Form 4241, 2009, - Rural Delivery Statistics Report

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United States Postal Service®
Post Office, State, and ZIP + 4 ®
(Follow Instructions in Chapter 5 of Handbook PO-603)
Rural Delivery Statistics Report
District
Carrier's Name
District ZIP Code™
Date of Count
Parcel
Vehicle
Regular
Centralized
NDCBU
Route
Route Miles
Finance No.
From - Through
Boxes
Boxes
Coll. Comps.
Lockers
Stops
No.
(Hundredths)
9. Customs
4. Flats, Catalogs,
8. Accountable
10.
3. DPS
1. Letter
2. Sector/ Seg-
Date
6. Parcels
Magazines,
5. DPS Flats
7. Boxholders
Mail Signature
Due, Rec’d for
Postage
ment Letters
Letters
Size
Item
Newspapers, Rolls
Del., C.O.D.
Due
Total
12. PS Form
17. Other Suit-
15.
18. Authorized
19. Authorized
20. Letters
11. Change of
16. Load
13. Marked Up
14. PS Form 3821
3982
Non-Signature
able Allowance
Date
Dismounts
Dismount
& Flats
Mail Pieces
(Completed)
Address
Vehicle*
(Exp. Req.)
(Exp. Req.)
Distance (Feet)
PARS Label
Scan Items
Collected
Total
21. Carrier
23. Parcel Ac-
25. Money Order
26. Return
Date of Local Pre-Count
22. Carrier
24. Registered,
27. Locked
Date
Pickup
cep ted Ordinary,
28. Reserved
Application
Receipt (“L”
Conference
Pickup “Items”
Certified Accepted
Pouch Weight
“Requests”
Insured, COD
Processed
Route Only)
High Option?
Yes
No
Leave Commitment
Signed?
Yes
No
Rotating Relief Day?
Yes
No
If 39:00 Plus, Convert to
Regular?
Yes
No
Current Detour?
Yes
No
Detour Miles (Hundredths)
Total
National
Neglected
EMA
In the event that I am eligible to elect a higher route classification, I agree to
Special
Amended
Vehicle Data
Govt. Veh.
use sufficient annual leave during the guarantee period to assure that my
Time Used During Count (Hrs. & Hund.) (Subtract
Number of Families Served
total actual work hours will not exceed 2,080 during the guarantee period.
Lunch Time from Office and/or Route Time as
Number of Locked Pouch Stops (If applicable)
Reported on PS Form 4240)
Carrier's Signature for “Leave Commitment”
Mail Withdrawal?
Yes
No
Office Time
Yes
Seasonal Route?
No
Route Time
Count Date Certified To Be Correct/Agreement with Count
In Season?
Carrier's Signature and Date (MM/DD/YYYY)
Yes
No
Net Total Time
Seasonal Miles (Hundredths)
Office
Auxiliary Assistance
Seasonal Regular Boxes
Postmaster's Signature and Date (MM/DD/YYYY)
Used
Route
Seasonal Central Boxes
Walking and Counting Time
4241
* Explanation Required when time exceeds 15 Min.
PS Form
, February 2009 PSN 7530-02-000-9207

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