PS Form 3500 "Application for Periodicals Mailing Privileges"

What Is PS Form 3500?

This is a legal form that was released by the U.S. Postal Service (USPS) on December 1, 2014 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 1, 2014;
  • The latest available edition released by the U.S. Postal Service (USPS);
  • Easy to use and ready to print;
  • Yours to fill out and keep for your records;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of PS Form 3500 by clicking the link below or browse more documents and templates provided by the U.S. Postal Service (USPS).

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Application for Periodicals
Mailing Privileges
See instructions on pages 3 and 4
Type of Publication—See DMM ® 207.6 (Check only one):
Foreign Publication—Complete Parts A and B
General Publication—Complete Parts A and B
Publication of Institutions and Societies With Publisher’s Advertising
Only—Complete Parts A and D
Requester Publication—Complete Parts A and C
Publication of State Department of Agriculture—Complete
Publication of Institutions and Societies With General Advertising—
Complete Parts A, D, and E
Parts A and D
Request for Permission to Mail at Special Periodicals Rates—
News Agents—Complete Part A and attach a separate sheet
Complete Part F and all other applicable parts
listing the publications you handle and where they are published.
Part A
1. Title of Publication as Shown on Publication
2. Name of Publisher ( Agent for Foreign
3. ISSN (If already assigned)
Publication)
4. Frequency of Issue (Be specific. For example, "weekly," "monthly except June")
5. Number of Issues Published Annually
6. Basic Annual Subscription Price
8. Complete address of Known Office of Publication, Including County. For foreign
7. Full Name of Owner (Individual, partnership, or corporation)
publications, agent’s address (not a Post Office™ box address)
9. If owned by a corporation, list the names of all stockholders owning or holding
1 percent or more of the total stock. (Attach a separate sheet if necessary)
10. Are any of the owners or stockholders interested financially in any
If response is "Yes," explain the interest.
Yes
business or trade represented by the publication? (Check one)
No
11. Do any of the persons or concerns that advertise in the publication
If response is "Yes," explain the interest.
Yes
have any interest therein? (Check one)
No
12. Is more than one copy of each issue furnished to any one advertiser
If response is "Yes," how many copies are furnished and what are the reasons.
Yes
therein? (Check one)
No
13. Date of issue on which application is based. (Usually issue published closest to
14. Total Number of Copies Printed (For foreign publications, number
date of filing)
of copies imported into United States)
15. Contact's Name
16. Contact's Address
17. Contact's Telephone Number
18. Signature of Publisher (or Agent for
I hereby certify that all information furnished on this form is in support of this application, including the Business Plan
Foreign Publication)
supporting an application under the New Launch procedure (if applicable), and other supporting documentation, is
accurate, truthful, and complete. I understand that anyone who furnishes false or misleading information or who omits
material information requested on this form may be subject to criminal sanctions (including fines and imprisonment)
19. Date Signed
.
and/or civil actions (including multiple damages and civil penalties)
20. Date of First Mailing Under Deposits After Application Was Filed
21. Amount of Application Fee Paid
22. Date Fee Paid
23. Name of Postal Employee to Contact With Any Questions About
24. Signature of Postmaster
25. Date Signed
This Application (Print)
26. Post Office Address
27. Area Code/Telephone Number
 Check if Centralized Acceptance Post Office
Part B
Check if
Application under New Launch procedure
Initial Audit of circulation by
Electronic Copies — Initial Audit of circulation
Applicable:
Authorized Audit Bureau Requested
by Authorized Audit Bureau Required
(Attach publisher’s signed business plan)
5. Copies Purchased by Others (Attach a separate sheet showing
$
1. Basic Annual Subscription Price
who purchased, for what price, and for what purposes)
2. Subscriptions Received by the Publisher at the Basic Annual
6. All Single Copies Sold (Newsstand, vendor, street sales)
Subscription Price From Persons to Whom Publication is Sent
3. Subscriptions Received Under Offer of a Premium or Other
7. Copies Furnished to Actual Advertisers in This Issue to Prove
Reduction Arrangement (Attach a separate sheet if necessary)
Insertion of Ads (One copy per advertiser)
Description of Premium or Reduction Arrangement
8. Copies Exchanged With Other Publications (One copy for another)
9. Other Paid Circulation (Describe)
Publisher's Cost Per Item Retail Value
Value Represented
4. Subscriptions Paid for With Dues or Contributions (Attach
10.
