FV-266 920-Kiwifruit (Producer) Confidential Background Questio

REPRODUCE LOCALLY .Include form number and date on al/ reproductions.

FORM APPROVED -OMB NO. 05Bl-o189

U. S. DEPAFtTMENT OF AGRICULTURE

AGRICULTURAL
MARKETING
SERVICE
FRUITANDVEGETABLE
PROGRAMS
CONFIDENTIAL KIWIFRUIT PRODUCER II,JOMINEE QUESTIONNAIRE

Kiwifruit AdministrativeCommittee.
INSTRUCTIONS: Please fill in all applicable spaces and sign your name.

1.C
b.

BUSINESS NAME (/fdlfferent from above)

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

S. DURING THE MOST RECENT SEASON,
PRODUCED.

IF AN EMPLOYEE OF A GROWER, :.t'I:LII-Y

TRAYS OR TRAY EQUIVALENTS
I:Mt'LOYERS'S

OF KIWIFRUIT FOR THE FRESH MARKET ON

ACRES WERE

NAME:

6. NAME OF FIRM(S)WHICH HANDLED YOUR KIWIFRUIT DURING THE CURRENTSEASON

7. OTHER INFORMATION CONCERNING EXPERIENCE/ELIGIBILITY

Marketing order committee members, in their official capacities,are prohibited from taking any action specifically designedto 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 govemment 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 expenditures 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.

If marketing order committee or subcommittee membersor committee membersare suedindividually or jointly for errors in judgment, mistakes or other actseither of omission or commission
(except for acts of dishonesty, willful misconduct, or gross negligence) in the conduct of their duties under the marketing agreementor order, they may be authorized legal defense by the
Department of Justice (DOJ). Alternatively, legal defensemay be provided through private counsel, if recommendedby the Department of Agriculture (USDA) and approved by DOJ. USDA
and DOJ enjoy an excellent working relationship with respect to providing legal representationfor committee members and employees,either by DOJ or through authorized private counsel
USDA is committed to a comprehensivelegal defensepolicy for all committee member!,and employeesacting within the scopeof their authorized committee duties and responsibilities.

\:>Ignature)

(Date)

Note: The following statementsaremadein accordancewith the PrivacyAct of 1974(5 U.S.C. 552a)andthe PaperworkReductionAct of 1995. The authorityfor requestingthis informationto be
suppliedon this form is the Agricultural Marketing AgreementAct of 1937,Secs.1-19,48 Stal 31, asamended,(7 U.S.C.601-674). Furnishingthe requestedinformationis necessaryfor the
administrationof the marketingorderprogram.
According to the PaperworkReductionAct of 1995,an agencymay not conductor sponsor,anda personis not requiredto respondto a collectionof informationunlessit displaysa valid OMB
controlnumber. The valid OMB control numberfor this informationcollectionis 0581-0189. The time requiredto completethis informationcollection is estimatedto average5 minutesper
response,including the time for reviewing instructions,searchingexistingdatasources,gatheringandmaintainingthe dataneeded,andcompletingandreviewingthe collectionof information.
TheU.S. Departmentof Agriculture (USDA) prohibits discriminationin all its programsandactivitieson the basisof race,color, nationalorigin, age,disability, andwhereapplicable,sex,marital
status,familial status,parentalstatus,religion, sexualorientation,geneticinformation,political beliefs,reprisal,or becauseall or part of an individual'sincomeis derivedfrom any public assistance
program(Not all prohibitedbasesapply to all programs.)Personswith disabilitieswho requirealternativemeansfor communicationof programinformation(Braille, largeprint, audiotape,etc.)
shouldcontactUSDA's TARGET Centerat (202) 720-2600(voice andmD).
To file a complaintof discrimination,write to USDA, Director, Office of Civil Rights, 1400Independence
Avenue,S.W.,Washington,D.C.20250-9410,
or call (800) 795-3272(voice) or (202)
720-6382(TOD). USDA is an equalopportunityproviderandemployer.

FV-266 (05/07)