FRZ-NOM Nomination Form for Foreign Processors and Importers of

Approved OMB No. 0581-0314

NOMINATION FORM FOR FOREIGN PROCESSORS AND IMPORTERS OF FROZEN MANGOS
NOMINATION TO SERVE ON THE NATIONAL MANGO BOARD (Under the Mango Promotion, Research, and Information Order (7 CFR Part 1206))
The Mango Promotion, Research, and Information Order provides that frozen mango importers and foreign processors of frozen mangos may submit nominees to serve on the National Mango Board. Importers of frozen mangos may submit their names for consideration to serve on the National Mango Board. Foreign processors of frozen mangos or organizations may submit nominees to serve on the National Mango Board. Attach a separate sheet if additional space is needed. Please submit a separate form for each nominee.
NAME, BUSINESS ADDRESS, AND TELEPHONE NUMBER OF NOMINEE		CHECK ONE
			( ) FROZEN MANGO IMPORTER Importer means any person importing mangos into the United States in a calendar year as a principal or as an agent, broker, or consignee of any person who produces or handles mangos outside of the United States for sale in the United States, and who is listed as the importer of record for such frozen mangos. Eligible nominees must import 200,000 pounds or more of frozen mangos annually ( ) FOREIGN PROCESSOR Foreign processor of frozen mangos or foreign processor means any person: (1) Who is engaged in the preparation of frozen mangos for market to the United States and/or who owns or shares the ownership and risk of loss of such mangos; and (2) Who exports frozen mangos to the United States.
NAME AND MAILING ADDRESS OF PARTY OR ELIGIBLE ORGANIZATION SUBMITTING NOMINATION
NAME OF RESPONDING OFFICIAL (PRINT)	SIGNATURE
TITLE OF RESPONDING OFFICIAL (PRINT)	DATE
RETURN ORIGINAL TO: NATIONAL MANGO BOARD Street City, State Zip Code

FRZ-NOM Expiration Date: March 31, 2022

(English)

DIVERSTIY STATEMENT

The National Mango Board (NMB) encourages industry members without regard to race, color, national origin, sex, religion, age, disability, political beliefs, sexual orientation, size of business/operation, and marital or family status or other basis protected by U.S. law to participate in NMB activities and seek a position on the NMB.

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 15 minute 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.

FRZ-NOM Expiration Date: March 31, 2022

(English)