SC-35 (958) ID/E. OR Onions - Diversion Report

REPRODUCE LOCALLY. Include form number and date on all reproductions. OMB No. 0581-0178

IDAHO-EASTERN OREGON ONION COMMITTEE

P.O. BOX 909, PARMA, ID 83660

PHONE: 208-722-5111 FAX: 208-722-6582

IDAHO-EASTERN OREGON ONION DIVERSION REPORT

This form is to be completed for each Certificate of Privilege permit number. This form is due within 72 hours of daily shipment(s) for spot sale onions and/or onions sold in 50 lb. bags; otherwise this form is due by 4 pm on the Wednesday immediately following the shipping week of Monday through Sunday.

COP Permit No.

Date of Shipment(s)

Receiver Name & Agent

Address

City

State

Zip

R.R. Car No. or Truck Licenses

Container & Label

Hundredweight (cwt.) Shipped

TOTAL Hundredweight (cwt.) SHIPPED

I, the undersigned, hereby certify to USDA and to the Idaho-Eastern Oregon Onion Committee (Committee) that this report represents all onions for this COP Permit Number that were diverted from fresh channels in accordance with the regulations of the Committee (7 C.F.R. 958.328) for the stated date of shipment. Falsification of information on this government document may result in a fine or imprisonment, or both (18 U.S.C. 1001).

Signature

Name

Title

Date

Firm

Phone

Address

City

State

Zip Code

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 8 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-35 (Exp. x/xxxx) Destroy previous editions.