RAS-AAE Raspberry--Application for Exemption from Assessment

Form Approved OMB 0581-0093
NATIONAL PROCESSED RASPBERRY COUNCIL
APPLICATION FOR EXEMPTION FROM ASSESSMENT
As stated in Section 1208.53 of the Processed Raspberry Promotion, Research
and Information Order (Exemption Procedures):
“Any producer who produces less than 20,000 pounds of raspberries for processing annually who desires to claim
an exemption from assessments during a fiscal year as provided in Section 1208.52 shall apply to the National
Processed Raspberry Council (Council), on a form provided by the Council, for a certificate of exemption. Such
producer shall certify that the producer’s production of raspberries for processing shall be less than 20,000
pounds for the fiscal year for which the exemption is claimed. Any importer who imports less than 20,000
pounds of processed raspberries annually who desires to claim an exemption from assessments during a fiscal
year as provided in Section 1208.52 shall apply to the Council, on a form provided by the Council, for a
certificate of exemption. Such importer shall certify that the importer’s importation of processed raspberries
shall not exceed 20,000 pounds, for the fiscal year for which the exemption is claimed.”

CERTIFICATION
(To Be Signed and Dated by Applicant)

I hereby certify that I produced or imported less than 20,000 pounds of raspberries for
processing in 20XX. I therefore request a certificate of exemption from the National
Processed Raspberry Council (Council) for the year 20XX.
Signature ____________________________________ Date: ________________
Please Print
Name of Applicant:

_________________________________________________

Company Name (if applicable): _________________________________________
Street Address: ______________________________________________________
City: ________________________________ State: ________________________
Zip Code: ____________________ Telephone No. _________________________
Tax ID# or Business ID#: _________________________________
Please send your completed Certificate of Exemption Application with supporting
documentation to the National Processed Raspberry Council at the following address:
National Processed Raspberry Council
Address
City, State zip
RAS-AAE (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 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.
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 15 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-AAE (Rev. 03/17) Destroy previous editions.