REPRODUCE LOCALLY. Include form number and date on all reproductions. OMB No. 0581-0189
UNITED STATES DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
FRUIT AND VEGETABLE PROGRAMS
CONFIDENTIAL BACKGROUND STATEMENT
(To be completed by public interest members and alternates)
The Secretary of Agriculture (the “Secretary”) needs the following information to determine whether you are qualified under Marketing Order No. 915 to serve on the Avocado Administrative Committee (the “Committee”). Statutory authority to collect the information is provided in 7 U.S.C. §§ 601-674. Failure to provide this information may hinder your selection by the Secretary. |
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EMAIL ADDRESS: |
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FAX NUMBER: (Include area code) |
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NUMBER OF YEARS: |
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□ YES □ NO |
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□ YES □ NO |
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□ YES □ NO |
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□ YES □ NO |
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Committee members are specifically precluded from authorizing the expenditure of Marketing Order funds for the purpose of attempting to influence legislation or government actions.
These same prohibitions apply to committee managers, staff, and contractors except that Committee managers may consult with U.S. Department of Agriculture employees during the pendency of informal rulemaking actions. |
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COMMENTS:
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CERTIFICATION STATEMENT: I certify that I meet the eligibility requirements of the Marketing Order and I am willing to serve on the Committee.
______________________________________________________ __________________________
Signature Date
NOTE: 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 0581-0189. The time required to complete this information collection is estimated to average 5 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, gender, religion, age, disability, political beliefs, sexual orientation, and marital or family status. (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 USDA, Director, Office of Civil Rights, Room 326-W, Whitten Building, 1400 Independence Avenue, SW, Washington, DC 20250-9410 or call (202 &20-5964 (voice and TDD). USDA is an equal opportunity provider and employer.
FV-97-1
(Rev.
7/10. Destroy previous editions.) Page
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | WZeng |
File Modified | 0000-00-00 |
File Created | 2021-01-31 |