CPR-4 Report of Billings To and/or Payments from Pool Handlers

Return to: Federal Milk Order No. 1—Northeast Marketing Area
333 North Fairfax Street
Mailing Address: P.O. Box 25828
Alexandria, VA 22313-5828
Tel: (703) 549-7000 —Fax (703) 549-7003
Email: [email protected] Website: www.fmmone.com

CPR-4
Form Approved, OMB No. 0581-0032
This report is required by the Order in
accordance with 7 U.S.C. 608c and d.
Failure to report can result in the
assessment of a civil penalty of up to
$1,000 per day (7 U.S.C. 608c (14)(B))
or, upon conviction, in a fine of up to
$5,000 per day (7 U.S.C. 608c (14)(A)).

REPORT OF BILLINGS TO AND/OR PAYMENTS FROM POOL HANDLERS*
NAME OF COOPERATIVE ASSOCIATION:

NAME OR PURCHASER

DATE:
DELIVERY
PERIOD

DATE
BILLED

AMOUNT
BILLED

AMOUNT RECEIVED
AND DEPOSITED

DATE
RECEIVED

*Include all amounts billed and/or received since previous report.
Report is due on the 20th of each month.
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 0581-0032. The time required to complete this information collection is estimated to average 0.5 hour 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.
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