FV-649 Certified Organic Producers & Marketers Application for

Print Form

REPRODUCE LOCALLY. Include form number and date on all reproductions.
U.S. DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
FRUIT AND VEGETABLE PROGRAMS

OMB No. 0581-0216

CERTIFIED ORGANIC HANDLER APPLICATION FOR
EXEMPTION FROM MARKETING PROMOTION ASSESSMENT
PAID UNDER FEDERAL MARKETING ORDERS

SECTION 1 - HANDLER APPLICATION
To request an exemption from assessment under the applicable Federal marketing orders, the handler must operate
under an approved organic process system plan authorized by the National Organic Program (NOP), and handle or market only products
that are eligible for a 100% organic product label under the NOP. The information on this form is required to make a
determination concerning a handler's eligibility for exemption. PLEASE SUBMIT THIS APPLICATION TO THE

APPROPRIATE MARKETING COMMITTEE/BOARD.
TO:

DATE:
MARKETING COMMITTEE/BOARD

MARKETING ORDER NUMBER

APPLICANT'S NAME:
NAME OF COMPANY:
MAILING ADDRESS:

STATE

CITY

ZIP

TELEPHONE NUMBER (Include Area Code):
FAX NUMBER (Include Area Code):
E-MAIL ADDRESS (Optional):
IN ORDER TO BE EXEMPT, THE ABOVE-NAMED ENTITY MUST MEET ALL OF THE FOLLOWING (Please check):

Operate under an approved organic process system plan authorized by the National Organic Program (NOP), and handle or
market products that are eligible for a 100% organic product label under the NOP.
Is not a split operation as defined by the Organic Foods Production Act (OFPA) and the NOP.

Is subject to assessments under the Federal marketing order program for which this exemption is requested.
PLEASE LIST ALL COMMODITIES HANDLED OR MARKETED, AND CHECK THE APPROPRIATE BOX(ES): (Attach

separate sheet, if necessary)
COMMODITY HANDLED/

ELIGIBLE TO BE LABELED

COMMODITY HANDLED/

ELIGIBLE TO BE LABELED

MARKETED

AS 100 % ORGANIC?

MARKETED

AS 100% ORGANIC?

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

IF APPLICABLE, PLEASE INDICATE THE NUMBER OF PRODUCERS FOR WHOM YOU HANDLE OR MARKET, AND
INCLUDE YOURSELF IN THE TOTAL IF YOU HANDLE OR MARKET YOUR OWN PRODUCTION:
Form FV-649 (09/07)

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REPRODUCE LOCALLY. Include form number and date on all reproductions.

OMB No. 0581-0216

A COPY OF YOUR ORGANIC HANDLING OPERATION CERTIFICATE PROVIDED BY A USDA-ACCREDITED

CERTIFYING AGENT UNDER THE OFPA AND THE NOP MUST BE ATTACHED; AND,

IF APPLICABLE, A COPY OF YOUR NOP PRODUCER CERTIFICATE, AND AN NOP CERTIFICATE FOR EACH
ADDITIONAL PRODUCER, FOR WHOM YOU HANDLE OR MARKET, MUST BE ATTACHED.

I certify that my firm meets these requirements and is eligible for an organic assessment exemption under the above-named
Federal marketing order for the 20
through 20
assessment period.

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

SECTION 2 - COMMITTEE/BOARD NOTIFICATION OF EXEMPTION (To be completed by Committee or Board only)
Your application dated requesting exemption from marketing promotion as sessments, including paid advertising, as specified under
the provisions of § 900.700 has been:
Approved, subject to compliance with § 900.700 regulations for the 20

through 20

assessment period.

Disapproved (Attached are the reasons for disapproval)

Marketing Committee/Board Representative Signature

Date

NOTE: 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 is 0581-0216. 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, age, disabililty, 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 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.

Form FV-649 (09/07)

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