Total Paid Distribution (Add items 2 through 9)
printed copies of forms used for taking these subscriptions)
11. Single or Bulk Copies for Free Distribution (Samples/comps)
13. Nominal Rate Subscriptions (DMM 207.6.1.2)
14. Total Nonsubscriber Distribution (Add items 11 through 13)
12. Expired Subscriptions
15. Total Copies Distributed (Add items 10 and 14)
16. Unsold Newsstand and Vending Copies on Hand, Inventory for
17. Total Copies Printed (Add items 15 and 16. Should match total on
Future Orders, Copies Destroyed, etc. (Attach documentation)
press run/order or number imported. Attach press run or print order)
18. Percentage of Qualified Subscribers (Divide item 10 by item 15)
3500
PS Form
, December 2014 (Page 1 of 4) PSN: 7510-05-000-4625
This form is on the Internet at www.usps.com
®
.
Application for Periodicals
Mailing Privileges
See instructions on pages 3 and 4
Type of Publication—See DMM ® 207.6 (Check only one):
Foreign Publication—Complete Parts A and B
General Publication—Complete Parts A and B
Publication of Institutions and Societies With Publisher’s Advertising
Only—Complete Parts A and D
Requester Publication—Complete Parts A and C
Publication of State Department of Agriculture—Complete
Publication of Institutions and Societies With General Advertising—
Complete Parts A, D, and E
Parts A and D
Request for Permission to Mail at Special Periodicals Rates—
News Agents—Complete Part A and attach a separate sheet
Complete Part F and all other applicable parts
listing the publications you handle and where they are published.
Part A
1. Title of Publication as Shown on Publication
2. Name of Publisher ( Agent for Foreign
3. ISSN (If already assigned)
Publication)
4. Frequency of Issue (Be specific. For example, "weekly," "monthly except June")
5. Number of Issues Published Annually
6. Basic Annual Subscription Price
8. Complete address of Known Office of Publication, Including County. For foreign
7. Full Name of Owner (Individual, partnership, or corporation)
publications, agent’s address (not a Post Office™ box address)
9. If owned by a corporation, list the names of all stockholders owning or holding
1 percent or more of the total stock. (Attach a separate sheet if necessary)
10. Are any of the owners or stockholders interested financially in any
If response is "Yes," explain the interest.
Yes
business or trade represented by the publication? (Check one)
No
11. Do any of the persons or concerns that advertise in the publication
If response is "Yes," explain the interest.
Yes
have any interest therein? (Check one)
No
12. Is more than one copy of each issue furnished to any one advertiser
If response is "Yes," how many copies are furnished and what are the reasons.
Yes
therein? (Check one)
No
13. Date of issue on which application is based. (Usually issue published closest to
14. Total Number of Copies Printed (For foreign publications, number
date of filing)
of copies imported into United States)
15. Contact's Name
16. Contact's Address
17. Contact's Telephone Number
18. Signature of Publisher (or Agent for
I hereby certify that all information furnished on this form is in support of this application, including the Business Plan
Foreign Publication)
supporting an application under the New Launch procedure (if applicable), and other supporting documentation, is
accurate, truthful, and complete. I understand that anyone who furnishes false or misleading information or who omits
material information requested on this form may be subject to criminal sanctions (including fines and imprisonment)
19. Date Signed
.
and/or civil actions (including multiple damages and civil penalties)
20. Date of First Mailing Under Deposits After Application Was Filed
21. Amount of Application Fee Paid
22. Date Fee Paid
23. Name of Postal Employee to Contact With Any Questions About
24. Signature of Postmaster
25. Date Signed
This Application (Print)
26. Post Office Address
27. Area Code/Telephone Number
 Check if Centralized Acceptance Post Office
Part B
Check if
Application under New Launch procedure
Initial Audit of circulation by
Electronic Copies — Initial Audit of circulation
Applicable:
Authorized Audit Bureau Requested
by Authorized Audit Bureau Required
(Attach publisher’s signed business plan)
5. Copies Purchased by Others (Attach a separate sheet showing
$
1. Basic Annual Subscription Price
who purchased, for what price, and for what purposes)
2. Subscriptions Received by the Publisher at the Basic Annual
6. All Single Copies Sold (Newsstand, vendor, street sales)
Subscription Price From Persons to Whom Publication is Sent
3. Subscriptions Received Under Offer of a Premium or Other
7. Copies Furnished to Actual Advertisers in This Issue to Prove
Reduction Arrangement (Attach a separate sheet if necessary)
Insertion of Ads (One copy per advertiser)
Description of Premium or Reduction Arrangement
8. Copies Exchanged With Other Publications (One copy for another)
9. Other Paid Circulation (Describe)
Publisher's Cost Per Item Retail Value
Value Represented
4. Subscriptions Paid for With Dues or Contributions (Attach
10.
Total Paid Distribution (Add items 2 through 9)
printed copies of forms used for taking these subscriptions)
11. Single or Bulk Copies for Free Distribution (Samples/comps)
13. Nominal Rate Subscriptions (DMM 207.6.1.2)
14. Total Nonsubscriber Distribution (Add items 11 through 13)
12. Expired Subscriptions
15. Total Copies Distributed (Add items 10 and 14)
16. Unsold Newsstand and Vending Copies on Hand, Inventory for
17. Total Copies Printed (Add items 15 and 16. Should match total on
Future Orders, Copies Destroyed, etc. (Attach documentation)
press run/order or number imported. Attach press run or print order)
18. Percentage of Qualified Subscribers (Divide item 10 by item 15)
3500
PS Form
, December 2014 (Page 1 of 4) PSN: 7510-05-000-4625
This form is on the Internet at www.usps.com
®
.
Application for Periodicals Mailing Privileges
(Continued)
Part C
Check if
Application under New Launch procedure
Initial Audit of circulation by
Electronic Copies — Initial Audit of circulation by
Applicable:
(Attach publisher’s signed business plan)
Authorized Audit Bureau Requested
Authorized Audit Bureau Required
Requests Received by the Publisher From the Persons to Whom
1.
6. All Single Copies Sold (Newsstand, vendor, street sales)
the Publication Is Sent (Not paid subscription copies)
2. Subscription Copies Paid for or Promised to be Paid for
7. Copies Sent in Fulfillment of Requests in a Manner Not
Including Those Below Nominal Rate
Covered in Items 1 through 6 (Explain)
3.
Copies Furnished to Actual Advertisers in This Issue to Prove
Insertion of Ads (One copy per advertiser)
4.
Copies Exchanged With Other Publications (One copy for
another)
Copies Requested by Employers for Employees by Name or
5.
Position (Attach samples of these requests)
8. Total Requested Distribution (Add items 1 through 7)
9. Requests More Than 3 Years Old
11. Total Sample Copies Distributed (In the mails or otherwise)
10. Requests Induced by a Premium Offer or Material Consideration
12. Total Nonrequester Distribution (Add items 9 through 11)
13. Total Copies Distributed (Add items 8 and 12)
14. Unsold Newsstand and Vending Copies on Hand, Inventory for
15. Total Copies Printed (Add items 13 and 14. Should match total
Future Orders, Copies Destroyed, etc. (Attach documentation)
on order or number imported. Attach press run or print order)
16. Percentage of Qualified Requesters (Divide item 8 by item 13)
Part D
Type of Organization (Complete one row)
Attach to Application
Publication is
By society or order
No. of Members
1. Benevolent or Fraternal
Published:
Under auspices of society or order
Certified copy of the constitution and bylaws and
Type:
the resolution or order showing the date publica-
2. Society
Literary
Professional
Historical
Scientific
tion was adopted by the organization
Under auspices
Publication Is
By trade union
3. Trade Union
Published:
of trade union
Evidence that the publication is actually issued
Publication Is
Church
Church organization
4. Church or Church Organization
by a church or church organization
Issued By:
Is publication issued by a regularly
Is publication issued by a public or
Is publication issued by
Certified copy of the charter, articles of incorpora-
established state institution of
nonprofit private elementary school or
a regularly incorporated
tion, legislative act creating the institution and
learning supported in whole or in
secondary institution of learning or its
institution of learning?
