DA-230S Annual Validation (Supplement, if applicable)

Dairy Products Mandatory Sales Reporting

DA-230-S Supplement 2-4-15

Dairy Mandatory Sales Reporting

OMB: 0581-0274

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OMB No. 0581-0274

Supplement - Multiple Plants Reporting Screening Table
Note: This supplement is required for all operations answering "YES" to Question 1 in Section 1 of the Annual validation.

1. Please list your company's headquarters location, all dairy plant locations, any firm with an exclusive marketing agreement:

Interviewer Note: List Company Name, Plant Name, Physical Address, Mailing Address, Contact, Telephone, and Dairy
Products Produced for each location.

Office
Use

Company Name

Physical Address

Contact Name

Plant
Id

Plant Name

Mailing Address

Telephone Number

Products
Produced

Question Answer Log
Q-2

Q-3

Q-4

HQ

(

)____________

(

)____________

(

)____________

(

)____________

P1

P2

P3

2. Does your office have full access to (insert Plant Name of each entry) weekly sales data (i.e. all ledgers, contracts,
invoices, and cash receipts)?
YES

NO

DNK

3. Does (insert Plant Name of each entry) produce and/or market products outside of the information you can provide to AMS (i.e. cheese is
reported through your office but the plant listed above sells dry whey using a different office)?
YES

NO

DNK

4. Does (insert Plant Name of each entry) market products of the same type outside of information you can provide to AMS (i.e. the plant
listed above may have walk-in cash sales you cannot access)?
YES

NO

DNK

[After completion of the supplement return to the Annual Validation Worksheet in Section 1, Question 2.]
DA-230-S (Supplement sheet to DA-230)

Page 1 of 3

Interviewer Note: List Company Name, Plant Name, Physical Address, Mailing Address, Contact, Telephone, and Dairy
Products Produced for each location.
Office
Use

Company Name

Physical Address

Contact Name

Plant
Id

Plant Name

Mailing Address

Telephone Number

Products
Produced

Question Answer Log
Q-2

Q-3

Q-4

P4

(

)____________

(

)____________

(

)____________

(

)____________

(

)____________

(

)____________

(

)____________

(

)____________

(

)____________

(

)____________

P5

P6

P7

P8

P9

P10

P11

P12

P13

DA-230-S (Supplement sheet to DA-230)

Page 2 of 3

Interviewer Note: List Company Name, Plant Name, Physical Address, Mailing Address, Contact, Telephone, and Dairy
Products Produced for each location.
Office
Use

Company Name

Physical Address

Contact Name

Plant
Id

Plant Name

Mailing Address

Telephone Number

Products
Produced

Question Answer Log
Q-2

Q-3

Q-4

P14

(

)____________

(

)____________

(

)____________

(

)____________

(

)____________

(

)____________

(

)____________

(

)____________

(

)____________

(

)____________

P15

P16

P17

P18

P19

P20

P21

P22

P23

DA-230-S (Supplement sheet to DA-230)

Page 3 of 3


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File Modified2014-10-08
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