Refer to the Livestock Feed Product Profile Instructions When Completing This Form

Refer to the Livestock Feed Product Profile Instructions when completing this form.

Applicant: / Applicant No.:
If packaging for another company, please list:
Brand on label:
Product:
Check the labeling category claim this product’s label will make.Attach samples of labels for all products for which this Organic Product Profile is used.
"100% organic" "organic" (95% organic ingredients)
Ingredients: Provide complete information about all ingredients used in this product.
Agricultural Ingredient
(must be Certified Organic) / Handler or Distributor on Label / Certification Agency / 100% Organic or Organic Ingredient / Proof of Certification (Transaction Certificate, Organic Certificate, Label) / Verified / % of Finished Product
Synthetic substances
allowed for use in organic
livestock production / Supplier of Synthetic Substance / Allowed in the National List §205.603(d)? / Synthetic feed additives allowed: (1) DL-Methionine, DL-Methionine-hydroxy analog, and DL-Methionine-hydroxy analog calcium (for use only in poultry production)
(2) Trace minerals, used for enrichment or fortification when FDA approved.
(3) Vitamins, used for enrichment or fortification when FDA approved. / % of Finished Product
Yes No / DL-Methionine product Trace mineralVitamin
Yes No / DL-Methionine product Trace mineralVitamin
Yes No / DL-Methionine product Trace mineralVitamin
Yes No / DL-Methionine product Trace mineralVitamin
Yes No / DL-Methionine product Trace mineralVitamin
Yes No / DL-Methionine product Trace mineralVitamin
Yes No / DL-Methionine product Trace mineralVitamin
Yes No / DL-Methionine product Trace mineralVitamin
Yes No / DL-Methionine product Trace mineralVitamin
Yes No / DL-Methionine product Trace mineralVitamin
Yes No / DL-Methionine product Trace mineralVitamin
Yes No / DL-Methionine product Trace mineralVitamin
Yes No / DL-Methionine product Trace mineralVitamin
Nonsynthetic substances / Supplier of
Nonsynthetic Substance / % of Finished Product / Nonsynthetic substances / Supplier of
Nonsynthetic Substance / % of Finished Product
Is Strychnine used? Yes No (See NOP Annotation §205.604(a))
Product Percentage of Organic Ingredients: % / Total Ingredients: %

Signature Date

Livestock Feed Product Profile / Organic / Print Date: 10/2/2018
Controlled Version: 3/6/2018 / Page 1 of 2 / © 2018 Minnesota Crop Improvement Association