5. Institution of
amendments thereto, and, when necessary, evi-
part by public taxation?
administrative or governing body?
Learning
dence to substantiate nonprofit status or support
 Yes
 No
 Yes
 No
 Yes
 No
by public taxation
6. State Agency of Health, Public Charities, Corrections, Agriculture,
Agency Issuing Publication
Evidence that authorized agency issues the
Conservation, Fish and Game, or Industrial Development
publication
Category Under Which Applying
Evidence that authorized station issues the
7. Educational Radio or Television Agency of a State or Political Subdivision
publication
of a State, or a Nonprofit Educational Radio or Television Station
Part E
1. Subscriptions From Members Who Received the Publication Paid
7. Total Sample Copies Distributed (In the mails or otherwise)
for by Dues or Assessments, Contributions, or Otherwise (Attach
a certified copy of the resolution or arrangement used for taking
these subscriptions)
8. Disposition and Number of Remaining Copies (Explain)
2. Copies Sent to Other Subscribers
3. Copies Exchanged With Other Publications (One copy for another)
9. Explanation From Item 4
4. Subscriptions Obtained in a Manner Not Covered Above
(Explain in block 9)
5. Copies Furnished to Actual Advertisers in This Issue to Prove
Insertion of Ads (One copy per advertiser)
6. Total Subscriptions (Add items 1 through 5)
Part F
B. Price (Check one box only)
A. Nonprofit Category (Check one box only)
1. If this application includes a request for
special Periodicals privileges, submit doc-
Science-of-Agriculture (DMM 207.11.2)
Religious
Philanthropic
Veterans
umentation that shows your organization
Fraternal
Classroom (DMM 207.10.4)
Educational
Agricultural
meets the requirements in DMM 207.10.
Other Qualified Organizations
(Check one box in either A or B)
Scientific
Labor
2. Was organization formed for profit or does any net income inure to the benefit of any private stockholder or individual?
 Yes
 No
3500,
PS Form
December 2014 (Page 2 of 4)
INSTRUCTIONS FOR COMPLETING PS FORM 3500, APPLICATION FOR PERIODICALS MAILING PRIVILEGES
APPLICANT
Complete PS Form 3500 when applying for any category of Periodicals mailing privilege.
Information about Periodicals mail is published in the Domestic Mail Manual (DMM ® ). You can access the DMM
on the Internet at http://pe.usps.gov.
If you're looking for...
Then turn to...
General eligibility for Periodicals rates
DMM 207.4
Standards for physical construction and mailpiece components
DMM 207.3
Postage rates for Periodicals
DMM 207.1
If you have questions about Periodicals mailing, check the DMM first. If you still need help:
Call the manager of Business Mail Entry at the district office that serves your ZIP Code™.
This information is listed in DMM 608.8.4.1
Call the USPS ® help line at 800-ASK-USPS ® .
All publications must first meet these basic standards to qualify for Periodicals rates:
1.
You must show intent to publish issues indefinitely with continuity from issue to issue. Your purpose must
be to transmit information of a general or specific nature.
You must publish issues at a regular frequency of at least four times a year.
2.
You must maintain a known office of publication where normal business is conducted during posted hours.
3.
Your publication must be formed of printed sheets.
4.
Completing the Application
There are several eligibility categories. Consult the DMM for full requirements, including advertising restrictions.
Then your publication may be
And you can
To apply,
If...
eligible as a...
read more in...
complete...
