OMB No. 0581-0178
FAR WEST SPEARMINT OIL ADMINISTRATIVE COMMITTEE 100 N. Fruitland, Suite B Kennewick, WA 99336 Phone: (509) 585-5460
Application for Additional Base CLASS 1 (SCOTCH)
Pursuant to section 985.153(c)(2) of Marketing Order No. 985, I hereby request that the appropriate quantity of additional base be issued to me effective June 1, 20___.
Additional Base Will be Added to:
(If more than one entity, please circle entity to receive additional base)
Signed ____________________________________________
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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 5 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.
Form K-1 (Rev. 01/2014. Destroy previous editions.)
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | AHatch |
| File Modified | 0000-00-00 |
| File Created | 2021-01-28 |