HR-76(a) Report of Route Disposition into Federal Milk Marketing

UNITED STATES DEPARTMENT OF AGRICULTURE
Address: XXX
XXX
Phone: XXX
Fax: XXX
E-mail: XXX

AGRICULTURAL MARKETING SERVICE
DAIRY PROGRAM
XXX FEDERAL MILK ORDER XXX

HR - 76(a)
Report of Route Disposition Into Federal Milk Marketing Orders

Note: This cover page is for information purposes only and does not need to be submitted to the market administrator's office.

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 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.
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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.
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UNITED STATES DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
DAIRY PROGRAM

Form HR-76(a)
Address: XXX

Form Approved, OMB No. 0581-0032

XXX
Phone: XXX

XXX FEDERAL MILK ORDER XXX

Fax: XXX
E-mail: XXX

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)).

Partially Regulated Distributing Plant
Report of Route Dispositions Into Federal Milk Marketing Orders

Handler

Delivery Period

Federal Order:
Federal Order:
Federal Order:
Product Pounds Fat Pounds Product Pounds Fat Pounds Product Pounds

Product
Homo - Whole
Homo - Whole - Organic
Flavored Milk
Flavored Milk - Organic
2% Reduced Fat - Plain
2% Reduced Fat - Fortified
2% Reduced Fat - Organic
1% LowFat - Plain
1% LowFat - Fortified
1% LowFat - Organic
Skim Nonfat - Plain
Skim Nonfat - Fortified
Skim Nonfat - Organic
Flavored Drink
Flavored Drink - Organic
Buttermilk - Plain
Buttermilk - Whole
Buttermilk - Organic
Eggnog

Total

Signature

Date

Fat Pounds