RAC-1001 Schedule for Redemption of Raisin Diversion Certificates

OMB No. 0581-0178

RAISIN ADMINISTRATIVE COMMITTEE

2445 Capitol Street, Suite 200

Fresno, California 93721

Phone: (559) 225-0520

SCHEDULE FOR REDEMPTION OF RAISIN DIVERSION CERTIFICATES

20___ CROP YEAR

Schedule No. ______________

The undersigned handler hereby requests release of reserve pool raisins to fulfill redemption of the Raisin Diversion Certificate attached.

Certificate No.	Creditable Diversion Weight (lbs)	Certificate No.	Creditable Diversion Weight (lbs)	Certificate No.	Creditable Diversion Weight (lbs)
	Total Creditable Diversion Weight				Lbs
		Multiplied by $_________ =		$
		RAC Release No.

The making of any false statement or representations in any matter within the jurisdiction of any agency of the United States, knowing it to be false, is a violation of title 18, section 1001 of the United States Code, which provides for a penalty of a fine or imprisonment of not more than five years, or both.

Handler _____________________________________ Date ____________________________

By ________________________________________ Title ___________________________

This report is required by law (7 U.S.C. 608d, 7 CFR 989.156(k)). Failure to report can result in a fine of $1,100 for each such violation, and each day during which such violation continues shall be deemed a separate violation.

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 0581-0178. 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.

RAC-1001 (Rev. 01/2014) Destroy previous editions.