SC-175 (955) Vidalia Onions Background Statement for Public Mem

REPRODUCE LOCALLY. Include form number and date on all reproductions. OMB No. 0581-0178

U.S. DEPARTMENT OF AGRICULTURE

AGRICULTURAL MARKETING SERVICE

SPECIALTY CROPS PROGRAM

CONFIDENTIAL BACKGROUND STATEMENT (PUBLIC MEMBER)

Marketing Order No. 955: Vidalia Onions Grown in Georgia

Information concerning nominees will be used by the Secretary of Agriculture in appointing public interest members and alternates to administrative committees of marketing agreements and orders.

1. Name ______________________________________ Telephone ___________________________

2. Mailing Address ________________________________________________________________________

3. State of residency __________________________________ Number of years _____________

4. Are you or any member of your immediate family directly associated with the Vidalia onion industry financially or otherwise? □ Yes □ No

5. If you have an indirect relationship with the Vidalia onion industry, please explain.

______________________________________________________________________________________

______________________________________________________________________________________

6. Please list all public interest and service type organizations of which you are or have been a member and positions held with each organization.

_________________________________________________________________________________

__________________________________________________________________________________

7. Marketing order committee members, in their official capacities, are prohibited from taking any action specifically designed to influence legislation, including any attempt to influence public opinion concerning legislation. Committee members may not communicate with any official of a State or Federal legislative body for the purpose of attempting to influence legislation.

Committee members are also prohibited from attempting to influence State or Federal government actions or policies or those of foreign governments, except as specifically authorized under the marketing order or expressly approved by the Secretary. Committee members are specifically precluded from authorizing the expenditure of marketing order funds for the purpose of attempting to influence legislation or government actions.

These same prohibitions apply to committee managers, staff, and contractors, except that committee manager may consult with the Department of Agriculture employees during the pendency of informal rulemaking actions.

I am willing to serve on the Vidalia Onion Committee.

______________________________________________ ____________________________________

Signature Date

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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.

SC-175 (Rev. 01/2017) Destroy previous editions.