DA-20 Dairy--Monthly Report & Remittance of Amount Due for all

Information is required by 7 CFR 1150.171. Failure to report can result in a fine. Information is held confidential (7 CFR 1150.173).

NATIONAL DAIRY PROMOTION AND RESEARCH BOARD
MONTHLY REPORT AND REMITTANCE OF AMOUNT DUE
FOR ALL MILK MARKETED COMMERCIALLY
BY PRODUCERS
(Under Dairy and Tobacco Adjustment Act of 1983)

Approved OMB No. 0581-0093

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 0581-0093.
The time required to
complete this information collection 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.

FAILURE TO REPORT OR REMIT AMOUNT DUE CAN RESULT IN A $1,000 FINE.

ID Number
Name
Address

Report of amount due on milk marketed by producers during

Month

Year

1. Milk from producers .........................................................................................................

lbs.

2. Milk From own production (Exclude raw milk sold to other plants) ..................................

lbs.

3. Total of lines 1 and 2 ........................................................................................................

lbs.

4. Gross amount due for marketings during the month (line 3 x $.0015)
(The rate of $.0015 per pound is equal to 15 cents per hundredweight.) ........................$
5. Deduct contributions – up to $.0010 x pounds from line 3 – made to
qualified State or regional dairy product promotion programs.
If you enter an amount, complete the form on the reverse side
of the blue copy of this report. ......................................................................................$
6. Net amount due for marketings during the month (line 4 minus line 5)............................$
7. Add or subtract adjustments for prior months (Explain) ...................................................$
8. Amount remitted with this report (line 6 plus or minus line 7) ..........................................$
The report and a check payable to the National Dairy Promotion
and Research Board or NDPRB in the amount shown on line 8
must be mailed by the last day of the month after the month in
which the milk was marketed to:

National Dairy Promotion and Research Board
35092 Eagle Way
Chicago, IL 60678-1350

I declare under the penalties provided by law, that this report has been examined by me and to the best of my knowledge and belief is a true and
complete report. I also certify that I am authorized to sign this report.
DATE

RESPONDING OFFICIAL’S NAME (Print)

TITLE (Print)

SIGNATURE

Form DA-20 (06/07)

Note: For inquiries regarding your assessment account, please telephone (847) 803-9794.

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 from any public assistance program
(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 TDD).
To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington, DC 20250-9410 or call (800) 795-3272 (voice) or (202)720-6382 (TDD).
USDA is an equal opportunity provider and employer.

MAIL THIS COPY WITH YOUR REMITTANCE

On the form below1, record the name of each qualified State or regional dairy product promotion
program to which you made contributions and the amount paid to each such organization for the
month that this report represents.
DO NOT LIST AMOUNTS PAID TO THE NDPRB.

1

NAME OF QUALIFIED
PROMOTION PROGRAM

AMOUNT
CONTRIBUTED

PROGRAM
CODE
(For NDPRB use only)

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$_____________

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You may attach a separate listing or computer printout showing the above information if you prefer.