DA-21 Dairy Continuance Referendum (Producers)

OFFICIAL REFERENDUM BALLOT:

OMB NO. 0581-0093

United States Department of Agriculture
Agricultural Marketing Service Dairy
Programs
DAIRY PROMOTION AND RESEARCH ORDER CONTINUANCE REFERENDUM
INDIVIDUAL PRODUCERS AND IMPORTERS

DAIRY PROMOTION AND RESEARCH ORDER

See the reverse of this form for instructions for completing the ballot. This ballot and the information provided will
be kept confidential. (Please type or print.)

Last Name of Producer or Importer

Middle Initial

First Name

(Business Name, if applicable)

Business Address

City

State

Zip Code

BALLOT: DO YOU FAVOR HAVING THE SECRETARY OF AGRICULTURE CONTINUE
THE DAIRY PROMOTION AND RESEARCH ORDER?

□ YES, continue the Order

(Place an “X” in only one space)

□ NO, terminate the Order

I was engaged in the production or importation of dairy products

I hereby CERTIFY that during
or milk for commercial use; and

(CHECK ONLY 1 BLOCK)

□ (A) I am a member of the cooperative association named below that marketed my milk:
□ (B) No cooperative association marketed my milk and I sold my milk to the plant named below:
□(C) I sold my milk directly to consumers under the following business name:
□(D) I imported milk or dairy products into the U.S. under the following business name:
Cooperative, plant, or business name of (A), (B), (C) or (D) above
City and State of Cooperative, plant, or business named above
If this ballot is being cast on behalf of any group of individuals, partnership, corporation, or other business entity
engaged in the production or import of dairy products or milk for commercial use, I CERTIFY that I have the
authority to cast this ballot and will submit evidence thereof if so requested by the Referendum Agent.

Name of Ballot Caster (Please Type or Print)

Signature

Date

FALSIFICATION OF INFORMATION ON THIS GOVERNMENT DOCUMENT 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)
(over)
Form DA-21 (08/07)

(FRONT PAGE)

OFFICIAL REFERENDUM BALLOT Instructions

OMB NO. 0581-0093

Dairy Promotion and Research Order Continuance Referendum
A national Order establishing a dairy promotion, research, and nutrition education program was authorized by the Dairy and
Tobacco Adjustment Act of 1983 and was fully implemented on May 1, 1984. The program provides for a 15-cent per
hundredweight assessment on all milk produced in the United States and marketed commercially by dairy farmers. The 2008
Farm Bill specifies a mandatory assessment rate of 7.5 cents per hundredweight of milk or equivalent thereof on dairy
products imported into the U.S. A board of 38 dairy farmers and importers, appointed by the Secretary of Agriculture,
administers the program.
The Secretary of Agriculture, pursuant to Section 116 of the Dairy and Tobacco Adjustment Act of 1983, has called for a
referendum among producers and importers during __
to determine whether the Dairy Promotion and Research Order
should be continued. For the program to continue, a majority of producers and importers voting in the referendum must favor
keeping the program.
The Referendum Agent has established the referendum period as
through
. The Act requires that a
cooperative association that votes on behalf of its members must advise its producer or importer members no later than 30 days
prior to the beginning of the referendum as to how it will vote. The Referendum Agent has determined that to meet the notice
requirement such cooperative must inform it’s members by
. A producer or importer member who opposes the
cooperative’s vote may cast an official individual producer or importer ballot with the member’s differing vote.
I. Voting. Voting will be conducted by mail. The Referendum Agent has determined that completed ballots must
be postmarked
through
as specified in the Referendum Order. Incomplete ballots or ballots
postmarked earlier or later than the dates specified in the Referendum Order will not be counted.
II. Persons Eligible to Vote. A producer engaged in the production or an importer of dairy products, or milk for
commercial use during
is eligible to vote. In the case of a producer or importer who is other than an
individual, the business unit is regarded as the producer or importer. Only one vote is permitted for each dairy
farm or importer business unit. A cooperative association may vote on behalf of its producer or importer
members. A producer or importer member opposed to the cooperative vote may cast an individual ballot.
III. Instructions for Completing the Ballot.
1. Complete the producer or importer name and business name (if applicable) including address.
2. Vote in the space provided.
3. Complete the certification section. A producer who is a member of or under contract to a cooperative should
check block (A) and indicate the name and address of the cooperative. A producer who does not market milk
through a cooperative should check block (B) and indicate the name and address of the plant to which the
producer sells milk. A producer who sells milk directly to consumers should check block (C) and indicate the
name and address of the distribution business.
4. Be sure to sign the ballot.
5. Mail the ballot in the return envelope not later than the date specified in the Referendum Order. If you did not
obtain a return envelope, mail your ballot to:
Referendum Agent
USDA, AMS, Dairy Programs
Room 2968-S, Mail Stop 0225
1400 Independence Avenue SW
Washington, D.C. 20250-0225
If you have questions or need information, on the referendum, call the Referendum Agent at (202) 720-6909.
According to the Paperwork Reduction Act of 1995, an agency my 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 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 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.
Form DA-21 (08/07)

(BACK PAGE)