FV-163 905-Citrus Grown in FL. Confidential Background Statemen

REPRODUCE LOCAlLY.

Include form number and date on a// reproductions.

Form Approved -OMB

No 0581-O18~

U.S. DEP~,RTMENT OF AGRK:Ul T~
AGRICULTURAL MARKETING SERVICE
FRUIT Ar.O VE~A8lE
PROGRAMS

CONFIDENTIAL EIACKGROUND STATEMENT
FOR
CITRUS ADMINISTR,ATIVE COMMITTEE (M.O. 905)
The Secretary of Agriculture needs the following information to determine whether you are qualified under Federal Marketing Order No. 905 to serve
on the committee. Statutory authority to collect the information is provided in 7 U.S.C. 608. Failure to provide this information may hinder your
selection by the Secretary.

SEASON:

AFFILIATION:

Grower:

4b.

-~

5. Years Growing

This Commodity

(If Producer) .

Enter your

5a. Last Season's

Acres
5b. Years Handling

5d.

6.

This Commodity

E-Mail

Address:

I

Crop

I

-

(If Handler)

Total Production

-

Sc. Approximate Number of 4/5 Bushel Equivalent Handled

Firm Name (If handler)

If grower, are you employed by a shipper organization?

7. Membership in Industry Organizations:

8. Offices held or any other particular activity in past fe",! years connected with industry programs:

FV -163

(07-03)

(Destroy

prevK,us

editions!

Marketing order committee members, in their offici~ capacitiEIS, are prohibited from taking any action specific~ly designed to influence
legislation, including any attempt to influence public opinion concerning legislation. Committee members may not communicate with any
official of a State or Federal legislative body for the purpose of attempting to influence legislation. Committee members are also
prohibited from attempting to influence State or Federal government actions or policies or those of foreign governments, except as
specifically authorized under the marketing order or expressly approved by the Secretary.
Committee members are specifically precluded from authorizing the expenditure of marketing order funds for the purpose of attempting
to influence legislation or government actions.
These same prohibitions apply to committee managers, staff, and contractors, except that committee
Department of Agriculture employees during the pendency of informal rulemaking actions.

managers may consult with the

If marketing order committee or subcommittee members or committee employees are sued individually or jointly for errors in judgment,
mistakes or other acts either of omission or commission (except for acts of dishonesty, willful misconduct, or gross negligence) in the
conduct of their duties under the marketing agreement or ordElr, they may be authorized legal defense by the Department of Justice
(DOJ). Alternatively, lega defense may be provided throultl private counsel, if recommended by the Department of Agriculture (USDA)
and approved by DOJ. USDA and DOJ enjoy an excellent working relationship with respect to provKiing legal representation for
committee members and employees, either by DOJ or through authorized private counsel. USDA is committed to a comprehensive legal
defense policy for all committee members and employees acting within the scope of their authorized committee duties and
responsibilities.

Certification

Statement:

I certify

that the information

Signature

abclve is correct and I am willing to serve on the committee

Date

Note: The foHowing statements are made in accordance with the Pliva'~y Act of 1974 (5 V.S.C. 552a) and the Pape/Work Reduction Act of 1995. The
authority for requesting this information to be supplied on this form is thE~Aglicultural Marketing Agreement Act of 1937, Secs. 1-19, 48 Stat. 31, as amended,
(7 V.S.C. 601-674). Fumishing the requested information is necessary for the administration of the marketing order program.
According to the PapelWork 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 0581-0189
The time required to
complete this information collection is estimated to average 5 minutes p~r response, including the time for relliewing instructions, searching existing data
sources, gathering and maintaining the data needed, and completing and reviewing the colection of information
The U.S. Department of Agriculture (USDA) prohibits discrimination in aUits programs and activities on the basis of race, color, national origin, age. disability,
and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because
all or part of an indillidua/'s income is derived from any pubic assistance program (Not aUprohibited bases apply to a6 programs.) Persons with disabHities
who require altemative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA's TARGET Center at
(202) 720-2600 (voice and TOO).
To lie a compaint of ciscrimnation, write to USDA. Director, omce of Cilli Rights, 1400 Independence Avenue, S. W., Washington, D. C. 20250-9410, or call
(800) 795-3272 (voice) or (202) 720-6382 (TOO). USDA is an equal °p;'lOrlunity provider and employer.

FV-163

Reverse

(05-01)

(Destroy

prevDus

editionsl