PAP-PIQ Paper-Production/Import Quarterly Report

OMB No. 0581-0093

Payment Due On or Before: ___________

PAPER AND PAPER-BASED PACKAGING PROMOTION, RESEARCH, AND INFORMATION ORDER

(7 CFR 1222)

PRODUCTION/IMPORT QUARTERLY REPORT

For the ____ Quarter (Please specify)

(Quarters are as follows: 1 = Jan, Feb, Mar; 2 = Apr, May, Jun; 3 = Jul, Aug, Sep; 4 = Oct, Nov, Dec)

The following statements are made in accordance with the Privacy Act of 1974 (U.S.C. 552a) and the Paperwork Reduction Act of 1995. The authority for requesting this information to be supplied on this form is the Commodity Promotion, Research, and Information Act of 1996, Pub. L. 104-127, 110 Stat. 1032 (7 U.S.C. 7411-7425). Furnishing the requested information is necessary for the administration of this program. Submission of the Tax Identification Number is mandatory, and will be used to determine affiliation or entity identification.

Contact Person:

Company Name:____________________________ Tax ID# or Importer ID#:

Address:

City:_____________________________ State:___________________ Zip Code:

E-mail:____________________________________ Web site:

Telephone Number:__________________________ Fax No.

* For domestic manufacturers, if plant location differs from the address above, please specify plant address:

___________________________________________________________________________________

Enter the quantity of salable short tons of paper and paper-based packaging manufactured within the United States during the applicable quarter, by type. Note: the assessment is on the roll stock, except the assessment for cut-size printing and writing papers (including folio sheets) imported or made by domestic manufacturers prior to leaving the manufacturer’s mill is on the cut-size paper.

	Printing, writing and related papers	Kraft packaging papers	Containerboard	Paperboard	Total
Short tons

Enter the salable quantity of short tons of paper and paper-based packaging imported into the United States during the applicable quarter and country of origin, by type. Note: the assessment is on the roll stock, except the assessment for cut-size printing and writing papers (including folio sheets) imported or made by domestic manufacturers prior to leaving the manufacturer’s mill is on the cut-size paper.

	Printing, writing and related papers	Kraft packaging papers	Containerboard	Paperboard	Total
Short tons by country of origin

TOTAL NUMBER OF SHORT TONS ON WHICH

ASSESSMENT IS DUE:

(Total Manufacture and/or Imported = Total short tons to be assessed)

Assessment rate ($0.xx per short ton) X $0.xx

TOTAL ASSESSMENT DUE:

I certify that the above information is true and correct to the best of my knowledge and the attached payment represents $0.xx per short of paper and paper-based packaging manufactured or imported during this reporting period for which I am required to pay the assessment. I also certify that I am authorized to sign this report.

Print Name and Title of Person Completing this Report

Signature Date

Please Mail your check to our LOCK BOX ADDRESS:

Paper and Packaging Board

Street

City, State Zip code

And e-mail this report to: xxx

Bank Wire/ACH Instructions:

Please contact: xxxx

E-mail: xx

Continue to next page for further instructions.

INSTRUCTIONS

Domestic manufacturers are required to pay assessments and file this report no later than the thirtieth calendar day of the month following the end of the quarter in which the paper and paper-based packaging was manufactured. The fiscal year runs from January through December. There are four quarters in each fiscal year. Quarter 1 covers January, February and March. Quarter 2 covers April, May, and June. Quarter 3 covers July, August, and September. Quarter 4 covers October, November, and December. Assessments for paper and paper-based packaging manufactured during Quarter 1 are due by April 30; for Quarter 2 by July 30; for Quarter 3 by October 30, and for Quarter 4 by January 30. Importers of paper and paper-based packaging shall pay through Customs; however, if Customs does not collect an assessment from the importer, the importer is responsible for paying the assessment directly to the Board and submitting this report to the Board with the assessment payment. All reports are held in strict confidence by the staff of the Board and the U.S. Department of Agriculture (USDA).

This report is required by law [7 U.S.C. 7416, 7 CFR Part 1222.52 and 7 CFR Part 1222.70]. Failure to report can result in a fine of not less than $1,000 or more than $10,000 for each such violation. Each such violation shall be deemed a separate violation. The making of any false statement or representation on this form, knowing it to be false, is a violation of Title 18, Section 1001 United States Code, which provides for the penalty of a fine of $10,000 or imprisonment of not more than five years, or both.

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 maintaining the data needed, and completing and reviewing 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. 20250-9410; (2) fax: (202) 690-7442; or (3) email: [email protected]. USDA is an equal opportunity provider, employer, and lender.

PAP-PIQ (rev. 03/17) Destroy previous editions.