FV-175 Vidalia Onions Background Statement for Public Member

REPRODUCE LOCALLY. Include form number and date on all reproductions. OMB No. 0581-0178

U.S. DEPARTMENT OF AGRICULTURE

AGRICULTURAL MARKETING SERVICE

FRUIT AND VEGETABLE PROGRAM

CONFIDENTIAL BACKGROUND STATEMENT (PUBLIC MEMBER)

Marketing Order No. 955: Vidalia Onions Grown in Georgia

Information concerning nominees will be used by the Secretary of Agriculture in appointing public interest members and alternates to administrative committees of marketing agreements and orders.

1. Name ______________________________________ Telephone ___________________________

2. Mailing Address ________________________________________________________________________

3. State of residency __________________________________ Number of years _____________

4. Are you or any member of your immediate family directly associated with the Vidalia onion industry financially or otherwise? □ Yes □ No

5. If you have an indirect relationship with the Vidalia onion industry, please explain.

______________________________________________________________________________________

______________________________________________________________________________________

6. Please list all public interest and service type organizations of which you are or have been a member and positions held with each organization.

_________________________________________________________________________________

__________________________________________________________________________________

7. Marketing order committee members, in their official capacities, are prohibited from taking any action specifically designed to influence legislation, including any attempt to influence public opinion concerning legislation. Committee members may not communicate with any official of a State or Federal legislative body for the purpose of attempting to influence legislation.

Committee members are also prohibited from attempting to influence State or Federal government actions or policies or those of foreign governments, except as specifically authorized under the marketing order or expressly approved by the Secretary. Committee members are specifically precluded from authorizing the expenditure of marketing order funds for the purpose of attempting to influence legislation or government actions.

These same prohibitions apply to committee managers, staff, and contractors, except that committee manager may consult with the Department of Agriculture employees during the pendency of informal rulemaking actions.

I am willing to serve on the Vidalia Onion Committee.

______________________________________________ ____________________________________

Signature Date

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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.

FV-175 (Rev. 01/2014. Destroy previous editions.)