KC-327 DelvStat Delivery Status Report

See Reverse

for Privacy Act, Public Burden and Nondiscrimination

Statements.

KC-327-DELVSTAT

Form Approved - OMB No. 0560-0177
U.S. DEPARTMENT

(5-22-02)

OF AGRICULTURE

Farm Service Agency

DELIVERY STATUS REPORT
INSTRUCTIONS:

Complete and FAX/Email by 11:00 a.m., Kansas City, Missouri time on or before the Notice to Deliver delivered not-later-than
(NL T) date.

1. TO

6. FROM (Vendor Name)

2. ORGANIZATIONAL

Dairy
3. MARKETING

UNIT

and Domestic

Branch
Operations Division,

SPECIALIST

4. FAX NO.

7. COMPANY

NAME

8. CONTACT

PERSON

Stop 8718

10. CONTRACT

NUMBER

t

FAX NO.

(

816-823-4195
5. E-MAIL ADDRESS

11. DELIVERY

PERIOD

@kcc.fsa.usda.gov
12.

r-

EXPECTED
TRANS.
DISPOSITION
MODE
NUMBER
NOTICE
DELIVER
NUMBER
14
15
18
nNo
(If17No,BY
fill16
out the TO
table
below.FOR
Make
copies
if needed.)
REASON
LATE
DELIVERY
Yes DELIVERED
ALL
NOT-LATER-THAN
(NLT)
DATE?

120. DATE

KC-327-DELVSTAT

(REVERSE)

PRIVACY ACT AND PUBLIC BURDEN STATEMENTS
The following statements are made in accordance with the Privacy Act of 1974 (5 USC 552a) and the Paperwork
The authority for requesting the following information is USDA-1, Article 67, Late Shipment/Liquidated Damages.
federal and state agencies of late deliveries. Furnishing the requested information is mandatory. Failure to furnish
in nonconsideration.
This information may be provided to other agencies, IRS, Department of Justice, or other
agencies, and in response to a court magistrate or administrative tribunal. The provisions of criminal and civil fraud
371,641,651,1001;
15 USC 714m; and 31 USC 3729, may be applicable to the information provided.

Reduction Act of 1995, as amended.
The information will be used to notify
the requested information may result
State and Federal Law enforcement
statutes, including 18 use 286, 287,

Federal agencies may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid
OMB control number. Public reporting burden for this collection of information is estimated to average 30 minutes per response, including the time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this
burden, to the U.S. Department of Agriculture, Kansas City Commodity Office (OMB No. 0560-0177), Chief, Planning and Analysis Division, Stop 8768,
P.O. Box 419205, Kansas City, Missouri 64141-6205.
NONDISCRIMINATION

STATEMENT

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 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
Washington, D.C. 20250-9410 or call (202) 720-5964 (voice or TOO). USDA is an equal opportunity provider and employer.

Avenue,

SW,