FV-222 California Raisins (Growers) Background Questionnaire

REPRODUCE

LOCALLY.

Include form number on all reproductions.

OMB No. 0581-<)178

u.s. DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
FRUIT AND VEGETABLE PROGRAMS

CONFIDENTIAL RAISIN ADMINISTRATIVE COMMITTEE
PRODUCER NOMINEE QUESTIONNAIRE
NOTE: Information to be used by the Secretary of Agriculture in selecting a producer member and alternate member on the Raisin Administrative
Committee under Federal Marketing Order No. 989. Statutory authority to obtain such information is provided in 7 U.S.C. 608.

1. Name:
2. (a) Residence:
(Street)

(City)

(State)

(Zip)

(City)

(State)

(Zip)

(b) Mailing Address: (If same, so state)
(Street)

Business(_

(c) Telephone Number: Home (_)
(d) Fax Number: (_)

)

(e) E-Mail Address:

3. Number of years you have been a producer of grapes utilized in the production of raisins:
4. Bearing acreage of grapes now being farmed by you:
5. County in which your vineyard(s) is located:

-

6. From the grapes produced by you in the 20
crop year, give tonnage (dry weight) of raisins made
tons.
Insert tonnage of each varietal type of such raisins:
Natural Thompson

Muscats

Golden Seedless

Zante Currants

Sultanas
Others

7. Are you a member of a cooperative marketing association, cooperative bargaining association, or any other
organization(s) furthering the interest of raisin or grape producers?
If so, state the name of each and your
position, if any, with each:
8. Have you ever been charged or convicted of any felony violations? (Generally, a felony is defined as any violation of law
punishable by imprisonment of longer than 1 year, except for violations called misdemeanors under State law which are
punishable by imprisonment of 2 years or less.) Yes _
No_
FV-222 (05/04)

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9. I hereby certify to the Raisin Administrative Committee and the Secretary of Agriculture that: (a) I am currently a
producer of grapes that are being utilized in the production of raisins; and (b) I produced grapes during the
20
crop year which were utilized in the production of raisins.
10. I am aware that the producer member and alternate positions are non-salaried. I am aware that these positions may
require travel. (Authorized travel expenses are reimbursable.)
11. Marketing order committee members, in their official capacities, are prohibited from taking any action specifically
designed to influence legislation, including any attempt to influence public opinion concerning legislation. Committee
members may not communicate with any official of a State or Federal legislative body for the purpose of attempting to
influence legislation. Committee members are also prohibited from attempting to influence State or Federal
government actions or policies or those of foreign governments, except as specifically authorized under the marketing
order or expressly approved by the Secretary. Committee members are specifically precluded from authorizing the
expenditure of marketing order funds for the purpose of attempting to influence legislation or government actions.
These same prohibitions apply to committee managers, staff, and contractors, except that committee managers may
consult with Department of Agriculture (USDA) employees during the pendency of informal rulemaking actions.
12. If marketing order committee or subcommittee members or committee employees are sued individually or jointly for
errors in judgment, mistakes or other acts either of omission or commission (except for acts of dishonesty, willful
misconduct, or gross negligence) in the conduct of their duties under the marketing agreement or order, they may be
authorized legal defense by the Department of Justice (DOJ). Alternatively, legal defense may be provided through
private counsel, if recommended by USDA and approved by DOJ. USDA and DOJ enjoy an excellent working
relationship with respect to providing legal representation for committee members and employees, either by DOJ or
through authorized private counsel. USDA is committed to a comprehensive legal defense policy for all committee
members and employees acting within the scope of their authorized
committee duties and responsibilities.
13. I hereby accept the nomination as a producer member or alternate producer member of the Raisin Administrative
Committee, and will serve in such position if elected by my peers and selected by the Secretary of Agriculture.

Signature

Date

Please type or print name as signed above:
Thefollowing statements are made in accordance with the Privacy Act of 1974 (U.S.c. 552a) and the Paperwork Reduction Act of 1995. The authority for requesting
this information to be supplied on thisform is the Agricultural Marketing Agreement Act of 1937. Secs. 1-19,48 Stat. 31, as amended, (7 U.S.c. 601-674). Furnishing the
requested information is necessary for the administration of the marketing order program. 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 6 minutes per response. including
the timefor 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 derivedfrom any public assistance program (Not all prohibited bases apply to all programs.) Persons with disabilities
who require alternative meansfor communication of program information (Braille. large print. audiotape, etc.) should contact USDA's TARGET Center at (202) 7202600 (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.