F/H Form 1(e) Hazelnuts Kernel Shipments

F/H Fonn Ie
OMB CONTR. NO.
0581-0178

KERNEL SHIPMENTS
Handler
Period

Date
Of
Ship

Invoice
Or
Lot No.

Giant

Jumbo

Extra
Large

Large

Med.

Small

W/B

Total

DOMESTIC SHIPMENTS

Total This Period
EXPORT SHIPMENTS

Country

Total This Period
Please return this form marked "No Activity" if no shipments have been made. Individual shipments need not be
itemized - monthly totals are acceptable.
This report is required by law (7 U.S.C. 60S(d), and 7 CFR 982.66 and 7 CFR 982.466). Failure to report can result in a fme of not less than $50 or
more than $5,000 for each such violation and each day during which such violation continues shall be deemed a separate violation.
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 0581-0178. The time required to complete this
information collection is estimated to average 15 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 ofinformation.
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 derivedfrom 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).

Tofile 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 (lDD). USDA is an equal opportunity provider and employer.