No Form number Raisin Adm. Cmte. Voluntary Independent Producer Nominat

OMS No. 0581-0178

RAISIN ADMINISTRATIVE COMMITI'EE
VOLUNTARY INDEPENDENT PROPUCER. NOMINATION
STATEMENT
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Note: The followingstatements are made in accordance with the Privacy Act 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 Marketing
Agreement Act of 1937, Sees. 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 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 0581~178. Thetime requiredto completethis informationcollectionis estimatedto average 5 minutes
per response, includingthe timeforreviewinginstructions,searchingexistingdata sources, gatheringand maintainingthe data

needed, and completing and reviewing the collection of information.

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The u.s. Department fAAgriculture (USDA) PfOhlbil&discrimination in all its programs and 8CIIviIieson the basis d race, color, national origin, age, disability, and where applicable, ~
mariIaI s1aIus, familial
parental statu&, religion, sexual orientation, genetic Information, pollicai beiefs, reprisal, or because all or part fAan individual's Incame is deri\/ed from any public assistance program (Not all prohibil8d bases apply to
all programs.) Persons with disabilities who require alternative means for communication of program infonnation (Braine. large prin~ audiotape, etc.) should contact USDA's TARGET Center at (202) 720-2600 (voice
and TOO).
To file a complaint of discrimination, write to USDA, Director, Office of Civil Rights. 1400 Independence
an equal opportunity provider and employer.

(06/04 )

Avenue, SW.. Washing1Dn, D.C. 20250-9410. or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is