BLU-GRF U.S. Highbush Blueberry Council Grower Report

OMB No. 0581-0093

U.S. HIGHBUSH BLUEBERRY COUNCIL
BLUEBERRY PROMOTION, RESEARCH, AND INFORMATION ORDER (7 CFR 1218)
GROWER REPORT FOR 20XX
If Payment is made: Mail Report and Payment to:

PART A: GROWER REPORT FOR 20XX SUBMITTED BY-

USHBC #1
C/O XXX Bank
Street
City, STATE Zip
If No Payment is due: Fax Report to
USHBC Office at xxx-xxx-xxxx

______________________________________________________________________

____________________

PLEASE READ THE INSTRUCTIONS ON THE REVERSE SIDE BEFORE COMPLETING REPORT

ASSESSMENTS ARE DUE NOVEMBER 30, 20XX

(Print Name of Individual Completing This Report)

(Tax Payer ID # or Employer ID#)

_________________________________________________________________________________________________*
(Print Name of Business/Company)

(Telephone No., Include Area Code)

(E-mail address)

__________________________________________________________ __________________ ______ ____________
(Address)

(City)

(State)

(Zip)

*PLEASE SELECT Y / N TO BE INCLUDED IN THE USHBC AMERILERT EMERGENCY EMAIL NOTIFICATION SYSTEM FOR URGENT MESSAGES, REMINDERS OR OTHER IMPORTANT NEWS (ENTER EMAIL
ADDRESS ABOVE)

PART B: GROWER ASSESSMENT CALCULATION TABLE
LINE 1: TOTAL POUNDS OF BLUEBERRIES PRODUCED DURING 20XX
POUNDS

INCLUDE ALL YOUR SALES TO PROCESSORS (HANDLERS), FRESH MARKET STAND SALES, U-PICK SALES, EXPORTS TO PROCESSORS OR HANDLERS
OUTSIDE OF THE UNITED STATES, DELIVERIES TO SHIPPERS, RETAILERS, ETC.
LINE 2: TOTAL POUNDS OF BLUEBERRIES DELIVERED TO FIRST HANDLERS (PROCESSORS) FOR WHICH ASSESSMENTS
HAVE BEEN COLLECTED BY THE HANDLER AND WILL BE SENT BY THE HANDLER TO THE USHBC
LINE 3: TOTAL POUNDS OF EXEMPTED ORGANIC BLUEBERRIES PRODUCED DURING 201XX
(PLEASE INDICATE USHBC ORGANIC EXEMPTION CERTIFICATION NUMBER:

)

LINE 4: TOTAL POUNDS OF BLUEBERRIES SOLD TO NON HANDLERS AND FOR WHICH I WILL NOW PAY AN ASSESSMENT
TO THE USHBC
CALCULATION: LINE 1 MINUS LINE 2 MINUS LINE 3 = LINE 4

(-)

POUNDS

(-)

POUNDS

(=)

POUNDS

LINE 5: TOTAL ASSESSMENT AMOUNT DUE TO USHBC (ASSESSMENT RATE OF $XX PER TON= $0.00X PER POUND)
(X .00X)

CALCULATION: TOTAL FROM LINE 4 X $0.00X = TOTAL ASSESSMENT DUE (LINE 5)

$

LINE 6: LATE PAYMENT FEE CALCULATION
PAYMENT MADE AFTER NOVEMBER 30 CHARGED ONE TIME LATE PAYMENT FEE OF 5% ON TOTAL ASSESSMENT DUE, PLUS MONTHLY INTEREST
CHARGE OF 1% PER MONTH ON THE TOTAL ASSESSMENT AND LATE PAYMENT CHARGE. ENTER YOUR TOTAL LATE PAYMENT FEE HERE:

LINE 7: TOTAL GROWER PAYMENT TO USHBC

(+) $
(=) $

CALCULATION: LINE 5 + LINE 6 = TOTAL PAYMENT DUE FROM GROWER (LINE 7)

PART C: REPORT OF GROWER DELIVERIES TO HANDLERS

GROWERS, LIST THE NAMES AND ADDRESSES FOR ALL HANDLERS (PROCESSORS) TO WHOM YOU SOLD BLUEBERRIES AND FOR WHICH AN USHBC ASSESSMENT HAS BEEN COLLECTED BY THE
HANDLER.(COPY FORM OR CONTINUE ON ANOTHER SHEET IF NECESSARY)
NAME OF HANDLER
ADDRESS
POUNDS
DELIVERED

TOTAL POUNDS OF BLUEBERRIES DELIVERED TO HANDLERS FOR WHICH ASSESSMENTS HAVE BEEN COLLECTED BY HANDLER
(Note: Total Pounds Listed Here Must Match Total Pounds Reported in Part B, LINE 2 Above)

