FV-219 California Raisins (Handlers) Background Questionnaire

REPRODUCE LOCALLY. Include form number and date on all reproductions. OMB. No. 0581-0178

U.S. DEPARTMENT OF AGRICULTURE

AGRICULTURAL MARKETING SERVICE

FRUIT AND VEGETABLE PROGRAM

CONFIDENTIAL RAISIN ADMINISTRATIVE COMMITTEE

HANDLER NOMINEE QUESTIONNAIRE

Information will be used by the Secretary of Agriculture (Secretary) in selecting handler members and alternate members on the Raisin Administrative Committee (RAC) under Federal Marketing Order No. 989. Statutory authority to obtain this information is provided in 7 U.S.C. 608.

1. Name:

2. Residential Address (incl. City, State, and Zip Code):

3. Mailing Address (if the same, so state):

4. Telephone Number: (H)_____________________________ (W)______________________

(C)

5. Fax Number:

6. E-mail Address:

7. Number of years you have been connected with the raisin packing business:

8. Raisin packing firm with which you are now connected:

9. Your position or title:

10. Tonnage of all raisins acquired by such raisin packing firm during the period from August 1, 20___ to July 31, 20___: _______________ tons (natural condition weight)

11. Check varietal types of raisins handled by such firm, and insert tonnage of each varietal type of such raisins:

□ Natural Seedless _____ □ Golden Seedless _______ □ Dipped Seedless _______

□ Muscats _______ □ Sultanas _______ □ Zante Currants _______

□ Others _______

12. Have you ever been charged or convicted of a felony? (Generally, a felony is defined as any violation of law punishable by imprisonment of longer than 1 year, except for violations called misdemeanors under State law which are punishable by imprisonment of 2 years or less.) □ Yes □ No

I am aware that the handler member and alternate positions are non-salaried. I am aware that these positions may require travel. (Authorized travel expenses are reimbursable.)

Marketing Order committee members, in their official capacities, are prohibited from taking any action specifically designed to influence legislation, including any attempt to influence public opinion concerning legislation. Committee members may not communicate with any official of a State or Federal legislative body for the purpose of attempting to influence legislation. Committee members are also prohibited from attempting to influence State or Federal government actions or policies or those of foreign governments, except as specifically authorized under the Marketing Order or expressly approved by the Secretary. Committee members are specifically precluded from authorizing the expenditure of marketing order funds for the purpose of attempting to influence legislation or government actions. These same prohibitions apply to committee managers, staff, and contractors, except that committee managers may consult with Department of Agriculture (USDA) employees during the pendency of informal rulemaking actions.

If Marketing Order committee or subcommittee members or committee employees are sued individually or jointly for errors in judgment, mistakes or other acts either of omission or commission (except for acts of dishonesty, willful misconduct, or gross negligence) in the conduct of their duties under the marketing agreement or Order, they may be authorized legal defense by the Department of Justice (DOJ). Alternatively, legal defense may be provided through private counsel, if recommended by the USDA and approved by DOJ. USDA and DOJ enjoy an excellent working relationship with respect to providing legal representation for committee members and employees, either by DOJ or through authorized private counsel. USDA is committed to a comprehensive legal defense policy for all committee members and employees acting within the scope of their authorized committee duties and responsibilities.

I hereby accept the nomination as a handler member or alternate handler member of the Raisin Administrative Committee, and will serve in such position if selected by the Secretary of Agriculture.

__________________________________________

Name

_____________________________________________ ________________________________

Signature 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 0581-0178. The time required to complete this information collection is estimated to average 6 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 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.

FV-219 (Rev. 01/2014) Destroy previous editions.