FV-309 Board Nomination Form by Producer/Handler

REPRODUCE LOCALLY. Include form number and date on all reproductions.

OMB No. 0581-NEW

UNITED STATES DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
FRUIT AND VEGETABLE PROGRAMS

INSTRUCTIONS FOR COMPLETING THE ATTACHED
NATIONAL LEAFY GREEN VEGETABLE BOARD NOMINATION FORM
BY PRODUCER/HANDLER
The National Leafy Green Vegetable Board (Board) administers the National Marketing Agreement Regulating Leafy
Green Vegetables. Nominees must be willing to serve on the Board for a two-year term of office. Each of the members
will have an alternate. Please complete the attached form if you wish to nominate yourself and/or another eligible person
for the following seats on the Board:
(a) 4 signatory handlers and 3 producers from Zone 1;
(b) 1 signatory handler and 1 producer from Zone 2;
(c) 1 signatory handler and 1 producer from Zone 3;
(d) 1 signatory handler and 1 producer from Zone 4;
(e) 1 signatory handler and 1 producer from Zone 5;

(f) 1 signatory handler and 1 producer from Zone 6;
(g) 2 signatory handlers and 1 producer from Zone 7;
and
(h) 1 signatory handler and 1 producer from Zone 8;

To the extent practicable, Board membership, including alternate members, shall include representation of the following
stakeholder groups (Receipts means “total income” (or in the case of sole proprietorship, “gross income”) plus “cost of
goods sold,” as these terms are defined and reported to the Internal Revenue Service (IRS). The annual receipts should be
averaged for the last three completed fiscal years.):
(i)
(ii)

(iii)

(iv)

Producers that have $750,000 per year or less in annual total receipts of leafy green vegetables;
Producers on diversified farms, where diversified farms are farms producing a variety of crops or
animals, or both, on one farm, as distinguished from specializing in a single commodity. For the
purposes of this subpart, variety of crops means any crop in addition to those included in the definition
of leafy green vegetable;
Certified organic businesses where producers have $750,000 per year or less in annual total receipts of
leafy green vegetables or signatory handlers have $7,000,000 per year or less in annual total receipts of
leafy green vegetables; and
Certified organic businesses where producers have $750,001 per year or more in annual total receipts of
leafy green vegetables or signatory handlers have $7,000,001 per year or more in annual total receipts
of leafy green vegetables.

The retailer, foodservice operator, and public members and their alternate members may not be engaged in the production
or handling of leafy green vegetables. The retailer and foodservice Operator members and alternates shall be, at the time
of their selection and throughout their term of office, an owner, officer or employee for the seat selected.
The completed Nomination Form must be postmarked, faxed, or hand-delivered to _____________________________, no
later than _____ p.m. on ________________, 20__ to be valid. Multiple Nomination Forms may be submitted.
As Nomination Forms are received, nominees will be notified of their nomination, and asked to complete a National Leafy
Green Vegetable Board Background Information form. All qualified nominees will be reported to the Secretary of
Agriculture. A full copy of the Marketing Agreement may be found online at ____________________________ or by
calling _______________.

FV-309 (Rev. 3/2011)

REPRODUCE LOCALLY. Include form number and date on all reproductions.

OMB No. 0581-NEW

UNITED STATES DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
FRUIT AND VEGETABLE PROGRAMS

NATIONAL LEAFY GREEN VEGETABLE BOARD NOMINATION FORM
BY PRODUCER/HANDLER
Nomination

Producer

Handler

Importer

Retailer

Foodservice Operator

Full Name

Phone Number

Company Name

Fax Number

Public

Email Address
Mailing Address
Nomination

Producer

Handler

Importer

Retailer

Foodservice Operator

Full Name

Phone Number

Company Name

Fax Number

Public

Email Address
Mailing Address
Nomination

Producer

Handler

Importer

Retailer

Foodservice Operator

Full Name

Phone Number

Company Name

Fax Number

Public

Email Address
Mailing Address
Nomination

Producer

Handler

Importer

Retailer

Foodservice Operator

Full Name

Phone Number

Company Name

Fax Number

Public

Email Address
Mailing Address
Nomination

Producer

Handler

Importer

Retailer

Foodservice Operator

Full Name

Phone Number

Company Name

Fax Number

Email Address
Mailing Address

FV-309 (Rev. 3/2011)

Public

REPRODUCE LOCALLY. Include form number and date on all reproductions.

OMB No. 0581-NEW

CERTIFICATION TO BE COMPLETED BY NOMINATOR: I certify that I am eligible or authorized to
complete this Nomination Form and all information provided is accurate to the best of my knowledge.
Signature

Date

Full Name

Title

Company Name
Phone Number

Fax Number

Email Address
Mailing Address
Please check one:

Signatory Handler

Producer

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-NEW. The time
required to complete this information collection is estimated to average 10 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. 202509410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.

FV-309 (Rev. 3/2011)