TOTAL=

CERTIFICATION:
I certify that the above information is true and correct to the best of my knowledge and that for any blueberries I sold outside of Handlers, during the reporting period,
as noted in the line 4 above, the attached remittance represents $XX per ton. I also certify that I am authorized to sign this report.
_____________________________________________

__________________________________________________

NAME (PRINT)

SIGNATURE

______________________________________
TITLE

_________________________
DATE

ANY FALSE STATEMENT OR MISREPRESENTATION ON THIS FORM MAY RESULT IN A FINE OF NOT MORE THAN $10,000, OR IMPRISONMENT FOR NOT MORE THAN 5 YEARS, OR BOTH (18 U.S.C. 1001)

BLU-GRF (REV.03/17) DESTROY PREVIOUS EDITIONS.

INSTRUCTIONS
The Grower Report is to be received from all growers annually. All blueberry growers are required to complete Part A, Part B and Part C
of this report, and sign the certification statement at the bottom of each report. The U.S. Highbush Blueberry Council (USHBC) must
receive the original of the report, with signature, by no later than November 30 of each calendar year. Note: If no payment is required
from the grower, a signed and completed copy of this form can be faxed to the USHBC office at XXX-XXX-XXXX.
Also note that a grower assumes the responsibility of a grower/handler on any of their product that the grower sells on their own (Line 4
of this report). Assessment required from a grower on this product must also be received by November 30 of each calendar year. A
late payment charge will be imposed on any grower who fails to remit the total amount due by December 31. The staff of the U.S.
Highbush Blueberry Council holds all reports in strict confidence.
Assessment Exemption: Any grower producing less than 2,000 pounds of blueberries annually can apply to the USHBC for
exemption from assessment.
Organic Assessment Exemption: Any grower producing organic blueberries can apply annually to the USHBC for exemption from
assessment on their organic production.
Submission of Reports and Payments: Reports and payments are to be sent to the U.S. Highbush Blueberry Council at the following
address:

USHBC #1, c/o XXX Bank, Street, City, State Zip
Handler Definition: The definition of First Handler is stated in Section 1218.7 of the Blueberry Promotion, Research and Information
Order (Part 1218) as follows:
“First Handler means any person, excluding a common or contract carrier, receiving blueberries from producers and who as
owner, agent or otherwise ships or causes blueberries to be shipped as specified in the Order. This definition includes those
engaged in the business of buying, selling and or/offering for sale; receiving; packing; grading; marketing; or distributing
blueberries in commercial quantities. This definition includes a retailer, except a retailer who purchases or acquires from, or
handles on behalf of any producer, blueberries. The term first handler includes a producer who handles or markets
blueberries of the producer’s own production.”

Responsibility for Assessment Collection: As stated in Section 1218.52 of the Blueberry Promotion, Research, and
Information Order (Part 1218), “The collection of assessments on domestic blueberries will be the responsibility of the first
handler receiving the blueberries. In the case of the producer acting as its own first handler, the producer will be required to
collect and remit its individual assessments.”
Late Payment Fees
As noted in Section 1218.52, Item E of the Order, “All final payments for a crop year are to be received no later than November 30 of
that year. A late payment charge shall be imposed on any handler who fails to remit to the USHBC the total amount for which any such
handler is liable on or before the due date established by the USHBC. In addition to the late payment charge, an interest charge shall
be imposed on the outstanding amount for which the handler is liable”.
The USHBC will levy a one-time late payment charge of 5% on the outstanding amount due and an interest charge of 1% per month on
the total outstanding balance plus the late payment charge.
Contact the USHBC office at (XXX) XXX-XXXX (phone) or (XXX) XXX-XXXX (fax) with any questions concerning this report,
grower exemptions or USHBC assessment requirements.
Mailing Address: USHBC, Street, City, State Zip

BLU-GRF (REV. 03/17) DESTROY PREVIOUS EDITIONS

NOTE: The following statements are made in accordance with the Privacy Act of 1974 (U.S.C. 522a) and the
Paperwork Reduction Act of 1995, as amended. The authority for requesting this information to be supplied on
this form is the Commodity Promotion, Research, and Information Act of 1996, Pub. L. 104-127, 110 Stat. 1032
(7 U.S.C. 7411-7425). Furnishing the requested information is necessary for the administration of this program.
Submission of Tax Identification Number (TIN) or Employer Identification Number (EIN) is mandatory, and
will be used to determine affiliation or entity identification.

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 0581-0093. 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, 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.

BLU-GRF (REV. 03/17) DESTROY PREVIOUS EDITIONS.