MAN-FHR Mango- First Handler's Report

Mail to: National Mango Board
Street
City, State Zip

OMB No. 0581-0093

MANGO PROMOTION, RESEARCH, AND INFORMATION ORDER
(7 CFR 1206)
FIRST HANDLER'S REPORT
PLEASE READ THE INSTRUCTIONS ON THE REVERSE SIDE BEFORE COMPLETING
________________________________________________________________
(Name)

___________________________________________________________
(Telephone No.-include area code, FAX No., E-mail address)

_______________________________________________________________
(Name of Business/Company)

___________________________________________________________
(Tax ID # or Employer ID#)

_________________________________________________________________________________________________________________________________________
(Address)
(City)
(County)
(State)
(Zip)
REPORT OF MANGOS HANDLED DURING

(MONTH)

20XX.

LIST BELOW THE NAME AND ADDRESS OF PRODUCERS FOR WHOM YOU HANDLED MANGOS.

NAME AND ADDRESS

PRODUCER FARM ID
OR TAX ID NO.

DATE OF
TRANSACTION

TOTAL
POUNDS

TOTAL DUE

ASSESSMENT
PAID

DATE OF
ASSESSMENT
PAID

____________________________________

I certify that the above information is true and correct to the best of my knowledge and the attached remittance represents X.X cents per pounds for all mangos handled during this
reporting period on which I was required to pay the assessment. I also certify that I am authorized to sign this report.

NAME (PRINT) ______________________________________ SIGNATURE _________________________________________
TITLE _____________________________________________________________ DATE ______________________________
The making of any false statement or representation on this form, knowing it to be false, is a violation of Title 18, Section 1001 United States Code, which
provides for the penalty of a fine of $10,000 or imprisonment of not more than five years, or both.

READ INSTRUCTIONS ON OTHER SIDE
MAN-FHR (Rev. 03/17) Destroy previous editions.

INSTRUCTIONS
First handlers are required to file this report monthly. The original of the report must be mailed
to the National Mango Board, with full remittance, within 30 days after the end of the month in
which the sale or non-sale transfer subject to assessments under part 1206. All reports are held in
strict confidence by the National Mango Board.
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. 104127, 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 importer identification
number 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, 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.

MAN-FHR (Rev. 03/17) Destroy previous editions.