CMC-CONF Third-Party Confirmation of Receipt of Withheld Fruit

OMB No. 0581-0304

Filing Date: __________________

Cranberry Marketing Committee
219A Main Street
Wareham, MA 02571
Phone: (508) 291-1510; Fax: (508) 291-1511
Website: www.usacranberries.com

THIRD-PARTY CONFIRMATION OF RECEIPT OF WITHHELD FRUIT

In accordance with the Cranberry Marketing Order (§929.57 Outlets for withheld cranberries), handlers of cranberries must notify the Cranberry Marketing Committee of any cranberries that are withheld from handling by completing a separate form titled “Handler Application for Outlets for Excess Fruit,” and receive committee approval for such diversion. Where such fruit is received by a third party (such as approved charities, foreign customers of whole fruit in undeveloped markets, or institution conducting cranberry research), handlers must submit this form – and have the recipient third party complete the “Transfer Confirmation” section.

Handler Name: __________________________________________ Handler Contact No.: _____________________________

Business Address: ______________________________________________________________________________________

Contact Name: _________________________________________ Telephone No.: __________________________________

Email Address: ________________________________________ Project Name: ____________________________________

Project Type: Charitable Institution Research & Development Noncompetitive Outlets

Nonhuman Food Use Other

Product Form: Fresh Fruit Processed Fruit Concentrate/Juice

How many equivalent barrels of withheld fruit will be utilized: __________ Documents provided to support this delivery

TRANSFER CONFIRMATION

Transferred to: ____________________________________________________________________________________

Address: _________________________________________________________________________________________

Quantity Transferred: ______________ Product Form: Fresh Fruit Processed Fruit Concentrate/Juice

Name: _____________________________________ Title: ____________________________________________

Signature: __________________________________ Date: ____________________________________________

HANDLER CERTIFICATION

I, _____________________hereby certify to the CMC and the Secretary of Agriculture that this is a true and correct record of information regarding the undersigned Handler for the current crop year, and that the undersigned handler has a good faith intent to withhold cranberries in accord with the Marketing Order as described herein. I further certify that I have the authority to make such representation on behalf of the undersigned handler.

Name: _________________________________________ Title: ____________________________________________

Signature: ______________________________________ Date: ____________________________________________

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 0581-0304. The time required to complete this information collection is estimated to average 3 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.

CMC-CONF (03/2018)