FV-220 California Raisins (Public Member) Background Questionna

OMS No. 0581-0178

REPRODUCE LOCALLY. Include form number and date on all reDroductions.

u.s. DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
FRUIT AND VEGETABLE PROGRAMS
CONFIDENTIAL RAISIN ADMINISTRATIVE COMMITTEE
PUBLIC REPRESENTATIVE NOMINEE QUESTIONNAIRE
NOTE:

Informationto be used by the Secretary of Agriculture in selecting a public member and alternatemember on the Raisin AdministrativeCommittee
under FederalMarketina Order No. 989. StatutoryauthoritYto obtain such informationis Drovidedin 7 U.S.C. 608.

1.

Name:

2.
(a)
Residence:
(Street)

(Zip)

(State)

(City)

(b) MailingAddress: (If same, so state)

(Zip)

Business (

(c) Telephone Number: Home (

(e) E-mail address:

(d) Fax Number: (
3.

(State)

(City)

(Street)

Your occupation
Employer:

Title:

4.

Consumer-oriented organizationsto which you belong:

5.

Do you (or members of immediatefamily) have financial interest in or close association with the production, processing, financing
or marketing of agricultural commodities? Yes _
No_
If answerisyes,pleaseindicateinterestor association.

6.

Are you a member of any marketing association, bargaining association, or any other organization furthering the
interest of raisin or grape producers? If so, state name and your position, if
any:

7.

Have you ever been charged or convicted of any felony violations? (Generally, afelony is defined as any violation of law
punishable by imprisonment of longer than 1 year, exceptfor violations called misderneanorsunder State law which are
punishable by imprisonment of2 years or less.) Yes _
No_

8.

I am aware that the public member and alternate positions are non-salaried. I am aware that these positions may require
travel. (Authorized travel expenses are reimbursable.)

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 Department of Agriculture (USDA) employees during the
pendency of infonnal rulemaking actions.

10.

If marketing order committee or subcommittee members or committee employees are sued individually or jointly for errors in
judgement, mistakes or other acts either of omission or commission (except for acts of dishonesty, wilful 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 (DO]). Alternatively, legal defense may be provided through private counsel, if recommended by
USDA and approved by DOJ. USDA and OOJ enjoy an excellent working relationship with respect to providing legal
representation for committee members and employees, either by OOJ 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.

11.

I hereby accept the nominationas a publicmember or alternate public member of the RaisinAdministrative
Committee, and willserve in such positionifselected by the Secretary of Agriculture.
(Signature)

(Date)

Please type or printname as signed above.

The following statements are made in accordance with the PrivacyAct of 1974 (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 MarketingAgreement Act of 1937, Secs. 1-19,48
Stat. 31, as amended, (7 U.S.C. 601-674). Furnishing the requested information is necessaryfor the administration of the marketing order
program. 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 displaysa valid OMB control number. The valid OMB control number for this information
collection is 0581-0178. The time required to complete this information collection is estimatedto average 6 minutes per response, including
the time for reviewinginstructions, searching existing data sources, gathering and maintainingthe data needed, and completing and
reviewingthe collection of information.
The u.S. Department of Agriculture (USDA) prohibits discriminationin all its programs and activitieson the basis of race, color, national
origin, gender, religion, age, disability,political beliefs,sexual orientation, and maritalor family status. (Not all prohibited bases apply to all
programs.) Persons with disabilitieswho require alternativemeans 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 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 TOO). USDA is an equal opportunity provider and employer.

FV-220 (05/04)

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