DA-229 Export Applicant Number Activiation

Reproduce Locally. Include form number and edition date on all reproductions.

U.S. Department of Agriculture
Agricultural Marketing Service
Dairy Program

Export Applicant Number Activation

FORM APPROVED - OMB NO. 0581-NEW

Dairy Grading Program
Fax:
630-437-5060
Email:
DairyNFO@ams.usda.gov
Mail To: USDA, AMS, DAIRY
2150 Western Ct.
Suite 100
Lisle, IL 60532

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 to complete this information collection is estimated to average X 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.

1. BUSINESS NAME:
2. USDA AMS DGB APPLICANT
NUMBER:
3. BILLING E-MAIL ADDRESS:
4. BILLING ADDRESS LINE 1:
5. AUTHORIZED BY:
6. TITLE:
7.

A/P CONTACT:

8.

PHONE:

9.

BUSINESS E-MAIL ADDRESS:

SIGNATURE:

DATE:

COMMENTS: