ACP-4 FMO Exempt Handler Notification

OMB No. 0581-0215
ADMINISTRATIVE COMMITTEE FOR PISTACHIOS
4938 East Yale Avenue, Suite 102, Fresno, CA 93727
Tel (559) 255-6480; Fax (559) 255-6485
Email: [email protected]

FMO EXEMPT HANDLER NOTIFICATION
This form is submitted to the Administrative Committee for Pistachios if, as a Handler, you receive 5,000 Pounds or
less (assessed weight) of pistachios in a given production year.

Section A: Handler must complete this form and mail to the ACP by November 15th of each production year.
Handler is responsible for keeping a copy of the completed form for their own records for 3 years following the
production year in which the pistachios were shipped.

Handler Name: _________________________________________________________________
Address: ______________________________________________________________________
City:_________________________________________________ State: ____ Zip Code: ______
Assessed weight handled: ________________________Lbs. Production Year: _____________

Handler signature:______________________________________ Date: ___________________
Name: _______________________________________________ Title: ___________________

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 05810215. 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.

ACP-4 (Rev. 05/2014. Destroy previous editions.)