FV-124 CA. Walnuts (Growers and Handlers) Background Questionna

OMS No. 0581-0178

u.s. DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
FRUIT AND VEGETABLE PROGRAMS

CONFIDENTIAL WALNUT MARKETING BOARD NOMINEE QUESTIONNAIRE
NOTE: lbis information will be used by the Secretary of Agriculture in selecting grower and handler members and alternates to
serve on the Walnut Marketing Board (Board) under Federal Marketing Order No. 984. Statutory authority to obtain this
information is Drovidedin 7 U.S.C. 608.
1. Name
2.

(a) Residence:
(Street)
(b) Mailing Address: (If same, so state)
(c) Telephone Number:

(City)
(Street)

<->

(City)
Cell ~
E-mail address

Home
BusinessL-J.

3.

Number of years of experience in the walnut industry

4.

(a) Are you a producer of walnuts?

_

yes

(State)

(a) Did you produce walnuts during the current year?

_

acres

no

yes

(b) If 5(a) is "yes," state kernelweight pounds of the English varieties of walnuts you produced:

6.

(Zip)

no

(b) If 4(a) is "yes", state acreage of the English varieties of walnuts you own or lease:
5.

(State)

(Zip)

(a) Areyou a memberof a cooperativemaIketingassociation?

_

yes

pounds

no

(b) If 6(a) is "yes," give name of cooperative; if"no," give name of firm, which handled your walnuts:

7.

If you are a walnut handler, employee, or officer of a walnut handler, states the following:
(a) Name of the handler(s)
(b) Your title and capacity
(c) Number of years experience in the position
(d) Please state the kernelweight poundage of the English varieties of walnuts handled by your firm during the current crop year
.
po~s

8.

When acting in my official capacity as a Board representative, I shall engage in only those activities that are authorized under
the walnut marketing order. I also understand that the Board cannot become involved in lobbying and political activities.

9.

If marketing order committee (or board) 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, willful 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 (DOJ). Alternatively, legal defense may be provided through private counsel, if recommended by
the Department of Agriculture (USDA) and approved by DOJ. USDA and DOJ enjoy an excellent working relationship with
respect to providing legal representation for committee members and employees, either by DOJ 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.

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10. I hereby certify tbat I am willing to serve as a member or altemate member on the Wabmt Marketing Board if selected by the
Secretaty of Agriculture.

(please type or print name as signed)

(Signature)

(Date)

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor. and a person is not required to respond to
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 tIns information collection is estilnated to average 5 Imnutes per response,
including tlIe time for re\ie"ing instructions. searching existing data sources. gatlIering and maintaining tlIe data needed. and
completing and revie"1ng tIle collection of infonnation.
The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and acti\ities on tIle basis of race. color,
national origin. age. disability. and where applicable. sex.. marital status. fallrilial status. parental stahlS. religion, sex1.18lorientatioll.
genetic informatioll. political beliefs. reprisal or because all or part of an individual's income is derived from any public assistance
program (Not all prolnbited bases apply to all programs.) Persons "1th disabilities who require altemative means for 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 discriminatioll. write to USDA, Director. Office of Civil Rights. 1400 Independence Avenue. S.W..
Waslringtoll. D.C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an eql181opporhllnty provider and
employer.

FV-124

(7/07)

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