F/H Form 1 (982) Hazelnuts Certifications Shipments & Diversion Req

OMB No. 0581-0178

HAZELNUT MARKETING BOARD

21595-A Dolores Way NE

Aurora, OR 97002-9738

Tel: (503) 678-6823

Fax: (503) 678-6825

REPORT OF HAZELNUT CERTIFICATIONS, SHIPMENTS AND DIVERSION REQUIREMENTS

For the period ending ________________________, 20___

The following represents the total quantity of inshell hazelnuts shipped to the free market, inshell shipments to export market, the inshell equivalent of the kernels that have been certified, or inshell certified as restricted. This report shall be submitted no later than the 10^th day following each reporting period. If no inshell hazelnuts are shipped or kernels certified or shipped during a reporting period, a report shall be submitted showing “no change” for that period. At the end of a handler’s operating season, the handler may indicate “final report,” and no further reports need be submitted.

				INSHELL WEIGHT - YEAR TO DATE
				OLD CROP	NEW CROP	TOTAL
A	FREE
	1.	Free - Inshell Shipments
	2.	Less: Declared Carry-In		--------------	--------------
	3.	Total Free Tonnage		--------------	--------------
B	RESTRICTED
	1.		Export Inshell
	2.		Kernels Certified (Inshell Equivalent)
	3.		Inshell Certified as Restricted
	4.		Total Restricted
	5.		Less: Restricted Carried In	--------------	--------------
	6.		Total	--------------	--------------
	7.		Add: Credits Purchased	--------------	--------------
	8.		Subtract: Credits Sold	--------------	--------------
	9.		Total Diversion Weight	--------------	--------------
C	COMPUTATION OF OBLIGATION
	1.		Diversion Requirement for This Crop Year Is:
	2.		Total Free - Inshell (Line A3)
	3.		Total Restricted Obligation (Line C1 x C2)
	4.		Less: Total Diversion Weight (B9)
	5.		Balance of Obligation

PLEASE RETURN ONLY THE SUMMARY SHEET AND THOSE SUPPORTING FORMS ON WHICH

NEW CERTIFICATION OR SHIPMENT INFORMATION IS RECORDED.

The total year to date diversion weight must be equal to, or in excess of, the total diversion requirement at the time of filing this report; otherwise, handler will be declared in default of the Hazelnut Marketing Order, unless handler has posted a bond with the Hazelnut Marketing Board in accordance with section 982.54 of the Order (7 CFR 982).

The undersigned certifies to the Board, and to the USDA, that the information given above is true and correct to the best of his knowledge and belief.

Dated____________________________________

Handler __________________________________ By ____________________________________________________

Address __________________________________ Title ___________________________________________________

This report is required by law (7 U.S.C 608(d), 7 CFR 982.66 and 7 CFR 982.466). Failure to report can result in a fine of not less than $50 or more than $5,000 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 15 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.

F/H Form 1 (Exp. x/xxxx) Destroy previous editions.