FV-175 Vidalia Onions Background Statement for Public Member

FORM APPROVED

- OMB

No. 0581-0178

U.S. DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
FRUIT AND VEGETABLE PROGRAMS

CONFIDENTIAL BACKGROUND STATEMENT

-FOR PUBLIC

MEMBER

MARKETING ORDER NO. 955

NOTE: Infonnation concerning nominees will be used by the Secretary of Agriculture in appointing public interest
members and alternates to administrative committees of marketing agreements and orders.

1.

Name

2.

Mailing Address

3.

State of residency,

4.

Are you or any member of your immediate family directly associated with the
Industry financially or otherwise?

5.

If you have an indirect relationship with the

6.

Please list all,public interest and service type organizations of which you are or have been a member and
positions held with each organization.

7.

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.

Phone No. (Area Code)

Number of years

Industry, please explain.

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
manager may consult with the Department of Agriculture employees during the pendency of infonnal
rulemaking actions.

FV-175 (05-04)

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I am willing to serve on the Committee.

(Date)

(Signature)

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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, gender, religion, age, disability, political beliefs, sexual orientation, and marital or
family status. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative
means fOf-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 USDA, Director, Office of Civil Rights, Room 326- W, Whitten
Building, 1400 Independence Avenue, SW, Washington, DC 20250-9410 or call (202) 720-5964 (voice and TDD).
USDA is an equal opportunity provider and employer.

FV-175 (05-04)

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