CIAB 3A Report of Export Sales Activity

REPRODUCE LOCALLY. Include form number and date on all reproductions. OMB No. 0581-0177

R

CIAB

FORM 3A

Crop Year

EPORT OF EXPORT SALES ACTIVITY

Cherry Industry Administrative Board

P.O. Box 388, DeWitt, MI 48820-0388

Tel: 517/669-1070 Fax: 517/669-1260

Handler: Handler ID#

Address, City, State, Zip:

Telephone No.:

PORTS of ENTRY* (Report in Units)	Hot Pack	IQF	5 + 1	Dried	Other	Total
Europe
Belgium
France
Germany
Netherlands
United Kingdom
Other(s) (specify)
Pacific Rim
Australia
Hong Kong
Japan
Korea
Singapore
Taiwan
Other(s) (specify)
North America
Canada
Mexico
South or Central America
Other(s) (specify)
Mid. East and Africa
Egypt
Israel
Saudi Arabia
Other(s) (specify)
Grand Total

The undersigned hereby certifies to the Secretary of Agriculture and the Cherry Industry Administrative Board that this is a true and correct statement of the sales activity of this handler for the listed years.

By:

Title:

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 0581-0177. 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.

CIAB Form 3A (Exp. X/XXXX) Destroy previous versions.