PMC 2.6 CA Dried Prunes - Statement of Proposed Disposition of S

OMB No. 0581-0178

STATEMENT OF PROPOSED DISPOSITION OF SUBSTANDARD PRUNES

Date: ___________________________

TO: Prune Marketing Committee PMC Approval Number: ____________

3840 Rosin Court, Suite 170

Sacramento, CA 95834

The undersigned hereby certifies to the United State Department of Agriculture and to the Prune Marketing Committee (Committee) for himself/herself and for and on behalf of _____________________________ (Handler) that the undersigned has purchased _________ pounds of substandard prunes on or about _______________, 20___, and that said prunes, subject to approval by the Committee, will be shipped to and converted by ___________________________________________________________________________ (Name and Address of Converter) into _________________________________________________ (usage).

Firm or Individual: _____________________________________________________________________

Address: _____________________________________________________________________________

By: ___________________________________________ Title: ___________________________

IMPORTANT NOTICE: The issuing of a false certificate, knowing it to be false, is a violation of title 18, section 1001 of the United States Code, which provides a penalty or imprisonment, or both.

This report is required by law (7 U.S.C. 608(d), 7CFR 993.50(e), 993.150(e)(1)(ii)).

FAILURE TO REPORT can result in a fine for each such violation and each day during which such violation continues will be deemed a separate violation.

This information is required to obtain authority from the Committee to dispose of substandard prunes and it will be used for that purpose.

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 2 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.

PMC 2.6 (Rev. 01/2014. Destroy previous editions.)