FV-84 916-Nectarines Confidential Background Questionnaire/Sta

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

CONFIDENTIAL. NECTARINE PRODUCER NOMINEE QUESTIONNAIRE
The following informationis requiredfor useby the Secretaryof Agricultureto determinethe eligibility andwillingnessof
nominessto serveon the NectarineAdministrativeCommitttee.
INSTRUCTIONS: Please fill in all applicable spacesand sign your name.
1. NAME

2. MAILING ADDRESS (City, State, and ZIP!

5. NUMBER OF YEARS YOU HAVE BEEN A PRODUCEROF NECTARINES

6. DID YOU PRODUCE NECTARINES WHICH WERE SHIPPED IN FRESH FORM
DURING THE CURRENT SEASON? (Mark "X" in appropriate box)

DYES

D NO

7. NAME OF FIRM WHICH HANDLED YOUR NECTARINES DURING THE CURRENT SEASON

8.

LIST OTHER DECIDUOUS

FRUIT CROPS AND ACREAGE IN WHICH YOU HAVE AN OWNERSHIP

INTEREST

9. Marketing order committee members, in their official capacities, are prohibited from taking any action specifically 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 managers may consult with
U.S. Department of Agriculture employees during the pendency of informal rulemaking actions.
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 respresentation 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.
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CERTIFICA nON STATEMENT:
the committee.

certify meetthe eligibility requirementsof the Order and I am willing to serve on

(Date)

(Signature)

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. 601~74).
Furnishing the requested information is necessary for the administration of the marketing order program.

NOTE:

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,
or call (800) 795-3272 (voice) or (202) 72~2
(TOO). USDA is an equal opportunity provider and employer.
,

FV-84 Reverse (05-07)

D.C. 20250-9410,

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