SC-217 915-Avocados Application for Registered Processor

REPRODUCE LOCALLY. Include form number and date on all reproductions. OMB No. 0581-0189

U.S. DEPARTMENT OF AGRICULTURE AGRICULTURAL MARKETING SERVICE SPECIALTY CROPS PROGRAM	APPLICATION FOR REGISTRATION AS AVOCADO PROCESSOR				Avocado Administrative Committee P.O. Box 900188 Homestead, FL 33090-0188 Tel: (305) 247-0848
Any person who desires to buy, as an approved manufacturer of avocado products, avocados for commercial processing, shall, prior thereto, submit to the Avocado Administrative Committee an application containing the following information (7 CFR § 915.141):
NAME OF APPLICANT
MAILING ADDRESS (City, County, State, and Zip Code)			EMAIL ADDRESS
REGISTERED AVOCADO HANDLER’S NUMBER		LOCATION OF PROCESSING FACILITIES
TYPE OF PRODUCT OR PRODUCTS TO BE MADE OR DERIVED FROM AVOCADOS
DESCRIPTION OF FACILITIES FOR PROCESSING AVOCADOS
STATE QUANTITY OF AVOCADOS PROCESSED DURING THE PREVIOUS YEAR		ESTIMATED QUANTITY OF AVOCADOS TO BE PROCESSED DURING THE CURRENT YEAR
FROM WHAT SOURCE DO YOU EXPECT TO RECEIVE AVOCADOS FOR PROCESSING?
HOW WILL THE AVOCADOS BE TRANSPORTED
WHERE WILL THE UNLOAD POINT BE?
CERTIFICATION STATEMENT: I hereby state that all the avocados obtained for processing into products will be used for that purpose only and will not be resold or disposed of in fresh fruit channels, and I agree to report such reports as are required by the Avocado Administrative Committee.
NAME OF FIRM
SIGNATURE AND TITLE				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 0581-0189. The time required to complete this information collection is estimated to average 5 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.

SC-217 (Rev. 9/2016. Destroy previous editions.)