PEA-DPP National Peanut Board First Handler Report Direct Purcha

OMB No. 0581-0093

NATIONAL PEANUT BOARD

First Handler Report – Direct Peanut Purchases – Purchases Not Under Marketing Assistance Loans

Peanut Promotion, Research, and Information Order – Fee Collection

Please Read the Instructions on the Reverse Side Before Completion

_____________________________________________________________________________________________________________________

(Name) (Business Telephone No., Include Area Code)

_____________________________________________________________________________________________________________________

(Name of Business/Company) (Tax I.D. No. or Employer ID No.)

_____________________________________________________________________________________________________________________

(Business Address) (City) (County) (State) (Zip)

Report of Peanuts Handled During ___________, 20XX

(month)

List Below the Name and Address of the Producers for whom you Handled Peanuts.

Name & Address of Producer	State/County	Crop Year	Purchase Price	Purchase Date	Assessment*	Quantity (Tons)	Price per Ton	Product ID

* Assessment = Purchase Price x 1%

I certify under the penalties provided by law, that this report is true, correct, and complete report. I also certify that I am authorized to sign this report. ¹

____________________________________________________________________________________________________________

(Name of Individual – Print) (Title)

____________________________________________________________________________________________________________

(Signature of Individual) (date)

PEA-DPP (09/07)

INSTURCTIONS

For peanuts placed in the Marketing Assistance Loan (MAL) program the 1% assessment is collected and remitted by USDA/Farm Service Agency. If the peanuts are not placed in the MAL program, first handlers shall collect from producers or first purchasers/handlers and pay assessments to the National Peanut Board (NPB) no later than 60-days after the last day of the month in which the peanuts were marketed. First handlers must complete this form or attach a list or CD of the producers for whom you handled peanuts and remit assessments to NPB at the address below within 60-days or a late payment fee will be assessed. If you submit a list or CD of producers, please complete the other portions of the form and remit with the assessments to NPB.

Mail this report with payment in full to:

National Peanut Board

Street

City, State Zip

¹ Any false statement or misrepresentation may result in a fine of not more than $10,000, or imprisonment for not more than 5 years, or both (18 U.S.C. 1001).

________________________________________________________________________________________________________

NOTE: The following statements are made in accordance with the Privacy Act of 1974 (U.S.C. 522a) and the Paperwork Reduction Act of 1995, as amended. The authority for requesting this information to be supplied on this form is the Commodity Promotion, Research, and Information Act of 1996, Pub. L. 104-127, 110 Stat. 1032 (7 U.S.C. 7411-7425). Furnishing the requested information is necessary for the administration of this program. Submission of Tax Identification Number (TIN) or Employer Identification Number (EIN) is mandatory, and will be used to determine affiliation or entity identification.

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.

PEA-DPP (09/07)