Form LS-87 Nomination of Sheep Industry Board

REPRODUCE LOCALLY. FORM APPROVED OMB NO. 0581-0263

U.S. DEPARTMENT OF AGRICULTURE AGRICULTURAL MARKETING SERVICE

NOMINATIONS TO THE NATIONAL SHEEP INDUSTRY IMPROVEMENT CENTER BOARD

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 0581-0263. The time required to complete this information collection is estimated to average 30 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.

STATE/UNIT

Pursuant to the Commodity Promotion, Research, and Information Act of 1996, the following names of sheep or goat producers are submitted as nominees to the National Sheep Industry Improvement Center Board from the indicated State.

NAMES(S) OF NOMINEE(S)

_{(List name(s) for each allotted position on the Board)}

IF MORE SPACE IS NEEDED, USE ADDITIONAL FORMS.

A COMPLETED BACKGROUND INFORMATION SHEET SIGNED BY EACH NOMINEE MUST BE ATTACHED.

_{3. IDENTIFICATION OF PERSON AND ORGANIZATION/ASSOCIATION SUBMITTING THESE NOMINATIONS}

A. NAME AND ADDRESS OF ORGANIZATION/ASSOCIATION	C. NAME AND TITLE (PRINT OR TYPE)
	D. EMAIL ADDRESS (name@provider.com)
B. FACSIMILE NO. AND AREA CODE	E. SIGNATURE	DATE

RETURN FORMS TO: Research and Promotion Division

Livestock, Poultry, and Seed Program, AMS

U.S. Department of Agriculture, Room 2608-S

1400 Independence Avenue, SW., STOP 0251

Washington, D.C. 20250-0251

_{FAX: (202) 720-1125}

LS-87 (07-16)

In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, gender identity (including gender expression), sexual orientation, disability, age, marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident.

Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the responsible Agency or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.

To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at http://www.ascr.usda.gov/complaint_filing_cust.html and at any USDA office or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW., Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: [email protected]. USDA is an equal opportunity provider, employer, and lender.