California FMMO Producer Payroll Report

UNITED STATES DEPARTMENT OF AGRICULTURE
Address: XXX

Form Approved, OMB No. 0581-NEW

AGRICULTURAL MARKETING SERVICE
DAIRY PROGRAM

XXX
Phone: XXX
Fax: XXX

XXX FEDERAL MILK ORDER XXX

E-mail: XXX

CALIFORNIA FMMO PRODUCER PAYROLL REPORT
Handler

Month's Production Results

Producer No.

Tank No.

Total Pounds of Milk

Producer Name

Pounds of Butterfat

Address

Pounds of Protein

City, State, Zip

Pounds of Other Solids
Average Butterfat Test
Average Protein Test
Average Other Solids Test

Organic
Month & Year
Rate

Value

Deductions

Rate

Value

PPD/Skim Blend

$

$

Hauling

$

$

Butterfat Price/Blend

$

$

Stops

$

$

Producer Protein Price

$

$

Marketing Service

$

$

Other Solids Price

$

$

National DPC

$

$

Somatic Cell Count

$

$

State DPC

$

$

$

Assignments

$

$

Value of Milk Production
Premiums

Rate

Value

Coop Dues

$

$

Cap. Retain

$

$

Bonus

$

$

CDFA Quota Assessment

$

$

rBST-Free

$

$

Other

$

$

Quality

$

$

Other

$

$

Volume

$

$

Other

$

$

Other

$

$

Other

$

$

Other

$

$

Total Deductions

$

Other

$

$

Other

$

$

Net Payment for Month

$

Other

$

$
Less Partial Payment

$

Less A/P Advance

$

Total Premiums

Gross Payment for Month

$

$

Net Check

$

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 1.5
hours 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, DC 20250-9410, or call (800) 795-3272
(voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.