FV-219 California Raisins (Handlers) Background Questionnaire

REPRODUCE

WCALL Y. Include form number and date on all reproductions.

U.S. DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
FRUIT AND VEGETABLE PROGRAMS

CONFIDENTIAL RAISIN ADMINISTRATIVE COMMITTEE
HANDLER NOMINEE QUESTIONNAIRE
NOTE:
Information will be used by the SecretaI)' of Agriculture in selecting handler members and alternate members on the Raisin Administrative
Committee under Federal Marketinl!: Order No. 989. Statutorv authoritY to obtain this information is Drovided in 7 U.S.C. 608.

1.

Name:

2.

(a)

Residence:

(b)

(Street)
Mailing Address: (If same, so state)

(Street)

(City)

(State)

(Zip)

(City)

(State)

(Zip)

(c) Telephone Number: Home

Business

(d) Fax Number:

(e) E-mail address:

3.

Number of years you have been connected with the raisin packing business:

4.

(a) Raisinpackingftrm with whichyou are now connected:
(b)

Your position or title:

5.

Tonnage of all raisins acquired by such raisin packing fIrm during the period August 1>--,
(natural condition weight.)

6.

Check varietal types of raisins handled by such ftrm and insert tonnage of each varietal type of such raisins:
Natural Seedless
Muscats

Golden Seedless
Sultanas

Dipped Seedless
Zante Currants

to July 31,_,

tons

was

Others

7.

Have you ever been charged or convicted of any felony violations? (Generally, a felony is defmed as any violation of law punishable by
imprisonment of longer than 1 year, except for violations called misdemeanors under State law which are punishable by imprisonment
of 2 years or less.) Yes.
No

8.

I am aware that the handler member and alternate positions are non-salaried. I am aware that these positions may require travel.
(Authorized travel expenses are reimbursable.)

9.

Marketing order committee members, in their official capacities, are prohibited from taking any action speciftcally designed to influence
legislation, including any attempt to influence public opinion concerning legislation. Committee members may not communicate with
any official of a State or Federa1legislative body for the purpose of attempting to influence legislation. Committee members are also
prohibited from attempting to influence State or Fedeml government actions or policies or those of foreign governments, except as
speciftcally authorized under the marketing order or expressly approved by the Secretary. Committee members are speciftcally
precluded from authorizing the expenditure of marketing 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 Department of Agriculture (USDA) employees during the pendency of informal rulemaking actions.

FV-219 (08/06)

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10. If marketing order committee 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 USDA and
approved by 00J. USDA and ooJ enjoy an excellent working relationship with respect to providing legal representation for committee
members and employees, either by ooJ 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.
11. I hereby accept the nomination as a handler member or alternate handler member of the Raisin Administrative Committee, and will
serve in such position if selected by the Secretary of Agriculture.
(Signature)

(Date)

Please type or print name as signed above.

The following statements 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, Secs. 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 rmless 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 6 minutes per response, including the timefor reviewing instructiom, 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, sa, 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 altemotive means for commrmication of program information (Braille, large print, audiotape, etc.) should contact
USDA's TARGEl' Center at (202) 720-2600 (voice and1DD).
To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, Room 32~W, Whitten Building, 1400 Independence Avenue, SW,
Washingtan, DC 20250-9410 or call 202-720-5964 (voice and 1DD). USDA is an equal opportunity provider and employer.

FV -219 (08106)

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