No Form number CA Dates--Request for Handler Exemptions Donation

Vegetable and Specialty Crops

CA Dates Request for Handlers Exemption Donation (01-14)

Vegetable and Specialty Crops Mandatory

OMB: 0581-0178

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OMB No. 0581-0178

SAMPLE LETTER



Date: ______________, 20__


California Date Administrative Committee

P.O. Box 1736
Indio, California 92202-1736


Re: Request for Handler Exemption – Donations


I wish to request an exemption from Marketing Order regulations for a donation of marketable dates. I wish to donate ___________ pounds of “C” grade dates to the _____________________________.

Name of organization


The address of the _______________________________ is ___________________________________.

Name of organization Street, City, State, Zip Code


If you have any questions, please feel free to call me.


Sincerely,





John Doe

Date Handling Company

P.O. Box 17

Indio, CA 92202

Phone No.: _______________________














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. A valid OMB control number for this information collection is 0581-0178. The time required to complete this information collection is estimated to average 12 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 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, D.C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.

(Rev. 01/2014) Destroy previous editions

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