FV-74 924-Fresh Prunes Confidential Background Questionnaire/S

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AGRICULTURAL MARKETING SERVICE
FRUIT AND VEGETABLE PROGRAMS

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Public Member
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Handler"

CONFIDENTIAL QUESTIONNAIRE

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Grower
The following information is for use by the Secretary in selecting members or alternate members for appointment to the
California Desert Grape Administrative Committee to admihister the Federal Marketing Order regulating the handling of
grapes grown in southeastern California.
1. NAME

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2. MAILING

ADDRESS

(Number,

Street, City, State, ZIP Code)

7. MY GRAPES ARE LOCATED IN COUNTY(IES)

TELEPHONE NO.

(Area code)

(TO BE COMPLETED BY PRODUCER ONL Y)

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9. ARE YOU AFFILIATED
[JfES

10.

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WITH A GRAPE HANDLER

(PACKER) A~; EMPLOYEE,

(If "Yes," what is your affiliation?) (TO BE COMPU:TED

Marketing order committee

members,

OFFICER, DIRECTOR, OR IN ANY OTHER CAPACITY?

BY PUBLIC MEMBER ONL Y)

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 81ttempting to influence legislation. Committee members are also
prohibited from attempting to influence State or Federal governrnent 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 authorizingl the expenditure
influence legislation or government actions.

of marketing order funds for the purpose of attempting

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 inlformalrulemaking actions.

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If marketing order committee or subcommittee members or ,::ommittee employees are sued individually or jointly for errors in judgment,
mistakes or other acts either of omission or commission (ex'~ept for acts of dishonesty, willful misconduct, or gross negligence) in the
conduct of their duties under the marketing agreement or orljer, 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 \\/orking 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.

CERTIFICATION
STATEMENT:
I hereby certify that I will serve on the California Desert Grape Administrative
Committee if appointed by the Secretary of Agriculture.

(Signature)

(Date)

Note: The following statements are made in ac:cordance with the Privac:y 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 11995,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 TDD).
To file a complaint of discrimination, write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, or
call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.

FV-74 Reverse (05-07)

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