DA-20R National Fluid Milk Processor Monthly Report & Remittanc

Approved OMB No. 0581-0093

NATIONAL FLUID MILK PROCESSOR

PROMOTION PROGRAM

MONTHLY REPORT AND REMITTANCE OF AMOUNT

DUE FOR ALL FLUID MILK PRODUCTS PROCESSED

AND MARKETED COMMERCIALLY IN CONSUMER-

TYPE PACKAGES BY FLUID MILK PROCESSORS

This report is required by 7 CFR 1160.211(a) of the regulations that implement the Fluid Milk Promotion Act of 1990 (Title XIX, Subtitle H, of the Food, Agriculture, Conservation, and Trade Act of 1990. Pub. L. 101-624), as amended. Failure to report or remit amount due can result in a substantial civil penalty. 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, and completing and reviewing the collection of information.

Official Use Only

ID Number

Name

Address

REPORT OF AMOUNT DUE ON FLUID MILK PRODUCTS MARKETED DURING Month _________ Year _________

Failure to report or remit amount due may result in a fine of not more than the maximum amount specified in Sec. 3.91 (b)(1)(xxxv) of this title for each violation.

1. Fluid milk products processed and marketed commercially in consumer-type

packages. lbs.

2. Add fluid milk products processed and packaged and transferred to other plants. lbs.

3. Subtract fluid milk products processed and packaged and transferred in from other

plants. lbs.

4. Subtract fluid milk products exported to locations outside the contiguous 48 States

and the District of Columbia. lbs.

5. Total fluid milk products processed and marketed commercially in consumer-type

packages subject to the assessment (sum of line 1 through line 4). lbs.

6. Amount due for this month (line 5 x $.0020).

(The rate of $.0020 per pound is equal to 20 cents per hundredweight.) $

7. Add or subtract adjustments for prior months. Attach a separate sheet which

explains the adjustments and shows the pounds and month(s) for each adjustment. $

8. Amount remitted with this report. Amount on line 6 plus or minus amount on line 7.

If no adjustments are made, the amounts on line 6 and line 8 will be the same. $

PAYMENT: This report and check made payable to the National Fluid Milk Processor Promotion Board in the amount shown on line 8 must be mailed to the National Fluid Milk Processor Promotion Board, PO Box 37094, Baltimore, MD 21297-3094, by the last day of the month following the month in which the fluid milk products were marketed. The postmark date of your remittance envelope will be used to determine the assessment of late-payment charges equal to 1.5% per month of the amount owed. Please allow time for postal service processing.

CERTIFICATION

I declare under the penalties provided by law that this report 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.

R ESPONDING OFFICIAL’S NAME (Please Print) TITLE (Please Print)

SIGNATURE OF RESPONDING OFFICIAL Date

Form DA-20R (06/10) Note: For inquiries regarding you assessment account, please telephone (301) 656-1551.

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 the 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, DC 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.