FV-138 Hazelnuts (Producer/Handler) Background Questionnaire

OMB No. 0581-0178

REPRODUCE LOCALLY. Include fonn number and date on all reproductions.

u.s. DEPARTMENTOF AGRICULTURE
AGRICULTURAL
MARKETINGSERVICE
FRUITANDVEGETABLEPROGRAMS

HAZELNUT MARKETING BOARD
2l595-A Dolores Way, N.E.
Aurora, OR 97002-9738

CONFIDENTIAL BACKGROUND STATEMENT
(INDUSTRY MEMBER)
MARKETING ORDER NO. 982
POSITION

DISTRICT
Name

COMMITTEE YEAR
Telephone

)

Address (Business)

(If you are a handler, also show your fmn's name and in what capacity you serve in such finn.)

Years growing (if grower member)

Hazelnut acreage (if grower member)

Years handling (if handler member)

Approximate tons handled (if handler member)

Membership in industry organizations

Marlceting order conunittee 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. Conunittee members may not communicate with any official of a State or Federal legislative body for the purpose of
attempting to influence legislation. Conunittee members are also prohibited fi"om attempting to influence State or Federal government actions or policies or those offoreign
governments, except as specifically authorized under the marketing order or expressly approved by the Secretary. Committee members are specifically precluded fi"om
authorizing the expenditure of marlceting 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 the Department of Agriculture (USDA) employees during the pendency of infonnal
rulemaking actions.
If marlceting order conunittee or subconunittee members or committee employees are sued individually or jointly for errors in judgement, mistakes or other acts, either of
omission or conunission (except for acts of dishonesty, willful misconduct, or gross negligence) in the conduct of their duties under the marlceting agreement or order, they
may be authorized legal defense by the Department of Justice (DOl). Alternatively, legal defense may be provided through private counsel, if recommended by USDA and
approved by DOJ. USDA and DOJ enjoy an excellent working relationship with respect to providing legal representation for conunittee members and employees, either by
DOJ or through authorized private counsel. USDA is conunitted to a comprehensive legal defense policy for all committee members and employees acting within the scope of
their authorized conunittee duties and responsibilities.

I am willing to serve on the Hazelnut Marketing Board.

(Signature)

(Date)

The above infonnation is required to detennine the eligibility and willingness of the nominee to serve on the committee.
According to the PaperwOIk 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
nwnber. The valid OMB control nwnber for this information collection is 0581-0178. The time required to complete this information collection is estimated to average 3 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. 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, sex, 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 ITom any public assistance program (Not all
prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program infonnation (Braille, l:uge print, audiotape, e\c.) should con\act USDA's
TARGET Center at (202) 720-2600 (voice and IDD). To file a complaint of discrimination, write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW., Washington, D.C.
20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (IDD). USDA is an equal opportunity provider and employer.

FV-138 (12/06)