OMB No. 0581-0189
UNITED STATES DEPARTMENT OF AGRICULTURE AGRICULTURAL MARKETING SERVICE SPECIALTY CROPS PROGRAM
CONFIDENTIAL QUESTIONNAIRE |
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The Secretary of Agriculture (Secretary) uses this completed form when appointing members or alternates to the California Desert Grape Administrative Committee for administering Marketing Order No. 925, regulating the handling of grapes grown in southeastern California. |
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□ Grower □ Handler □ Public Member □ Organic |
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7(a) NUMBER OF YEARS ALREADY SERVED ON COMMITTEE |
(a) DURING THE CURRENT CROP YEAR, I PRODUCED _____________________ LUGS OF GRAPES GROWN ON _________________ ACRES, WHICH I OWN OR LEASE. CERTIFIED ORGANIC? Yes No |
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(b) MY GRAPES ARE LOCATED IN COUNTY(IES):
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(c) WHAT IS THE NAME OF THE SHIPPER WHO HANDLES YOUR GRAPES?
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HOW MANY LUGS DID YOU HANDLE IN THE CURRENT CROP YEAR? |
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ARE YOU AFFILIATED WITH A GRAPE HANDLER (PACKER) AS AN EMPLOYEE, OFFICER, DIRECTOR, OR IN ANY OTHER CAPACITY? (to be completed by public member only) □ YES □ NO If Yes, what is your affiliation? |
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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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CERTIFICATION STATEMENT: If appointed by the Secretary of Agriculture, I hereby accept the appointment to the position set forth and, agree to serve during the period for which I am appointed and until my successor has been selected and has qualified.
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Signature Date
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 OMB 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.
In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, gender identity (including gender expression), sexual orientation, disability, age, marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident.
Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the responsible Agency or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.
To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at http://www.ascr.usda.gov/complaint_filing_cust.html and at any USDA office or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: program.intake@usda.gov. USDA is an equal opportunity provider, employer, and lender.
SC-74 (Rev. 9/2016. Destroy previous editions.)
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | WZeng |
File Modified | 0000-00-00 |
File Created | 2021-01-23 |