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REVISED 10/26/99 /H Form 1a
ICR 201103-0581-006 · OMB 0581-0178 · Object 23848201.
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| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
|---|---|
| File Title | REVISED 10/26/99 /H Form 1a |
| Author | OREGON HAZELNUTS |
| Last Modified By | Writer |
| File Modified | 2010-11-02 |
| File Created | 2026-08-15 |
| Conversion State | complete |
Extracted Text
HAZELNUT MARKETING BOARD 21595-A Dolores Way NE Aurora, OR 97002-9738 Tel: (503) 678-6823 Fax: (503) 678-6825 FREE TONNAGE SHIPMENTS Handler ___________________________________ Period _____________________________________ Date of Shipment Invoice/Lot Number Inspection Number Jumbo Large Medium Total Country CURRENT YEAR Total Current Period Last Period Yr-To-Date Total Yr-To-Date Within 0utside PRIOR YEAR Production Area Total Current Period Last Period Yr-To-Date Total Yr-To-Date NOTE: If an export shipment is made where conditions of sale do not meet the Hazelnut Marketing Board requirements, that shipment must be reported as a domestic sale. Please identify all such shipments and note the country the product is exported to in the Country column. If the shipment is made to or through another handler, provide the name of the handler to prevent duplication in reporting shipments. This report is required by law (7 U.S.C 608(d), 7 CFR 982.66 and 7 CFR 982.466). Failure to report can result in a fine of not less than $50 or more than $5,000 for each such violation and each day during which such violation continues shall be deemed a separate violation. 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 15 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.