DA-20 Dairy--Monthly Report & Remittance of Amount Due for all

Information is required by 7 CFR 1150.171. Failure to report can result in a fine. Information is held confidential (7 CFR 1150.173).

NATIONAL DAIRY PROMOTION AND RESEARCH BOARD
MONTHLY REPORT AND REMITTANCE OF AMOUNT DUE
FOR ALL MILK MARKETED COMMERCIALLY
BY PRODUCERS
(Under Dairy and Tobacco Adjustment Act of 1983)

Approved OMB No. 0581-0093

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, and completing and reviewing the
collection of information.

Failure to report or remit amount due may result in a civil penalty of not more than the maximum amount specified in Sec. 3.91(b)(1)(xx) of this title for each violation.

RETAIN THIS COPY FOR YOUR RECORDS
ID Number
Name
Address
Report of amount due on milk marketed by producers during
Month

Year

1. Milk from producers .........................................................................................................

lbs.

2. Milk From own production (Exclude raw milk sold to other plants) ..................................

lbs.

3. Total of lines 1 and 2 ........................................................................................................

lbs.

4. Gross amount due for marketings during the month (line 3 x $.0015)
(The rate of $.0015 per pound is equal to 15 cents per hundredweight.) ........................$
5. Deduct contributions – up to $.0010 x pounds from line 3 – made to
qualified State or regional dairy product promotion programs.
If you enter an amount, complete Part A on the reverse side
of the blue copy of this report. ......................................................................................$
6. Deduct Organic Milk Exemption (Per § 1150.157(a))
If you enter an amount, complete Part B on the reverse side
of the blue copy of this report. ......................................................................................$
7. Net amount due for marketings during the month (line 4 minus line 5 and line 6)...........$
8. Add or subtract adjustments for prior months (Explain) ...................................................$
9. Amount remitted with this report (line 7 plus or minus line 8) ..........................................$
The report and a check payable to the National Dairy Promotion and Research
Board or NDPRB in the amount shown on line 9 must be mailed by the last
day of the month after the month in which the milk was marketed to:

National Dairy Promotion and Research Board
35092 Eagle Way
Chicago, IL 60678-1350

I declare under the penalties provided by law, that this report has been examined by me and to the best of my knowledge and belief is a true and
complete report. I also certify that I am authorized to sign this report.
DATE

RESPONDING OFFICIAL’S NAME (Print)

TITLE (Print)

SIGNATURE

Form DA-20 (Rev. 02/17) Destroy all previous editions.

Note: For inquiries regarding your assessment account, please telephone (847) 803-9794.

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.

Part A - Qualified Promotion Program Deduction
1

In the space below, record the name of each qualified State or regional dairy product promotion program to which you made contributions
and the amount paid to each such organization for the month that this report represents. DO NOT LIST AMOUNTS PAID TO THE
NDPRB.
Program
Name Of Qualified
Amount
Code
Promotion Program
Contributed
(For NDPRB
Use Only)
$
$
$
$
$
$
$

Total

$

Part B - Exempt Organic Milk Deduction
2

In the space below, record the name of the producer, the payroll number, the pounds of exempt organic milk, the rate of the
exemption (minimum rate is $0.0005 per pound) and the value of the exemption.

Name of Producer

Payroll Number

Pounds of
Exempt Milk

Exemption
Rate
(Per cwt.)

Value

$
$
$
$
$
$
$
$

Total

Form DA-20 (Rev. 02/17)

(Reverse)

______________

$____________

For
NDPRB
Use Only

1
2

You may attach a separate listing or computer printout showing Part A information if you prefer.
You may attach a separate listing or computer printout showing Part B information if you prefer.