RAS-ACO Raspberry--Application for Certification of Org.

OMB No. 0581-0093

APPLICATION FOR CERTIFICATION OF ORGANIZATION
PROCESSED RASPBERRY PROMOTION, RESEARCH,
AND INFORMATION ORDER
(7 CFR PART 1208)
The following statements are made in accordance with the Privacy Act of 1974 (U.S.C. 522a) and the Paperwork Reduction Act of 1995,
as amended. The authority for requesting this information to be supplied on this form is from the applicable commodity legislation for
research and promotion programs. Furnishing the requested information is necessary for the administration of this program.
Submission of Tax Identification Number (TIN) or importer identification number is mandatory and will be used to determine affiliation
or entity identity.

1. Please mark an “X” in the appropriate block for which organization or association you are applying for
certification: (Mark only one box. If you are applying for more than one group below, a separate form must be
filled out for each group.)
[ ] Foreign Producers

[ ] Importers

[ ] Domestic Producers

2. Name of Organization: __________________________________________ Tax ID# __________________

Address: ________________________________________________________________________________
City: _________________________ State: ________________ Zip: __________________
Phone No. ____________________ Fax No. ____________________ E-Mail: ______________________
3. Total Members in most recent calendar year: _________________
4. What percent of your members are considered foreign producers __________; importers ___________;
domestic producers ________?
5. What is the Volume of raspberries for processing that the Association represents (pounds)? _____________
6. If foreign producer organization: Does your organization represent a substantial number of foreign producers
who produce or market a substantial volume of processed raspberries? If yes, describe.

7. If importer organization: What percent of the total volume of processed raspberries imported in the U.S. do
your members represent? (pounds and percent of total) ________ pounds

________ percent of total imports

8. If State producer organization: Does your State produce a minimum of three million pounds of raspberries
for processing? If yes, how much ___________?
9. How long has your organization been in existence? _________
10. List of Source(s) from which your organization operating funds are derived: ________________________
________________________________________________________________________________________
11. Describe purpose/function of the organization: _______________________________________________
________________________________________________________________________________________

RAS-ACO (Rev. 03/17) Destroy previous edition.

CERTIFICATION AND SIGNATURE
I hereby certify that: (1) an interest of this organization is in the production or marketing of processed raspberries and (2) the information
provided in response to the above items is true, complete, and correct to the best of my knowledge. The organization also agrees to take
reasonable steps to publicize to non-members the availability of open Council positions and will consider nominating a non-member if he or she
expresses an interest in serving on the Council. The Secretary of Agriculture may examine our books, documents, papers, records, files, and
facilities to verify any of the information submitted and may procure such other information as may be required to determine this
organization’s eligibility for certification.

____________________________________________________________________
Print Name and Title of Person Completing this Application
___________________________________________________________________________________________________

Signature

Date
********************************************************

IMPORTANT NOTES
NOTE: Information is collected in order to determine eligibility of organizations to nominate foreign
producers, and importers to serve as members of the National Processed Raspberry Council. Application is
voluntary and information is held confidential.
Organizations must apply for certification by the Secretary to be eligible to participate in the making of
nomination of foreign producers and importers to serve as members and alternates of the Council as
provided in the Processed Raspberry Promotion, Research, and Information Order. Information
submitted in response to all items must be complete. Please type or print clearly. Send original only to:
Branch
Street, City, State, Zip Code

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.

RAS-ACO (Rev. 03/17) Destroy previous edition