Nomination of Sorghum Producers for Appt. to Sorghum Bd.

REPRODUCE LOCALLY.

FORM APPROVED. - OMB NO. 0581-0093
U.S. DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE

NOMINATION OF SORGHUM PRODUCERS FOR APPOINTMENT TO
THE SORGHUM PROMOTION, RESEARCH, AND INFORMATION BOARD
____________________________________________________________________________________________________________________________________

Pursuant to the Commodity Promotion, Research, and Information Act of 1996, the following names of sorghum producers
are submitted as nominees to the Sorghum Promotion, Research, and Information Board (Board) from the indicated State.

1. STATE/UNIT

__________________________________________________________________________________________________________________________________________________________

NAME(S) OF NOMINEE(S)

(List name(s) for each allotted position on the Board)

IF MORE SPACE IS NEEDED, USE ADDITIONAL FORMS.
A COMPLETED BACKGROUND INFORMATION SHEET SIGNED BY EACH NOMINEE MUST BE ATTACHED.

3. IDENTIFICATION OF PERSON AND ORGANIZATION/ASSOCIATION SUBMITTING THESE NOMINATIONS

A. NAME AND ADDRESS OF ORGANIZATION/ASSOCIATION

C. NAME AND TITLE (PRINT OR TYPE)

D. EMAIL ADDRESS ([email protected])

B. FACSIMILE NO. AND AREA CODE

RETURN FORMS TO:

LPS (Rev. 04/17)

Research and Promotion Division
Livestock, Poultry, and Seed Program, AMS
U.S. Department of Agriculture
Street
City, State Zip
FAX: (202) 720-1125

E. SIGNATURE

DATE

See reverse for burden/non-discrimination statement

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 0581-0093. 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 maintain the data needed, and completing and review the collection of information.
In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies,
offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national
origin, religion, sex, gender identity (including gender expression), sexual orientation, disability, age, marital status, family/parental status, income derived
from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded
by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident.
Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign
Language, etc.) should contact the responsible Agency or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the
Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.
To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at
http://www.ascr.usda.gov/complaint_filing_cust.html and at any USDA office or write a letter addressed to USDA and provide in the letter all of the
information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: (1)
mail: U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, SW., Washington, D.C. 202509410; (2) fax: (202) 690-7442; or (3) email: [email protected]. USDA is an equal opportunity provider, employer, and lender.