BLU-GRF U.S. Highbush Blueberry Council Grower Report

OMB No. 0581-0093

U.S. HIGHBUSH BLUEBERRY COUNCIL

BLUEBERRY PROMOTION, RESEARCH, AND INFORMATION ORDER (7 CFR 1218)

G

If Payment is made: Mail Report and Payment to:

USHBC #1

C/O XXX Bank

Street

City, State Zip

If No Payment is Due: Fax Report to

USHBC Office at xxx-xxx-xxxx

ROWER REPORT FOR 20XX

please read the instructions on the reverse side before completing report

ASSESSMENTS ARE DUE NOVEMBER 30, 20XX

PART A: GROWER REPORT FOR 20 X X SUBMITTED BY-

______________________________________________________________________ ____________________

(Print Name of Individual Completing This Report) (Tax Payer ID # or Employer ID#)

___________________________________________________________________________________________________

(Print Name of Business/Company) (Telephone No., Include Area Code) (E-mail address)

__________________________________________________________ __________________ ______ ____________

(Address) (City) (State) (Zip)

PART B: GROWER ASSESSMENT CALCULATION TABLE-

LINE 1: TOTAL POUNDS OF BLUEBERRIES SOLD DURING 20XX Include all your sales to processors (handlers), fresh market stand sales, u-pick sales, exports to processors or handlers outside of the united states, deliveries to shippers, etc.	POUNDS
LINE 2: TOTAL POUNDS OF BLUEBERRIES DELIVERED TO FIRST HANDLERS (PROCESSORS) FOR WHICH ASSESSMENTS HAVE BEEN COLLECTED BY THE HANDLER AND WILL BE SENT BY THE HANDLER TO THE USHBC	POUNDS
LINE 3: TOTAL POUNDS OF BLUEBERRIES SOLD TO NON HANDLERS AND FOR WHICH I WILL NOW PAY AN ASSESSMENT TO THE USHBC Calculation: LINE 1 Minus LINE 2 = LINE 3	POUNDS
LINE 4: TOTAL ASSESSMENT AMOUNT DUE TO USHBC (Assessment Rate of $xx Per Ton= $.xxx Per Pound) Calculation: Total From LINE 3 X $.xxx = TOTAL ASSESSMENT DUE (LINE 4)	$
LINE 5: LATE PAYMENT FEE CALCULATION payment made after november 30 charged one time late payment fee of 5% on total assessment due, plus monthly interest charge of 1% per month on the total assessment and late payment charge. enter your total late payment fee here:	$
LINE 6: TOTAL GROWER PAYMENT TO USHBC Calculation: LINE 4 + LINE 5 = Total Payment Due From Grower (LINE 6)	$

PART C: REPORT OF GROWER DELIVERIES TO HANDLERS

Growers List the Names and Addresses for All Handlers (Processors) to whom you sold blueberries and for which a ushbc assessment has been collected by the handler.

(copy form or continue on another sheet if necessary)

name of handler	address		pounds delivered
Total Pounds of Blueberries Delivered to Handlers For Which Assessments Have Been Collected By Handler (Note: Total Pounds Listed Here Must Match Total Pounds Reported in Part B, LINE 2 Above)		TOTAL=

CERTIFICATION:

I certify that the above information is true and correct to the best of my knowledge and that for any blueberries I sold outside of Handlers, during the reporting period, as noted in the line 3 above, the attached remittance represents $xx per ton. I also certify that I am authorized to sign this report.

______________________________________ ________________________________

NAME (PRINT) SIGNATURE

______________________________________ _________________________

TITLE DATE

Any false statement or misrepresentation on this form may result in a fine of not more than $10,000, or imprisonment for not more than 5 years, or both (18 U.S.C. 1001)

BLU-GRF (rev.08/10) Destroy previous editions.

INSTRUCTIONS

The Grower Report is to be received from all growers annually. All blueberry growers are required to complete Part A, Part B and Part C of this report, and sign the certification statement at the bottom of each report. The U.S. Highbush Blueberry Council (USHBC) must receive the original of the report, with signature, by no later than November 30 of each calendar year. Note: If no payment is required from the grower, a signed and completed copy of this can be faxed to the USHBC office at xxx-xxx-xxxx.

Also note that a grower assumes the responsibility of a grower/handler on any of their product that the grower sells on their own (Line 3 of this report). Assessment required from a grower on this product must also be received by November 30 of each calendar year. A late payment charge will be imposed on any grower who fails to remit the total amount due by November 30. The staff of the U.S. Highbush Blueberry Council holds all reports in strict confidence.

Assessment Exemption: Any grower producing less than 2,000 pounds of blueberries annually can apply to the USHBC for exemption from assessment.

Submission of Reports and Payments: Reports and payments are to be sent to the U.S. Highbush Blueberry Council at the following address:

USHBC #1, c/o XXX Bank, Street, City, State Zip

Handler Definition: The definition of First Handler is stated in Section 1218.7 of the Blueberry Promotion, Research and Information Order (Part 1218) as follows:

“First Handler means any person, excluding a common or contract carrier, receiving blueberries from producers and who as owner, agent or otherwise ships or causes blueberries to be shipped as specified in the Order. This definition includes those engaged in the business of buying, selling and or/offering for sale; receiving; packing; grading; marketing; or distributing blueberries in commercial quantities. This definition includes a retailer, except a retailer who purchases or acquires from, or handles on behalf of any producer, blueberries. The term first handler includes a producer who handles or markets blueberries of the producer’s own production.”

Responsibility for Assessment Collection: As stated in Section 1218.52 of the Blueberry Promotion, Research, and Information Order (Part 1218), “The collection of assessments on domestic blueberries will be the responsibility of the first handler receiving the blueberries. In the case of the producer acting as its own first handler, the producer will be required to collect and remit its individual assessments.”

Late Payment Fees

As noted in Section 1218.52, Item E of the Order, “All final payments for a crop year are to be received no later than November 30 of that year. A late payment charge shall be imposed on any handler who fails to remit to the USHBC the total amount for which any such handler is liable on or before the due date established by the USHBC. In addition to the late payment charge, an interest charge shall be imposed on the outstanding amount for which the handler is liable”.

Beginning Month XX, 20XX, the USHBC will levy a one-time late payment charge of 5% on the outstanding amount due and an interest charge of 1% per month on the total outstanding balance plus the late payment charge.

Contact the USHBC office at (xxx) xxx-xxxx (phone) or (xxx) xxx-xxxx (fax) with any questions concerning this report, grower exemptions or USHBC assessment requirements.

Mailing Address: USHBC, Street, City, State Zip

NOTE: The following statements are made in accordance with the Privacy Act of 1974 (U.S.C. 522a) and the Paperwork Reduction Act of 1995, as amended. The authority for requesting this information to be supplied on this form is the Commodity Promotion, Research, and Information Act of 1996, Pub. L. 104-127, 110 Stat. 1032 (7 U.S.C. 7411-7425). Furnishing the requested information is necessary for the administration of this program. Submission of Tax Identification Number (TIN) or Employer Identification Number (EIN) is mandatory, and will be used to determine affiliation or entity identification.

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 0581-0093. The time required to complete this information collection is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, 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, D.C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.

BLU-GRF (rev. 08/10) Destroy previous editions.