Agriculture Wool Apparel Manufacturers Trust Fund

For 9902.51.11 & 9902.51.15 OMB No.: 0551-NEW

Expires XX/XX/201x

APPLICATION FOR 2015 PAYMENTS

TO MANUFACTURERS OF CERTAIN WORSTED WOOL FABRICS

If data provided is to be treated as Business Confidential, please indicate prominently across top of form. 

Company Name:	_______________________	Contact Name:	______________________
Company Address:	_______________________ 	Contact Address:	______________________ 
	_______________________ 		______________________ 
	_______________________ 		______________________
Company Federal Tax Identification Number:	________________	Contact Telephone Number:		____________________ 
		Contact Email Address:		____________________

Certification Statement: I, the duly authorized representative, as an employee, officer or agent, with personal knowledge of the matters set out in the application, certify that the information contained herein is complete and accurate, signed and sworn before a Notary Public, and acknowledging that false representations to a federal agency may result in criminal penalties under federal law.

________________________ _______ Signature of Representative Date

________________________ _______ Signature of Notary Date

Public reporting for this collection of information is estimated to average 3 hours per response, including the time for reviewing instructions, and completing and reviewing the collection of information. All responses to this collection of information are voluntary, and will be provided confidentiality to the extent allowed under the Freedom of Information Act. Notwithstanding any other provision of the law, no person is required to respond to nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless the collection of information displays a current valid OMB control number 0551 - NEW. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Import Policies and Export Reporting Division at: [email protected]

Continuation Sheet

Section 1. For manufacturers of worsted wool fabrics, containing 85 percent or more by weight of wool, with average fiber diameters greater than 18.5 micron (Harmonized Tariff Schedule of the United States (HTS) heading 9902.51.11).

	Worsted Wool Fabrics, Containing 85% or More by Weight of Wool, with Average Fiber Diameters Greater than 18.5 Microns (HTS Heading 9902.51.11)
Period	January-December 2014
Quantity and Value	Linear Yards	($)
Actual Production (fob plant)
Names and Addresses of Plants Weaving Wool Fabric of the Kind Described in in HTS 9902.51.11 in calendar year 2014.	1)
	2)
	3)
	4)
	5)
Period	January-December 1999
Quantity and Value	Linear Yards	($)
Actual Production (fob plant)
Names and Addresses of Plants Weaving Wool Fabric of the Kind Described in in HTS 9902.51.11 in calendar year 1999.	1)
	2)
	3)
	4)
	5)
Period	January-December 2000
Quantity and Value	Linear Yards	($)
Actual Production (fob plant)
Names and Addresses of Plants Weaving Wool Fabric of the Kind Described in in HTS 9902.51.11 in calendar year 2000.	1)
	2)
	3)
	4)
	5)
Period	January-December 2001
Quantity and Value	Linear Yards	($)
Actual Production (fob plant)
Names and Addresses of Plants Weaving Wool Fabric of the Kind Described in in HTS 9902.51.11 in calendar year 2001.	1)
	2)
	3)
	4)
	5)

If additional space for listing plants and/or contractors is needed, use this page again after printing or attach a blank sheet of paper with the requested information.

Continuation Sheet

Section 2. For manufacturers of worsted wool fabrics, containing 85 percent or more by weight of wool, with average fiber diameters of 18.5 micron or less (HTS heading 9902.51.15, previously HTS heading 9902.51.12).

	Worsted Wool Fabrics, Containing 85% or More by Weight of Wool, with Average Fiber Diameters Less than 18.5 Microns (HTS Heading 9902.51.15)
Period	January-December 2014
Quantity and Value	Linear Yards	($)
Actual Production (fob plant)
Names and Addresses of Plants Weaving Wool Fabric of the Kind Described in in HTS 9902.51.15 in calendar year 2014.	1)
	2)
	3)
	4)
	5)
Period	January-December 1999
Quantity and Value	Linear Yards	($)
Actual Production (fob plant)
Names and Addresses of Plants Weaving Wool Fabric of the Kind Described in in HTS 9902.51.15 in calendar year 1999.	1)
	2)
	3)
	4)
	5)
Period	January-December 2000
Quantity and Value	Linear Yards	($)
Actual Production (fob plant)
Names and Addresses of Plants Weaving Wool Fabric of the Kind Described in in HTS 9902.51.15 in calendar year 2000.	1)
	2)
	3)
	4)
	5)
Period	January-December 2001
Quantity and Value	Linear Yards	($)
Actual Production (fob plant)
Names and Addresses of Plants Weaving Wool Fabric of the Kind Described in in HTS 9902.51.15 in calendar year 2001.	1)
	2)
	3)
	4)
	5)

If additional space for listing plants and/or contractors is needed, use this page again after printing or attach a blank sheet of paper with the requested information.

Scan and e-mail completed and notarized form to: [email protected]