HON-HTR Honey Transaction Report (Domestic & Imported Honey/Hone

FORM APPROVED

OMB No. 0581-0093

TR – xxxx TRANSACTION REPORT (TR)*

FOR DOMESTIC AND IMPORTED HONEY/HONEY PRODUCTS

HONEY RESEARCH, PROMOTION AND CONSUMER INFORMATION ORDER

THIS INFORMATION IS REQUIRED BY LAW

ALL INFORMATION PROVIDED IS HELD STRICTLY CONFIDENTIAL

A. GENERAL INFORMATION
THIS TRANSACTION REPORT IS FOR (check only one):
[ ] Domestic honey acquired during period	[ ] Imported honey acquired during period
[ ] Handler’s own honey processed during period	[ ] Adjustment to previous TR number ___________
Month/Period covered by this report __________________________
Crop Year of Honey (if domestic) ________________	Country of Origin (if imported) __________________
*Please refer to the TRANSACTION REPORT INSTRUCTIONS for completion guidelines (furnished by the National Honey Board-call us for your copy).

B. HANDLER INFORMATION	C. PRODUCER/IMPORTER INFORMATION (If different than handler)
First Handler Name ___________________________	Producer/Importer Name________________________
Company Name ______________________________	Company Name ______________________________
Address ____________________________________	Address _____________________________________
City ________________________________________	City ________________________________________
State _____________________ Zip ______________	State ________________________ Zip ___________
Tax ID# or Employer # ________________________	Tax ID# or Employer # ________________________
Phone (____)________________________________	Phone (_____)________________________________
Fax (____)__________________________________	Fax (_____)__________________________________
E-mail _____________________________________	E-mail ______________________________________
Web site ____________________________________	Web site ____________________________________

D. TRANSACTION INFORMATION
1. Date of this transaction (not report date) ___/____/____	4. Amount collected by the Farm Service Agency or U.S. Customs $_____________
2. Pounds in this transaction ____________	5. Assessment due (subtract 4 from 3) $_____________
3. Assessment amount (pounds x .01) $____________

E. CERTIFICATION AND SIGNATURE

If assessment is not remitted with this report and it is later determined that the assessment in whole or part was not previously collected, I understand that my obligation to collect and remit the assessment for this transaction to the NHB has not been relieved. I also certify, under the penalties provided by law, that this report is a true, correct, and complete report, and that I am authorized to sign this report.

__________________________________________________________________________________________

Signature (First Handler) Title Date

Send Transaction Report (white copy only) and assessment to the National Honey Board, 11409 Business Park Circle, Suite 210, Firestone, Colorado, 80504, Call (800) 553-7162 or e-mail to: reporting @nhb.org with questions.

SEE IMPORTANT NOTES ON BACK OF THIS FORM

HON-HTR (09/07)

IMPORTANT NOTES

Note 1: The making of any false statement or representation on this form, knowing it to be false, is a violation of Title 18, Section 1001 of the United States Code which provides for the penalty of a fine of $10,000 or imprisonment of not more than five years, or both.

Note 2: Questions regarding the use of this form or how to fill it out may be answered by referring to the “Transaction Report Instructions,” available by telephoning the National Honey Board at (xxx) xxx-xxxx or by writing to the National Honey Board, Address, City, State, Zip.

Note 3: 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 the form is the Honey Research, Promotion, and Consumer Information Act (7 U.S.C. 4601-4613). Furnishing the requested information is necessary for the administration of this program. Submission of the Tax Identification Number (TIN) or Employer Identification Number (EIN) is mandatory, and will be used to determine affiliation or entity identity.

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 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-HTR (09/07)