ORG-NOM Nomination for Appointment to Organic Research & Promoti

OMB No. 0581-NEW

NOMINATION FOR APPOINTMENT TO THE ORGANIC RESEARCH AND PROMOTION BOARD

ORGANIC RESEARCH AND PROMOTION ORDER

(7 CFR PART 1255)

The following statements are made in accordance with the Privacy Act of 1974 (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 Commodity Promotion, Research, and Information Act of 1996, Pub. L. 104-127, 110 Stat. 1032 (7 U.S.C. 7411-7425). Furnishing the requested information is necessary for the administration of this program. Submission of the Tax Identification Number is mandatory, and will be used to determine affiliation or entity identification.

Names of Nominees and Position (Producer, Voluntarily Assessed Producer, Handler, Product Processor, Public Member, or Importer and the REGION) for which each person is nominated. Nominees must meet eligibility requirements as described in §§ 1255.40 and 1255.41 of the Order. Nominees that are qualify for more than role may seek nomination for any role for which he or she is eligible. Domestic producers must be domiciled in the region for which they seek nomination.

Nominee Name ________________________________________ Region (1 through 6)___________________

Position(s) sought _______________________________________

Mandatorily or Voluntarily Assessed? __________________________________

Address:

Name of Person or Organization submitting these nominations

Name of Organization/Person: _______________________________________ Tax ID/Bus. #________________

Address: ___________________________________________________________________________________

City: _________________________ State: ________________ Zip: __________________

Phone No. ______________________ Fax No. _____________________

E-Mail: ________________________

Print Name and Title of Person Completing this Nomination

________________________________________________________________________________________________________

Signature Date

Return Original Forms to: U.S. Department of Agriculture

AMS, Specialty Crops Program

Promotion and Economics Division

Organic Research & Promotion Program Nominations

1400 Independence Avenue, S.W., Room 1406-S

Washington, DC 20250-0244

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-NEW. The time required to complete this information collection is estimated to average 15 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.

ORG-NOM