CIAB Form #5A Inventory Reserve Summary

I

CIAB

FORM #5 A

OMB # 0581-0177

Original

Changed

(Mark Type)

NVENTORY RESERVE SUMMARY

C herry Industry Administrative Board

P.O. Box 388, DeWitt, MI 48820-0388

Tel: 517/669-1070 Fax: 517/669-1260

This report is required of all Handlers processing fruit from regulated districts during any regulated crop season. It is due by close of business, Eastern time, November 1 and at any other time that rotation of stock in reserve inventory is desired.

Handler: Handler ID#

Address:

City, ST Zip:

Telephone No.:

WAREHOUSE CONVERTED LBS.

NAME	LOCATION	Raw Product Equivalent

1. For each warehouse listed on this form, a Form #5 B, Inventory Location Report, must be prepared and must accompany the report.

By:

Title:

Date:

Page of (see other side for additional information)

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0581-0177. The time required to complete this information collection is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual’s income is derived from any public assistance program (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at (202) 720-2600 (voice and TDD). To file a complaint of discrimination, write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.