F/H Form 1(f) (982) Hazelnuts Receipt & Disposition Produced Outside U

Vegetable and Specialty Crops

FH Form 1(f) Receipt and Disp of Hazelnuts Produced Outside US (01-17)

Vegetable and Specialty Crops Mandatory

OMB: 0581-0178

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OMB No. 0581-0178

HAZELNUT MARKETING BOARD

21595-A Dolores Way NE

Aurora, OR 97002-9738

Tel: (503) 678-6823

Fax: (503) 678-6825


RECEIPT AND DISPOSITION OF HAZELNUTS PRODUCED OUTSIDE THE USA


Handler ____________________________________ Period _____________________________________


Receipt of Product

Date Of Receipt

Inspection Certificate No.

Country of Origin

Pounds Inshell

Pounds Kernels

Total Pounds























































Total Current Period





Last Period Year-to-Date





Total Year-to-Date






Disposition of Product

Date Of Receipt

Inspection Certificate No.

Country

Pounds Inshell

Pounds Kernels

Total Pounds























































Total Current Period





Last Period Year-to-Date





Total Year-to-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 0581-0178. The time required to complete this information collection is estimated to average 15 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.

F/H Form 1(f) (Rev. 01/2017) Destroy previous editions.

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleF/H Form 1e
Authorpolly
File Modified0000-00-00
File Created2021-01-20

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