PEC-NOM Nomination Appointment Form

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NOMINATION FOR APPOINTMENT TO THE AMERICAN PECAN PROMOTION BOARD

(Under the Commodity Promotion, Research, and Information Act of 1996, Pub. L. 104-127,110 Stat. 1032 (7 U.S.C. §§7411-7425)

and the Pecan Promotion, Research, and Information Order, 7 C.F.R. 1223)

The following statements are made in accordance with the Privacy Act of 1974 (U.S.C. §552a) and the Paperwork Reduction Act of 1995. The authority for requesting the information to be supplied on this form is the Commodity Promotion, Research, and Information Act of 1996, Pub. L. 104-127, 110 Stat. 1032

(7 U.S.C. §§7411-7425). Furnishing the requested information is necessary for the administration of this program. Submission of the Tax Identification Number

is mandatory and will be used to determine affiliation or entity identification.

The Pecan Promotion, Research, and Information Order (Order) provides that producers or importers of pecans may nominate producers or importers to serve on the American Pecan Promotion Board. Nominees must meet the eligibility requirements as described in §1223.40 and §1222.41 of the Order. Nominated producers must produce the majority of their pecans in the region (East, Central or West) for which they are nominated. Producers may only be nominated in one region.

Attach a separate sheet if additional space is needed. Please submit a separate form for each nominee.

Did the nominee produce or import 50,000 pounds or more of pecans in-shell (25,000 pounds or more shelled)?
Y___ N___

[ ] EAST

[ ] CENTRAL

[ ] WEST

NAME AND MAILING ADDRESS OF PERSON OR ORGANIZATION SUBMITTING NOMINATION:

FILL OUT ATTACHED NOMINEE BACKGROUND FORM TO PROVIDE A SHORT SUMMARY OF THE NOMINEE’S EXPERIENCE IN THE PECAN INDUSTRY AS WELL AS THE NOMINEE’S INVOLVEMENT IN ANY INDUSTRY ORGANIZATIONS.

Signature and Title of Person Completing this Nomination

___________________________________________________________________________________________________________________________

Signature Date

Printed Name: ____________________________________________________ Title: ________________________________________________

RETURN TO:

American Pecan Promotion Board
Street Address
City, State, Zip

Attention: Nominations

Phone: xxx.xxx.xxxx

Email: xxx

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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-NEW. 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.

PEC-NOM (Expiration Date XX/XX/20XX) See reverse for burden/non-discrimination statement