FV-97 915-Avocados Confidential Background Questionnaire/State

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Form Approved -OMB

No. 0581-0189

u.s. DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
FRUIT AND VEGETABLE PRDGRAMS

CONFIDENTIAL BACKGROUND STATEMENT (Avocados)
(To be completed by grower and handler member and alternate nominees)
The Secretary of Agriculture needs the following information to determine whether you are qualified under Federal Marketing Order No.
915 to serve on the committee. Statutory authority to collect the information is provided in 7 U.S.C. 601-674. Failure to provide this
information may hinder your selection by the Secretary.
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POSITION

(Please mark "X" in appropriate

GROWER

D MEMBER

box):

0

GROWER

HANDLER

ALTERNATE

D MEMBER

D

HANDLER

ALTERNATE

MEMBER
DISTRICT

NUMBER

MEMBER

(Please marlc "X" in appropriate box):
01

:. ~A~E~
2.

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BUSINESS ADDRESS

3. TELEPHONE

02

I E-MAILADDRESS:
(City, County, State, and ZIP) NOTE: If a handler, also show finn name and in what capacity you serve in such finn.

NUMBER

Include area code:

AX NUMBER

in appropnate

Include area code

bo

AVACADO

AVACADOALTERNATE

0 COMMITTEE 0

COMMITTEE
MEMBER

MEMBER
5. YEARS
A
WIN OR
R HANDLING
N AVOCADOS .
GROWING
(Mark "X" in appropriate box for grower or handler).

D GROWER

0

HANDLER

6a. AVOCADO
6a.
(ifgrower):V
A
PRODUCTION LAST SEASON I grower:

6b. APPROXIMATE

NUMBER

7. LIST OF MEMBERSHIP

OF 55-LB EQUIVALENT

HANDLED

LAST SEASON (if handler):

IN INDUSTRY ORGANIZATIONS:

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 managers may consult with U.S.
Department of Agriculture employees during the pendency of informal rulemaking actions.
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10. 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 order, they may be authorized legal defense by the
Department of Justice (DOJ). Alternatively, legal defense may be provided through 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 providing 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.

COMMENTS

CERTIFICATION
STATEMENT:
serve on the committee.

(Signature)

I certt

tty requlfements 0

mg to

(Date)

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Note: The following statements are made in accordance with the Privacy Act of 1974 (5 U.S.C. 552a) and the Paperwork Reduction
Act of 1995. The authority for requesting this information to be supplied on this form is the Agricultural Marketing Agreement Act of
1937, Secs. 1-19,48 Stat. 31, as amended, (7 U.S.C. 601-674). Furnishing the requested information is necessary for the
administration of the marketing order program.
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 0581-0189. 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.
The U.S. Department of Agriculture (USDA) prohibits discrimination in all its 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 individual's income is derived from any public assistance
program (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative 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 file a complaint of discrimination, write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W.,Washington,
D.C.20250-941 0, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.

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