LPS-84 Nomination for Appointment to the Lamb Board

FORM APPROVED - OMB NO. 0581-0093

REPRODUCE LOCALLY. Include form number and edition date on all reproductions.
UNITED STATES DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE

Please mark an "X" in appropriate block:

Producer
Seedstock Producer

NOMINATION FOR APPOINTMENT TO THE LAMB
PROMOTION, RESEARCH, AND INFORMATION
BOARD (BOARD)

Feeder
First Handler

NOTE: 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.

NOTE: Information is collected to obtain names of nominees for appointment as members of the Board. Response is
voluntary. Pursuant to the Lamb Promotion, Research, and Information Order, the following names are submitted as
nominees.
NAME(S) OF NOMINEE(S)
(List name(s) for each allotted position on the Board)

IF MORE SPACE IS NEEDED, USE ADDITIONAL FORMS. A COMPLETED ADVISORY COMMITTEE BACKGROUND INFORMATION FORM SIGNED BY
EACH NOMINEE MUST BE ATTACHED.
WHEN NOMINATIONS ARE THE RESULT OF A CAUCUS, LIST THE CERTIFICATION NUMBERS OF ORGANIZATIONS OR
ASSOCIATIONS PARTICIPATING IN THE CAUCUS.
A.

E.

I.

B.

F.

J.

C.

G.

K.

D.

H.

L.

IDENTIFICATION OF PERSON AND ORGANIZATION/ASSOCIATION SUBMITTING THESE NOMINATIONS
CERTIFICATION
NUMBER

NAME AND ADDRESS

NAME AND TITLE (Type or print)

SIGNATURE

DATE

RETURN ORIGINAL OF THIS FORM AND THE ADVISORY COMMITTEE BACKGROUND INFORMATION FORM TO:

Research and Promotion Division
Livestock, Poultry, and Seed Program, AMS
U.S. Department of Agriculture
Street
City, State Zip
LPS-84 (Rev. 04/17) (Destroy previous editions.)

FAX – (202) 720-1125

See reverse for burden/non-discrimination statement

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
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any program or activity conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by
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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
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To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at
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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.,
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