HR-EZ Report of Receipts & Utilization (Schedules 1, 2, & 3)

UNITED STATES DEPARTMENT OF AGRICULTURE
1930-220th St. SE, Ste. 102
Bothell, WA 98021
Phone: (425) 487-6009
Fax: (425) 487-2775
E-mail: fmmaseattle@fmmaseattle.com

AGRICULTURAL MARKETING SERVICE
DAIRY PROGRAMS
FEDERAL MILK ORDERS 124 & 131

4835 E Cactus Rd., Ste. 440
Scottsdale, AZ 85254
Phone: (602) 547-2909
Fax: (602) 547-2906
E-mail: ma@fmma.net

HR - EZ
Report of Receipts and Utilization
(includes schedules 1, 2, and 3)

Note: This cover page is for information purposes only and does not need to be submitted to the market administrator's office.

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 0581-0032. The time
required to complete this information collection is estimated to average 1 hour 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,
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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
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(1) mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 202509410; (2) fax: (202) 690-7442; or (3) email: program.intake@usda.gov.
USDA is an equal opportunity provider, employer, and lender.

UNITED STATES DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
DAIRY PROGRAMS

Form HR-EZ, Page 1
1930-220th St. SE, Ste. 102
Bothell, WA 98021
Phone: (425) 487-6009

Exp. XX/XXXX
4835 E Cactus Rd., Ste. 440
Scottsdale, AZ 85254
Phone: (602) 547-2909

FEDERAL MILK ORDERS 124 & 131

Fax: (425) 487-2775
E-mail: fmmaseattle@fmmaseattle.com

Fax: (602) 547-2906
E-mail: ma@fmma.net

REPORT OF RECEIPTS AND UTILIZATION

Handler Name
Plant Location
Month/Year

OMB 0581-0032

For M. A. Use Only
Month-Year
Order

Line

This report is required by the order in accordance with 7 U.S.C. 608 c and d. Failure to report can result in the assessment of a civil penalty
of up to $1,000 per day (7 U.S.C. 608c (14)(B)) or, upon conviction, in a fine of up to $5,000 per day (7 U.S.C. 608c (14) (A)).
Product
Pounds

Butterfat
Pounds

For M.A. Use Only

Product
Pounds

Butterfat
Pounds

For M.A. Use Only
Form
Prod. Class

Product
Pounds

Butterfat
Pounds

BEGINNING INVENTORIES

1 Class I (Packaged)
2 Class IV (Bulk)

RECEIPTS
3 Own Farm Production
4 Other Dairy Farms

(No. of Farms)
(No. of Farms)

OTHER RECEIPTS

Type
1/

Identify Name, City, State

Form
2/

Product
3/

Class
Type

5
6
7
8
9
10
11 Nonfluid milk products: Class II (from Sch. 1, Line 15)

x 10.54

Lbs.

x 10.54
12 Nonfluid milk products: Class I, III, & Loss (from Sch. 1, Line 16)
Lbs.
13
TOTAL RECEIPTS AND BEGINNING INVENTORIES

UTILIZATIONS
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31

Type

Form

Product

Class

For M.A. Use Only

Total Class I Route Disposition (In & Out of Marketing Area)
Closing Inventory -- Class I Packaged
Closing Inventory -- Bulk (Class IV)
Movements to Other Plants (Identify)

Used to Produce (Identify Product)

32 NFMS Used to Fortify FMP
33

x 9.89
Lbs.
TOTAL UTILIZATIONS AND ENDING INVENTORIES

34
1/ (T)ransfer; (D)iversion.

2/ (B)ulk weights; (F)arm weights; (P)ackaged.

SHRINKAGE (OVERAGE)
3/ (W)hole; (S)kim; (Cr)eam; (Co)ndensed; (V) Various Packaged.

Date

Person Authorized to Sign for Handler

Handler:

Location:

Line

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

Homo - Whole

Form HR-EZ, Schedule 1

FEDERAL ORDERS 124 & 131

TOTAL ROUTE DISPOSITION
PRODUCT (Specify) 1/

Month & Year:

PRODUCT
POUNDS

AVG.
TEST

BUTTERFAT
POUNDS

GALLONS

HALF
GALLONS

QUARTS

PINTS

10 OZ

Flavored Milk
2% Reduced Fat
1% Lowfat - Plain
Skim Nonfat - Plain
Flavored Drink
Buttermilk
TOTAL ROUTES
1/ Identify products of different butterfat tests on separate lines.

Total to Page 1, Line 14

RECONCILIATION OF NONFLUID MILK PRODUCTS
Other (Specify):
Butter
Pounds
1
2
3
4
5
6
7

AVAILABILITY:
Beginning Inventory
Purchases
Manufacture
Sales (minus)
Dumpage (minus)
Ending Inventory (minus)
Pounds Available for Use

8
9
10
11
12
13

ACCOUNTABILITY: (USE)
Used to Fortify Class I
Used in Class II
Used in Class III
Total Pounds Used
Loss (Line 7 Minus 12)

14
15
16

TOTAL NONFLUID RECEIPTS:
Nonfluid: Class II
Nonfluid: Class I & III, (plus Loss)

Pounds

Butterfat

Nonfat Dry Milk
Pounds

Butterfat
x .008

HALF
PINTS

OTHER
Specify: ____

Handler:

Location:

Month & Year:

Form HR-EZ, Schedule 2

FEDERAL ORDERS 124 & 131

Line

OUT-OF-AREA ROUTE DISPOSITION

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

PRODUCT (Specify) 1/

Homo - Whole

IDENTIFY AREA 2/:
PRODUCT
POUNDS

AVG.
TEST

PRODUCT
POUNDS

AVG.
TEST

Line

GALLONS

HALF
GALLONS

QUARTS

PINTS

10 OZ

HALF
PINTS

OTHER
Specify: ____

HALF
GALLONS

QUARTS

PINTS

10 OZ

HALF
PINTS

OTHER
Specify: ____

Flavored Milk
2% Reduced Fat - Plain
1% Lowfat - Plain
Skim Nonfat - Plain
Flavored Drink
Buttermilk
TOTAL

OUT-OF-AREA ROUTE DISPOSITION

16
17
18
19
20
21
22
23
24
25
26
27
28
29
30

BUTTERFAT
POUNDS

PRODUCT (Specify) 1/

Homo - Whole

IDENTIFY AREA 2/:
BUTTERFAT
POUNDS

Flavored Milk
2% Reduced Fat - Plain
1% Lowfat - Plain
Skim Nonfat - Plain
Flavored Drink
Buttermilk
TOTAL
1/ Identify products of different butterfat tests on separate lines.
2/ Identify Federal order number, city & state.

GALLONS

Handler:

Location:

Month&Year

Form HR-EZ, Schedule 3

FEDERAL ORDERS 124 & 131

CLOSING INVENTORIES

Line

CLASS I

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

16
17
18
19
20
21

PRODUCT (Specify) 1/

Homo - Whole

PRODUCT
POUNDS

AVG.
TEST

BUTTERFAT
POUNDS

GALLONS

HALF
GALLONS

Flavored Milk
2% Reduced Fat - Plain
1% Lowfat - Plain
Skim Nonfat - Plain
Flavored Drink
Buttermilk
TOTAL
1/ Identify products of different butterfat tests on separate lines.

Raw Milk
Skim
Buttermilk
Bulk Cream
Concentrated FMP
TOTAL, BULK

-

Total to Page 1, Line 15

CLASS IV

-

-

Total to Page 1, Line 16

QUARTS

PINTS

10 OZ

HALF
PINTS

OTHER
Specify: ___