HON-HIF National Honey Board Handler Information Form

National Honey Board

Street OMB No. 0581-0093

City, State Zip

xxx-xxx-xxxx

HANDLER INFORMATION FORM

Your name and company name

Address, City, State and Zip code

If you process/pack any of your own honey (for sale to bakeries, farmers markets, grocery stores, for export or the like), write your name in the first blank. List the handlers to whom you have sold honey in the last several years (crop years xxxx, xxxx and xxxx). Continue on the back of this sheet if you need more room.

1.

Handler name and company name

Address, City, State and Zip code

2.

Handler name and company name

Address, City, State and Zip code

3.

Handler name and company name

Address, City, State and Zip code

4.

Handler name and company name

Address, City, State and Zip code

Thank you for completing this form. Please return to the National Honey Board at the address listed above.

HON-HIF (09/07)

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 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 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-HIF (09/07)