HR-EZ Report of Receipts & Utilization, (schedules 1,2, & 3)

UNITED STATES DEPARTMENT OF AGRICULTURE
Address: XXX
XXX
Phone: XXX
Fax: XXX
E-mail: XXX

AGRICULTURAL MARKETING SERVICE
DAIRY PROGRAMS
XXX FEDERAL MILK ORDER XXX

HR - EZ
Report of Receipts and Utilization
(includes schedules 1, 2, and 3)

Note: This cover page is for information purposes only and does not need to be submitted to the market administrator's office.

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 0581-0032. The time required to complete this information collection is estimated to average 1 hour 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.
The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national
origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic
information, political beliefs, reprisal, or because all or part of an individual's income is derived from any public assistance program. (Not
all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program
information (Braille, large print, audiotape, etc.) should contact USDA's TARGET Center at (202) 720-2600 (voice and TDD). To file a
complaint of discrimination, write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 202509410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.

UNITED STATES DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
DAIRY PROGRAM

Form HR-EZ, Page 1
Address: XXX
XXX
Phone: XXX
Fax: XXX
E-mail: XXX

Form Approved, OMB No. 0581-0032

XXX FEDERAL MILK ORDER XXX
REPORT OF RECEIPTS AND UTILIZATION

Line

Handler Name
Plant Location
Month/Year

For M. A. Use Only
Month-Year
Order

This report is required by the order in accordance with 7 U.S.C. 608 c and d. Failure to report can result in the assessment of a civil penalty
of up to $1,000 per day (7 U.S.C. 608c (14)(B)) or, upon conviction, in a fine of up to $5,000 per day (7 U.S.C. 608c (14) (A)).
Product
Butterfat
BEGINNING INVENTORIES
Pounds
Pounds
1 Class I (Packaged)
2 Class IV (Bulk)

RECEIPTS
3 Own Farm Production
4 Other Dairy Farms

For M.A. Use Only

Product
Pounds

Butterfat
Pounds

For M.A. Use Only
Form
Prod. Class

Product
Pounds

Butterfat
Pounds

(No. of Farms)
(No. of Farms)

OTHER RECEIPTS

Type
1/

Identify Name, City, State

Form
2/

Product
3/

Class
Type

5
6
7
8
9
10
11 Nonfluid milk products: Class II (from Sch. 1, Line 15)

Lbs.

x 10.54

12 Nonfluid milk products: Class I, III, & Loss (from Sch. 1, Line 16)
Lbs.
x 10.54
13
TOTAL RECEIPTS AND BEGINNING INVENTORIES

UTILIZATIONS
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33

Type

Form

Product

Class

For M.A. Use Only

Total Class I Route Disposition (In & Out of Marketing Area)
Closing Inventory -- Class I Packaged
Closing Inventory -- Bulk (Class IV)
Movements to Other Plants (Identify)

Used to Produce (Identify Product)

NFMS Used to Fortify FMP

Lbs.
x 9.89
TOTAL UTILIZATIONS AND ENDING INVENTORIES

34
1/ (T)ransfer; (D)iversion.

2/ (B)ulk weights; (F)arm weights; (P)ackaged.

SHRINKAGE (OVERAGE)
3/ (W)hole; (S)kim; (Cr)eam; (Co)ndensed; (V) Various Packaged.

Date

Person Authorized to Sign for Handler

Handler:

Location:

Month & Year:

Form HR-EZ, Schedule 1

XXX FEDERAL MILK ORDER XXX
Line

TOTAL ROUTE DISPOSITION

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

PRODUCT (Specify) 1/

PRODUCT
POUNDS

AVG.
TEST

BUTTERFAT
POUNDS

GALLONS

HALF
GALLONS

QUARTS

PINTS

10 OZ

Homo - Whole
Flavored Milk
2% Reduced Fat
1% Lowfat - Plain
Skim Nonfat - Plain
Flavored Drink
Buttermilk
TOTAL ROUTES
1/ Identify products of different butterfat tests on separate lines.

Total to Page 1, Line 14

RECONCILIATION OF NONFLUID MILK PRODUCTS
Other (Specify):
Butter
Pounds
1
2
3
4
5
6
7

AVAILABILITY:
Beginning Inventory
Purchases
Manufacture
Sales (minus)
Dumpage (minus)
Ending Inventory (minus)
Pounds Available for Use

8
9
10
11
12
13

ACCOUNTABILITY: (USE)
Used to Fortify Class I
Used in Class II
Used in Class III
Total Pounds Used
Loss (Line 7 Minus 12)

14
15
16

TOTAL NONFLUID RECEIPTS:
Nonfluid: Class II
Nonfluid: Class I & III, (plus Loss)

Pounds

Butterfat

Nonfat Dry Milk
Pounds

Butterfat
x .008

HALF
PINTS

OTHER
Specify: ____

Handler:

Location:

Month & Year:

Form HR-EZ, Schedule 2

XXX FEDERAL MILK ORDER XXX

Line

OUT-OF-AREA ROUTE DISPOSITION

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

PRODUCT (Specify) 1/

IDENTIFY AREA 2/:
PRODUCT
POUNDS

AVG.
TEST

PRODUCT
POUNDS

AVG.
TEST

Line

GALLONS

HALF
GALLONS

QUARTS

PINTS

10 OZ

HALF
PINTS

OTHER
Specify: ____

HALF
GALLONS

QUARTS

PINTS

10 OZ

HALF
PINTS

OTHER
Specify: ____

Homo - Whole
Flavored Milk
2% Reduced Fat - Plain
1% Lowfat - Plain
Skim Nonfat - Plain
Flavored Drink
Buttermilk
TOTAL

OUT-OF-AREA ROUTE DISPOSITION

16
17
18
19
20
21
22
23
24
25
26
27
28
29
30

BUTTERFAT
POUNDS

PRODUCT (Specify) 1/

IDENTIFY AREA 2/:
BUTTERFAT
POUNDS

Homo - Whole
Flavored Milk
2% Reduced Fat - Plain
1% Lowfat - Plain
Skim Nonfat - Plain
Flavored Drink
Buttermilk
TOTAL
1/ Identify products of different butterfat tests on separate lines.
2/ Identify Federal order number, city & state.

GALLONS

Handler:

Location:

Month&Year

Form HR-EZ, Schedule 3

XXX FEDERAL MILK ORDER XXX
CLOSING INVENTORIES

Line

CLASS I
PRODUCT (Specify) 1/

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

Homo - Whole

16
17
18
19
20
21

Raw Milk
Skim
Buttermilk
Bulk Cream
Concentrated FMP
TOTAL, BULK

PRODUCT
POUNDS

AVG.
TEST

BUTTERFAT
POUNDS

GALLONS

HALF
GALLONS

Flavored Milk
2% Reduced Fat - Plain
1% Lowfat - Plain
Skim Nonfat - Plain
Flavored Drink
Buttermilk
TOTAL
1/ Identify products of different butterfat tests on separate lines.

-

Total to Page 1, Line 15

CLASS IV

-

-

Total to Page 1, Line 16

QUARTS

PINTS

10 OZ

HALF
PINTS

OTHER
Specify: ___