RAC-1000R (989) Application for a Raisin Certificate (Vine Removal

OMB No. 0581-0178

RAISIN ADMINISTRATIVE COMMITTEE

2445 Capitol Street, Suite 200

Fresno, California 93721

Phone: (559) 225-0520

APPLICATION FOR A _____________ RAISIN DIVERSION CERTIFICATE

VINE REMOVAL ONLY

1. Producer name:										RAC USE ONLY
2. Mailing address:
3. E-mail address:
4. Telephone number:
5. Location and address of production unit to be diverted:
6. Acres to be removed:								planted acres (Producer must submit with the application a
general map of production unit showing rows and vines to be removed.)
7. Documents attached (provide any two of those listed):
			Plat map
			Irrigation tax bill
			Property tax bill
			Other with APN (Assessor’s parcel number)
8. Creditable fruit weight of ___________________ (specify varietal type) raisins produced on production unit in 20___ crop year:
				pounds (Producer must submit delivery report from handler prior to July 31, 20___.)
9. If different than producer’s name above, name under which raisins were delivered:
10. Name of handler(s) to whom meeting raisins were delivered:
	Initial the box if you have removed the vines since the 20___ crop was harvested, or you intend to remove vines before June 1, 20___ on production unit for which this application is being submitted.

I hereby agree to comply with all the regulations established for, and to discharge fully any obligation assumed by, or charged to me under the Raisin Diversion Program, and certify that all parties (owners, lessors, lessees, banks, or other lenders) with an equity interest in the crop, vines, or land on which the vines will be removed, consent to the filing of this application. I further agree to ensure that raisin-variety grapes are not replanted by me, by successors to the land, or by others, until after July 31, 20___. If raisin-variety grapes are replanted on this land before July 31, 20___ by any person, I agree to pay the Raisin Administrative Committee (RAC) $700 per ton of the creditable fruit weight represented on the certificate, or to see that the vines are removed.

The making of any false statement or representations in any matter within the jurisdiction of any agency of the United States, knowing it to be false, is a violation of title 18, section 1001 of the United States Code, which provides for a penalty of a fine or imprisonment of not more than five years, or both.

Signature ____________________________________ Title ___________________________

This report is required by law (7 U.S.C. 608d, 7 CFR 989.56, 7 CFR 989.156(h)(1)). Failure to report can result in a fine of $1,100 for each such violation, and each day during which such violation continues shall be deemed a separate violation.

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 0581-0178. 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.

INSTRUCTIONS FOR COMPLETING FORM RAC-1000R

Producer’s address should be the address to which you wish correspondence mailed.

Location of production unit. In addition to a numbered address, please provide the location (e.g. NW corner of Shields and Dickenson; East side of Road 28 approximately half way between Avenues 7 and 8).

A production unit must be physically identifiable having permanent boundaries (either natural or man-made). No partial production units will be accepted for vine removal. A production unit is the planted acres and does not include home sites, yard acres or roads.

Creditable fruit weight (meeting weight) of raisins produced on a production unit must be verifiable from delivery records furnished RAC by handlers to whom you delivered raisins. If you have more than one production unit, the raisin deliveries should be identified as John Doe - River Ranch, Bluff Ranch, Ranch #1, Ranch #2, etc. The producer may be requested to provide additional information when the delivery record is not readily identifiable with the production unit on the application.

Any production units that have revised weights subsequent to the program announcement date may be referred to the RAC Executive Committee for review prior to approval.

Documents required include copies of any TWO of the following: Plat map from County Hall of Records, Irrigation Tax Bill, County Tax Bill or any other Document containing an Assessor’s Parcel Number.

If you wish to divert more than one production unit and wish a diversion certificate to be issued for each unit, please complete and submit a separate application for a diversion certificate for each unit.

The applicant, whose application has been approved, agrees that by participating in the Raisin Diversion Program, the information in the application may be disclosed to the RAC, its representatives or agents.

The applicant, whose application has been approved, authorizes RAC representatives and agents to have access to the production unit in the diversion program during reasonable daytime hours during the crop year to confirm compliance with the program. Such access shall include entry into production unit(s), if deemed necessary.

Applications for a ___________ Raisin Diversion Certificate must be received in the RAC by 4:30 p.m. on December 20, 20___ or if submitted by mail, must be filed by CERTIFIED MAIL not later than December 20, 20___.

The following statements are made in accordance with the Privacy Act of 1974 (5 U.S.C. 552a) and the Paperwork Reduction Act of 1995, as amended.  The authority for requesting the information to be supplied on this form is the Agricultural Marketing Agreement Act of 1937, Secs. 1-19, 48 Stat. 31, as amended, (7 U.S.C. 601-674).  Furnishing the requested information is necessary for the administration of the marketing order program.  Submission of the Tax Identification Number (TIN) is mandatory, and will be used to determine affiliation or entity identity.  If a TIN is not disclosed, the information provided will not become invalid if another means of identifying the entity exists.

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.

RAC-1000R (Rev. 01-17) Destroy previous editions.