H-13 Expected Bulk Milk receipts and Usage

UNITED STATES DEPARTMENT OF AGRICULTURE
1930-220th St. SE, Ste. 102
Bothell, WA 98021
Phone: (425) 487-6009
Fax: (425) 487-2775
E-mail: [email protected]

AGRICULTURAL MARKETING SERVICE
DAIRY PROGRAMS
FEDERAL MILK ORDERS 124 & 131

4835 E Cactus Rd., Ste. 365
Scottsdale, AZ 85254
Phone: (602) 547-2909
Fax: (602) 547-2906
E-mail: [email protected]

H - 13
Expected Bulk Milk Receipts and Usage

Note: This cover page is for information purposes only and does not need to be submitted to the market administrator's office.

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 1 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.
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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
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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.

UNITED STATES DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
DAIRY PROGRAMS

Form H-13
1930-220th St. SE, Ste. 102
Bothell, WA 98021
Phone: (425) 487-6009
Fax: (425) 487-2775

Form Approved, OMB No. 0581-0032
4835 E Cactus Rd., Ste. 365
Scottsdale, AZ 85254
Phone: (602) 547-2909
Fax: (602) 547-2906

FEDERAL MILK ORDERS 124 & 131

E-mail: [email protected]

E-mail: [email protected]

DISTRIBUTING PLANT
EXPECTED BULK MILK RECEIPTS AND USAGE
Month:

Handler:
Plant Location:

A) Expected Grade A Receipts
1.
2.

Product Pounds

Producers
§ .9(c) coops. (specify)
a.
b.
c.

3.

Other Bulk Grade A (specify)
a.
b.
c.

4.

Total

B) Expected Class I Needs
1.
2.
3.

Fluid Milk Products packaged in the plant
Other Class I Needs (specify)
Total

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)).
I declare under the penalties provided by law, that this report (including any accompanying schedules and
statements) has been examined by me and to the best of my knowledge and belief is a true, correct, and
complete report. I also certify that I am authorized to sign this report.

Name of Handler

Date

Authorized Signature

Title