FV-260 929-Cranberries Qualification Statement Grower Member

To

UNITED STATES DEPARTMENT OF AGRICULTURE
AGRICULTURAL
MARKETING SERVICE
FRUIT AND VEGETABLE DIVISION

OMBNo.O581-0189

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QUALIFICA TION STATEMENT
Cranbef1ry Marketing

(Confidential)
Committee -Members

and Alternates

The following information will be used by the Secretary for use in selecting members or alternate
members of the Cranberry M.3rketing Committee. The Cranberry Marketing Committee administers the
Federal Marketing Order 929, which regulated the handling of cranberries grown in Massachusetts,
Rhode Island, Connecticut, ~~ew Jersey, Wisconsin, Michigan, Minnesota, Oregon, Washington, and
Long Island in the State of New York. Statutory authority to obtain this information is provided in 7 USC

608.

PLEASE PRINT OR TYPE ALL RESPONSES
Name:
Home Address
Zip Code:

State

CityfTown:

Number of years in cranben-y business:
During the last crop year I produced

barrels of cranberries

on

acres, which I 0 own or 0 lease.
Location of cranberry acreage (county and name of nearest town):

My cranberries are handled by the following handler(s) or marketing organization:

Other information: Positions or affiliations with industry groups, associations, etc.

If selected by the Secretary of Agriculture will you serve as a (pleasespecify)0
Alternate

Member on the Cranberry Marketing Committee.

Signature

Q YES

[]

Member

or 0

NO

Date:

According to the Paperwork Redta:tion Act of 1995, an agency may not cond1M:tor spoosor, and a person is not requil1:d to respond to a collectioo
ofinfomlation unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0581-0]89. The
time required to complete this infonnation collection is estimated to average 5 minutes per response, including the time for reviewing instructions,
searching existing data sources, gathering :uId maintAining the data needed, and completing and reviewing the collection of infomlation.
The U.S. Department of Agriculture (USDA) JH"Ohibitsdiscrimination in all its programs and activities on the basis of race, color, national origin,
age, disability, and where applicable, sex, mmital statlti, familial status, parental status, religion, sexual orientation, genetic infonnation, political beliefs,
reprisal, or because all or part of an individual's income is derived from any public assistance JH"Ogram
(Not all prohibited bases apply to all programs.)
Persons with disabilities who require alternative means for conxnunicatiOll of program information (Braille, large print, audiotape, etc.)
should contact USDA's TARGET Center at (202) 720-2600 (voice and TDD).

file a complaintof dis..-rimination,
write USDA, Director,Office of Civil Rights, 1400Independence
Avenue,SW, Washington,DC 20250-9410or call
(800) 795-3272(voice) or (202) 720-6382(roD). USDA is an equalopportWlityproviderandemployer.

FV-260 (05/07)