General Publication
DMM 207.6.1
Parts A and B
At least 50 percent of your total distribution goes to
individuals who have paid above a nominal rate
At least 50 percent of your total distribution goes to
DMM 207.6.4
Requester Publication
Parts A and C
qualified requesters, whether or not they have paid for
the subscription
Publication of a State Department
Parts A and D
DMM 207.6.3
Your publication is issued by a state department of
of Agriculture
agriculture
Foreign Publication
DMM 207.6.6
Parts A and B
Your publication originates in another country but you
have a known office of publication through an agent
or broker in the United States
Your publication is issued by an institution or society
Publication of an Institution
DMM 207.6.2
Parts A and D
and contains the institution's or society's advertising
or Society With Publisher's
only
Advertising Only
Your publication is issued by an institution or society
Publication of an Institution or
DMM 207.6.2
Parts A, D, and E
and contains general advertising
Society With General Advertising
In addition, if your publication is issued by a nonprofit organization, you may qualify for discounted rates. Read DMM 207.10
and complete Part F.
If you are a person or business selling two or more publications from different publishers, you are considered a News Agent. Read
DMM 207.6.7 and complete Part A. Attach a separate sheet listing the publications you handle and where they are published.
3500,
PS Form
December 2014 (Page 3 of 4)
INSTRUCTIONS FOR COMPLETING PS FORM 3500
(Continued)
Filing the Application
Submit your application to the Post Office that serves your known office of publication. Bring all of the following:
1. A completed PS Form 3500.
2. For an application filed under the “General” or “Requester” category, the publisher must check the appropriate space in Part B or
Part C, as applicable, if the application is being submitted under the New Launch procedure.
3. The publisher must check the applicable space in Part B or Part C, as applicable, if requesting or if required to have the initial audit
of circulation be performed by an authorized audit bureau.
4. Two copies of the issue of the publication described in this application marked to show the advertising content. Indicate on the
cover both the total units (e.g., column inches, square inches, pages) and the percentage of advertising and nonadvertising. If the
publication is in a foreign language, provide a brief translation of its contents.
5. The application fee. This fee is nonrefundable and may be paid by cash, check (payable to “Postmaster”), or credit card.
6. If you intend to mail at a Post Office other than the Post Office that serves your known office of publication, you must submit
a completed PS Form 3510-M, Application for Additional Mailing Office for Periodicals Publication.
Publisher's Records
You must make adequate records available to the Postal Service™ to permit verification of the figures on your application.
The Postal Service will contact you to schedule this review. (Not applicable for an application filed under the “General” or
“Requester” category if the initial verification of circulation will be performed by an authorized audit bureau.)
POSTMASTER
Process PS Form 3500 as follows:
1. Review the application for completeness.
2. Complete items 20 through 27 on page 1. Round-date the application in this area.
3. Forward the application and one marked copy of the publication to the manager of the Pricing and Classification
Service Center (PCSC).
PRICING AND CLASSIFICATION SERVICE CENTER
90 CHURCH STREET, STE 3100
NEW YORK NY 10007-2951
PRICING AND CLASSIFICATION SERVICE CENTER
1. Review the application to determine if the basic Periodicals criteria are met.
2. If the criteria are met, the PCSC manager sends a memo to the postmaster or BME manager giving instructions on how
to audit the publication, with a list of the specific records to be reviewed. These records may include the following, as
applicable:
a.
Print order and printer's invoice.
b.
Mailing labels or a mailing list.
c.
Subscription/requester list.
d.
Records of newsstand and over-the-counter sales and returns.
e.
Stubs or copies of receipts issued.
f.
Records of vending machine sales and returns.
g.
Records of membership dues paid (if they include a subscription fee).
h.
Assignment and collection records for carriers other than USPS.
i.
Cash receipts, cashbook, or similar source records that show subscription payments.
j.
Records showing the number of copies destroyed.
k.
Records of gift subscriptions.
l.
Records of bulk orders.
.
3. Once the audit is completed and returned, the PCSC manager rules on the application
.
PRIVACY NOTICE: See our privacy policy on www.usps.com
®
3500,
PS Form
December 2014 (Page 4 of 4)
Page of 4