MA 201 Notification of Producer Change(s)

Return to: Federal Milk Order No. 1—Northeast Marketing Area
302A Washington Avenue Ext.
Albany, NY 12203-7303
Submitting Handler ___________________________________________________
Tel: (518) 452-4410 —Fax (518) 464-6468
Email: [email protected] Website: www.fmmone.com
Please Check Type of Change:

Notification of Producer Change(s)

New Producer
Address or Name Change

Instructions: On or before the 9th day after the end of the month, each handler shall
report to the Market Administrator all producer changes in farm operators.

Going Out of Business
Dairy Farmer for Other Market Re-association

MA
Number

Patron
Number

MA 201
Form Approved, OMB No. 0581-0032
This report is required by the Order in
accordance with 7 U.S.C. 608c and d. Failure to
report can result in the assessment of a civil
penalty of up to $1,000 per day (7 U.S.C. 608c
(14)(B)) or, upon conviction, in a fine of up to
$5,000 per day (7 U.S.C. 608c (14)(A)).

Check if
Organic
Name:

Mailing Address
(if mailing address is different from farm address please provide both)
Address:

Name:

Address:

Name:

Address:

Name:

Address:

Name:

Address:

Name:

Address:

Producer

Delivery
Start Date
Stop Date

Name of Handler/Cooperative Involved in
Change or Division Number

MA Office Use
___________________________________________________________________________________________________________________________________________
Person Authorized to Sign for Handler
Title

_____________________
Date

Initials ___________ Date ________________

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 0581-0032. The time required to complete this information
collection is estimated to average 0.5 hour 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, DC 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.