MA-201 Notification of Producer Change(s)

Submitting Handler ___________________________________________________

Please Check Type of Change:

Instructions: On or before the ____ day after the end of the month, each handler shall
report to the Market Administrator all producer changes in farm operators.

Going Out of Business
Dairy Farmer for Other Market Re-association

Check if
Organic
Name:

Mailing Address
(if mailing address is different from farm address please provide both)
Address:

Name:

Address:

Name:

Address:

Name:

Address:

Name:

Address:

Name:

Address:

Producer

MA 201
Form Approved, OMB No. 0581-0032
This report is required by the Order in accordance with 7 U.S.C. 608c 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)).

Notification of Producer Change(s)

New Producer
Address or Name Change

Patron
Number

Return to: XXX Federal Milk Order XXX
Address: XXX
XXX
Tel: XXX — Fax: XXX
Email: XXX

Delivery
Start Date
Stop Date

Name of Handler/Cooperative Involved in
Change or Division Number

Stock Certificate or
Contract No.

MA Office Use

Person Authorized to Sign for Handler

Title

Date

Initials ___________ 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 0581-0032. 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.
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, DC 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.