No Form No. (959) So. TX Onion - Application for Registered Onion Ha

OMB No. 0581-0178

SOUTH TEXAS ONION COMMITTEE

901 Business Park Drive, Suite 500, Mission, TX 78572

Phone: (956) 584-9331 Fax: (956) 584-0300

APPLICATION FOR REGISTERED ONION HANDLER

Effective Date: ______________ Expiration Date: _______________

If you plan to HANDLE onions GROWN in the following South Texas counties, you must register as a Handler. Counties: Aransas, Atascosa, Bee, Brooks, Calhoun, Cameron, DeWitt, Dimmit, Duval, Frio, Goliad, Hidalgo, Jim Wells, Jim Hogg, Karnes, Kenedy, Kinney, Kleberg, LaSalle, Live Oak, Maverick, McMullen, Medina, Nueces, Refugio, San Patricio, Starr, Uvalde, Val Verde, Victoria, Webb, Willacy, Wilson, Zapata, Zavala.

PLEASE FURNISH THE INFORMATION REQUESTED BELOW, AND MAIL AS QUICKLY AS POSSIBLE!

TAX ID NO. or

FIRM OR INDIVIDUAL: ______________________________________ S. S. NO.: ___________________

MAILING ADDRESS: _________________________________________________________________________

PHYSICAL ADDRESS: ________________________________________________________________________

OFFICE PHONE: ____________________ SALES: _______________________ FAX: ________________

SALES STAFF: _______________________________________________________________________________

____________________________________________________________________________________________

LIST OF BRAND NAMES OR LABELS: __________________________________________________________

____________________________________________________________________________________________

TYPES OF CONTAINERS SHIPPED (CARTONS, BAGS, ETC. AND WEIGHT OF EACH CONTAINER).

_______________________________ ______________________________

_______________________________ ______________________________

_______________________________ ______________________________

_______________________________ ______________________________

_______________________________ ______________________________

WILL YOU BE INDIVIDUALLY LABELING YOUR PRODUCT? □ YES □ NO

SIGNATURE _____________________________ PRINT NAME _____________________________________

The following statements are made in accordance with the Privacy Act of 1974 (5 U.S.C. 552a) and the Paperwork Reduction Act of 1995. The authority for requesting this information to be supplied on this form is the Agricultural Marketing Agreement Act of 1937, Secs. 1-19, 48 Stat. 31, as amended, (7 U.S.C. 601-674). Furnishing the requested information is necessary for the administration of the marketing order program.

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 5 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.

Rev. 01/2014. Destroy previous editions.