F/H Form 1(a) Hazelnuts Domestic Inshell Shipments

F /H Form la
OMB NO.

REVISED 10/26/99
FREE TONNAGE SHIPMENTS

0581-0178

Handler
Period
Invoice or
Lot Number

Date of
Shipment

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Inspection
Number

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Jumbo

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Lan!:e

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Medium

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Total

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Country

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Total

CUITent

Last Period
Total

Yr-To-Date
Yr-To-Date

Period

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PRIOR

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Within
Production

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I Outside
Area

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Total
CUITent
Period
Last Period
Yr-To-Date
Total
Yr-To-Date
NOTE: If an export shipment is made where conditions of sale do not meet Board requirements, that shipment must be reported as a domestic
sale. Please identifYall such shipments and note the COWltrythe product is exported to in the Cmmtry column.
If the shipment is made to or through another handler, provide the name of the handler to prevent duplication in reporting shipments.
This report is required by law (7 U.S.C 608(d), and 7 CFR 982.66 and 7 CFR 982.466). Failure to report canresuh in a fine of not lessthan $50 or more than $5,000 for
each such violation and each day during which such violation continuesshall be deemed a separate violation.
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 displays a 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 estimated to average 15 minutes per response, including the timefor 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, s~ 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 TARGEI' 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 (I'DD). USDA is an equal opportunity provider and employer.