RAS-FHR Raspberry--First Handler/Importer Report

OMB No. 0581-0093

FIRST HANDLER’S/IMPORTER’S REPORT FOR PROCESSED RASPBERRY
PROMOTION, RESEARCH, AND INFORMATION ORDER
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 from the applicable
commodity legislation for research and promotion programs. 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 identity.

Name: ____________________________________________________________
Company Name: ______________________________________ Tax ID# or Business ID#: ____________
Address: _______________________________________________________________________________
City: ___________________ State: ____________
E-Mail: _________________________
Phone No.: ______________________

Zip Code: _____________

Web site: ______________________________
Fax No.:__________________

PERIOD COVERED BY THIS REPORT:
FOR ADDITIONAL SPACE, YOU MAY ATTACH YOUR OWN SEPARATE SHEETS.
For questions about completing this report call (xxx) xxx-xxxx

This section represents all assessable processed raspberries.
1.) LIST POUNDS OF PROCESSED RASPBERRIES OF YOUR OWN PRODUCTION:

____________________

2.) LIST POUNDS OF PROCESSED RASPBERRIES PURCHASED FROM PRODUCERS:

List the name and address and other pertinent information of each producer along with the corresponding pounds purchased
from each producer.

__________________________________________________________________

__________________

__________________________________________________________________

_________________

3.) LIST POUNDS OF PROCESSED RASPBERRIES IMPORTED:

List the total of each Harmonized Tariff Code along with the corresponding pounds imported.

__________________________________________________________________

_________________

__________________________________________________________________

_________________

__________________________________________________________________

_________________

TOTAL ALL POUNDS FROM ABOVE.

_______________________

4.) DEDUCT THE NUMBER OF POUNDS OF CERTIFIED ORGANIC PROCESSED RASPBERRIES*: ____________________
TOTAL POUNDS ON WHICH ASSESSMENT IS DUE:
Assessment rate $0.xx per pound.
ASSESSMENTS DUE:
5.) DEDUCT ASSESSMENT CREDITS:

TOTAL ASSESSMENTS DUE

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

_______________________
x 0.xx

___________________________
_____________________________

__________________________

OMB No. 0581-0093

CERTIFICATION AND SIGNATURE
I certify that the information is true and correct to the best of my knowledge and the attached payment
represents $0.xx per pound on all processed raspberries handled/imported during this reporting period for
which I am required to pay the assessments as the first handler/importer. I also certify that I am authorized to
sign this report.
________________________________________________________________________
Print Name and Title of Person Completing this Report
Signature

Date

Please Mail To: National Processed Raspberry Council
Address
City, State zip

This report is required by law [7 U.S.C. 7416, 7 CFR Part 1212.52 and 7 CFR Part 1212.70]. Failure to report can result in a fine of not less than $1,000 or more than
$10,000 for each such violation. Each such violation shall be deemed a separate violation. 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.
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.

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