Nomination for Appointment to the Honey Packers & Import

OMB No. 0581-0093

NOMINATION FOR APPOINTMENT TO THE HONEY PACKERS AND IMPORTERS RESEARCH, PROMOTION, CONSUMER EDUCATION AND INDUSTRY INFORMATION ORDER

(7 CFR PART 1212)

The following 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 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).

1. Please mark an “X” in the appropriate block for which you are submitting nominations. (Mark only one box.
If you are submitting nominations for more than one group below, a separate form must be filled out for each group.)

[ ] Producers [ ] Importers [ ] First Handlers [ ] Importer/Handler [ ] Marketing Cooperative

2. Names of Nominees and Position for which each person is nominated (List two names for each allotted position on the Board)

3. When nominations are the result of a caucus, list the organizations or associations participating in the caucus.

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

4. Name of Person or Organization submitting these nominations

Name of Organization/Person: ____________________________________________ Tax ID/SS#________________

Address: _______________________________________________________________________________________

City: _________________________ State: ________________ Zip: __________________

Phone No. ______________________ Fax No. _____________________ E-Mail: ________________________

This organization/person represents: [ ] Producers [ ] Importers [ ] First Handlers [ ] Marketing Cooperatives

Print Name and Title of Person Completing this Nomination

________________________________________________________________________________________________________

Signature Date

Return Original Forms to: National Honey Board

Street, City, State, Zip Code

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.

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(rev. 08/10) (Expires XX/XX/XXXX)