APC Form 5 Inshell Pecans Exported to Mexico for Shelling & Returne

REPRODUCE LOCALLY. Include form number and date on all reproductions.

OMB 0581-NEW

INSHELL PECANS EXPORTED TO MEXICO FOR SHELLING
AND RETURNED TO THE UNITED STATES AS SHELLED MEATS
APC Form 5 - Instructions

This report is submitted pursuant to 7 CFR 986.178 and is subject to audit
verification by the American Pecan Council (7 CFR 986.79)
The completed form must be delivered to the American Pecan Council no later than the tenth day of the month.
Please note:
You need only insert data in the blank WHITE cells. The APC staff will complete any information in the 'SHADED' cells. If
completing the form electronically, once the information is entered, the column totals will be calculated automatically. If completing the
form by hand, the amounts you provide will be added to the data submitted in the previous periord and totaled by the APC staff.
The following are instructions for completing APC Form 5 - Inshell Pecans Exported to Mexico for Shelling and Returned to the United
States as Shelled Meats
Month: Enter the Month being reported upon.
Handler Number: Enter the Handler Number
Current Period - Inshell Sent to Mexico for Shelling:
1. Enter the date the Inshell was shipped to Mexico
2. Enter the amount of inshell, in pounds, shipped to Mexico for processing
3. Enter the date that the Shelled Meats were returned to the United States
4. Enter the amount of Shelled Meats, in pounds, that were returned to the United States
UPON COMPLETION: Read the Certification statement at the bottom of the form and write in/type the Handler/Company name. Then
sign and date the form in the spaces provided and fax or email to __________: Fax - (___) ___________; Email - ______@___________.

§986.81   Confidential information.
All reports and records submitted by handlers to the Council staff, which include data or information constituting a trade secret or disclosing the
trade position, or financial condition or business operations of the handler, shall be kept in the custody of one or more employees of the
Council and shall be disclosed to no person except the Secretary of Agriculture.
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 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.

APC Form 5 (11/2017)

American Pecan Council
REPRODUCE LOCALLY. Include form number and date on all reproductions.

OMB No. 0581-NEW

Month:__________________

Handler Number: _________

INSHELL PECANS exported to MEXICO for SHELLING
and returned to the UNITED STATES as SHELLED MEATS
This report is submitted pursuant to 7 CFR 986.178 and is subject to audit
verification by the American Pecan Council (7 CFR 986.79)

INSHELL exported to Mexico for Shelling
Date INSHELL exported to
Mexico

Current Period (lbs)

Prior Period YTD (lbs)
+

=

+

=

+

=

Total Year to Date (lbs)
0
0
0

SHELLED MEATS, produced from U.S. INSHELL, being returned to the U.S.
Date SHELLED MEATS imported
from Mexico

Current Period

Prior Period YTD

Total Year to Date

+

=

+

=

+

=

0
0
0

(Name of Handler/Company)

(Handler Address)

(Signature)

Date: ____________
The making of any false statements or representations in any matter within the jurisdiction of any agency of the United States,
knowing it to be false, is a violation of title 18, section 1001, of the United States Code, which provides for a penalty of a fine for
individuals and for organizations or imprsonment, or both.

Upon completion, fax or email form to ____________: Fax - (___) ___-____; Email -____________@_________
APC Form 5 (11/2017)