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OMB No.  0581-0093

UNITED STATES DEPARTMENT OF AGRICULTURE/
	NATIONAL HONEY BOARD
	CANDIDATE PROFILE

The National Honey Nominations Committee requests the following information to help determine your qualifications, eligibility and availability to serve on the National Honey Board.

1.	Name___________________________________________________________

Home/Main Address________________________________________________

City/State/Zip_____________________________________________________

Phone (day)____________________ (evening)__________________________

	Email_________________________________

2.	For which Board position____________________________________________

3.	Submitted by  ____________________________________________________


If you are a candidate for a Producer Position, please answer questions 4, 5 & 6.

4.	Indicate your operation size:  (___) Hobbyist 1-50 colonies, (___) Sideliner 50-300), (___) Commercial beekeeper – 300+

5.	Do you also pack honey?______________________

6.	If  you are a Producer, during 3 of the 5 preceding years, did you purchase for resale more honey than you produced?____________________________


If you are a candidate for a Handler/Importer Position, please answer questions 7 & 8.

7.	If you are a Packer, do you import honey?______________________________

8.	If you import honey, did you receive at least 75 percent or more of your gross 
income (generated by the sale of honey and honey products) from the sale of imported honey or honey products during 3 of the 5 preceding years?_________


HON-CPA  (09/07)
All candidates please answer the remaining questions.

9.	Work Experience - Honey related_____________________________________

________________________________________________________________

Other Work Experience  ____________________________________________

________________________________________________________________
10.	Explain how you are involved in honey marketing directly, either retail or wholesale?_______________________________________________________
            ________________________________________________________________

11.	Please list offices held and awards received in the honey and beekeeping industry: ________________________________________________________________

________________________________________________________________

	Please list your community involvement:
	________________________________________________________________

	________________________________________________________________

12.	As a member of the Board, would you be willing and able to attend Board and committee meetings? (several per year)___________________________
	And, will you work to support the objectives and goals of the NHB?___________

13.	What qualifications would you bring to the National Honey Board?
________________________________________________________________

________________________________________________________________

________________________________________________________________

14.	Please list three reasons why you think the National Honey Board is important to the Honey Industry:
	1.______________________________________________________________

	2.______________________________________________________________

	3.______________________________________________________________


HON-CPA  (09/07)

15.	Please list three specific areas (in order of importance)) that you feel the National Honey Board should be focusing on that would be most beneficial to the Honey Industry:
	1.______________________________________________________________

	2.______________________________________________________________

	3.______________________________________________________________

16. 	What specific qualifications and/or experience do you have that would help the
National Honey Board achieve its goals?
________________________________________________________________

________________________________________________________________

	________________________________________________________________

17.	Please list the names and phone numbers of three references involved in the Honey industry:
	1.______________________________________________________________

	2.______________________________________________________________

	3.______________________________________________________________

You may attach no more than 2 pages of additional information.  Please sign and return this form to the National Honey Board, Street, City, State  Zip.

_____________________________________________ 	_______________
Signature	Date

FYI:  The reason for the burden statement is in Public Law 104-13, Paperwork Reduction Act of 1995 (PRA), Section 3506, (c) 1 (B) (i to iii and I to V).  The reason for the non-discrimination statement is Departmental Regulation No. 4300-3 "Equal Opportunity Public Notification Policy" November 16, 1999, Section 7.

BURDEN AND NONDISCRIMINATION STATEMENTS: 

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.  

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 to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.

HON-CPA  (09/07)