, and the purpose. Copies purchased in bulk for promotional purposes
and copies purchased by advertisers for advertising purposes are not
valid subscriptions and must be reported in item 11.
6. Single-Copy Sales
Record all single copies sold. This includes newsstand sales, vending
machine sales, street copy sales, and copies sold over the publisher's
counter. Many newsstand copies are consigned to newsstands with
return privileges for unsold copies. List only the sold copies. Unsold
copies must be reported in item 16.
7. Advertiser Proof Copies
Record the number copies furnished to the advertisers in the publication.
Each advertiser in an issue is entitled to one proof copy to show that the
ad was published. One copy per advertiser is counted as paid circulation.
8. Exchange Copies
Record any copies that are exchanged with other publications on a
one-for-one basis. Additional copies are considered
nonsubscriber/nonrequester copies and must be reported in item 11.
9. Other Paid Circulation
Record any other paid circulation that does not fit the previous items and
describe how the subscriptions were sold (e.g., copies sold through agents).
10. Total Paid Distribution
Add items 2 through 9 to determine total paid distribution.
11. Number of Bulk and Sample Copies
Record the number of distributed sample copies and bulk orders.
These include all promotional and complimentary copies.
12. Expired Subscriptions
Record the number of expired subscriptions. These are unpaid copies mailed
to subscribers who have let their subscriptions run out without renewing.
13. Nominal Rate Subscriptions
List all subscriptions sold at a rate below half the value of the basic
subscription price and any subscriptions sold with a premium that exceeded
half the value of the basic subscription price of the publication.
14. Total Nonsubscriber Distribution
Add items 11 through 13 to determine the total nonsubscriber distribution.
15. Total Copies Distributed
Add items 10 and 14 to determine the total distribution of the publication.
16. Unsold Newsstand and Vending Machine Copies, Plus Other
Nondistribution
Record the total copies returned or recycled from newsstands and vending
machines, spoiled copies from production runs, office copies, copies held in
storage, and copies sent to the Post Office with this application. These
copies are not distributed and are not considered when determining paid
distribution. Attach documentation that substantiates the disposition of the
nondistributed copies.
17. Total Copies Printed
Add items 15 and 16. This total should equal the total copies printed in
Part A, item 14.
18. Percentage of Qualified Subscribers
Divide item 10 by item 15 to determine the percentage of qualified
distribution. For the publication to be eligible for the Periodicals rates as
a general publication, the percentage of qualified distribution must be 50
percent or more of the total distribution.
Part C
Complete Part C if you are applying for a Requester publication.
1. Requests Received by the Publisher
Record the number of requests for free copies of the publication.
Requests may be in the form of written, signed, and dated forms. They
may be obtained through telemarketing or the Internet. Appendix E
explains how those types of requests are verified and what
documentation is needed. Persons are not deemed to have requested
the publication if their request is induced by a premium offer or by
receipt of material consideration.
2. Paid Subscriptions
List the number of copies received through subscriptions. Copies may
be paid at nominal rates and still qualify as valid requester circulation.
3. Advertiser Proof Copies
Record the number of copies furnished to the advertisers in the
publication. Each advertiser in an issue is entitled to one proof copy to
show that the ad was published. One copy per advertiser is counted as
requested circulation.
4. Exchange Copies
List any copies that are exchanged with other publications on a
one-for-one basis. Additional copies are considered sample copies and
must be reported in item 11.
5. Copies Requested by Employers
Enter all copies requested for employees by their employer or
department head. Lists must be maintained to show who requested the
copies and the recipients. The ultimate recipients must be listed by
name and/or title. Requests by officials of membership organizations to
have copies sent to members do not qualify as valid request circulation
and must be reported in item 11.
6. Single-Copy Sales
Enter the number of single copies sold or requested over the
publisher's counter or sold through vending machines.
7. Copies Sent in Fulfillment of Requests in a Manner Not Covered Above
Record the number of copies requested in manners not covered in
items 1 through 6 and explain those manners (attach a separate sheet
if necessary).
8. Total Requested Distribution
Add items 1 through 7.
9. Requests More Than 3 Years Old
List the number of requests that are more than 3 years old. These are
not considered valid requests.
10. Requests Induced by a Premium Offer or Material Consideration
List any requests obtained by a premium offer or other inducement.
These are not eligible for the Periodicals rates.
11. Sample Copies
List all complimentary and other samples (e.g., trade show giveaways),
regardless of whether they are mailed or distributed by other means.
12. Total Nonrequester Distribution
Add items 9 through 11 to determine the total nonrequester distribution.
13. Total Distribution
Add items 8 and 12 to determine total distribution of the publication.
14. Nondistributed Copies
Record the total copies returned or recycled from newsstands and
vending machines, spoiled copies from production runs, office copies,
copies held in storage, and copies sent to the Post Office with this
application. These copies are not distributed and are not considered when
determining the qualified requester distribution. Attach documentation that
substantiates the disposition of the nondistributed copies.
15. Total Copies Printed
Add items 13 and 14. This should equal the press run or print order
listed in Part A, item 14.
16. Percentage of Requested Distribution
Divide item 8 by item 13 to determine the percentage of qualified
requester distribution. To be eligible for the Periodicals rates of postage,
the percentage of qualified requester distribution must be 50 percent or
more of the total distribution for the publication.
Parts D and E
Complete Part D if you are applying for an Institutions and Societies
publication that will have no advertising or publisher's advertising only.
Complete both Parts D and E if you are applying for an Institutions and
Societies publication that will have general advertising. See Appendix C to help
you determine whether or not you are eligible to have general advertising.
In Part D, check the type of organization that most closely describes your
organization. Check only one type of organization and complete the rest of
the details requested for that type of organization. Evidence to support the
eligibility of the organization is defined in the right-hand column for each type.
You must submit this evidence with the application.
Part F
Complete Part F if you are applying for special rates based on the eligibility of
the organization. Appendix D describes the various types of organizations
and how they qualify. Note: Requester publications (Part C) are not eligible
for special rates.
In item 1A, check the type of organization you are applying under. Provide
copies of by-laws, constitution, and articles of incorporation, as appropriate,
to provide proof that your organization meets its stated primary purpose. You
must also submit evidence of nonprofit status, such as a copy of an IRS
exemption from the payment of federal income tax, or other evidence, such
as a financial statement prepared by a responsible independent auditor (e.g.,
certified public accountant).
In item 1B, check the appropriate box if you are applying for either the
Classroom rates as a Classroom publication or the Science-of-Agriculture
rates as a Science-of-Agriculture publication.
In item 2, check the appropriate box.
Documentation
The following circulation records must be available for examination by Postal
Service personnel at the known office of publication:
a. The print order(s) or press run(s) for the entire production of issues of
the publication.
b. A list of subscribers or requesters.
c. Records of newsstand sales and returns.
d. Vending machine records.
e. Records or lists to substantiate any other paid circulation, such as
street sales, delivery by news carriers, and over-the-counter sales.
f. Order forms for subscriptions or requests.
g. Dues or membership forms.
h. Cashbooks, credit receipts, bank deposit slips, or other financial
records to support payment of subscriptions and other paid circulation.
i. Records of copies destroyed, copies stored for future fulfillment,
in-house office copies, and recycled newsstand returns.
Publication Copies
All applications for Periodicals mailing privileges must be accompanied by
two copies of the issue published nearest to the date of the application. One
of these copies must be marked to show the advertising and nonadvertising
content. The percentage of advertising and nonadvertising must be shown on
the cover.
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