PH-1 Information Report for Designation as Producer-Handler

UNITED STATES DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
DAIRY PROGRAMS

1930 – 220th St. SE, Ste. 102
Bothell, WA 98021

N

Phone: (425) 487-6009
Fax: (425) 487-2775

FEDERAL MILK ORDERS 124 & 131

E-Mail: [email protected]

N

4835 E Cactus Rd., Ste. 365
Scottsdale, AZ 85254
Phone: (602) 547-2909
Fax: (602) 547-2906
E-Mail: [email protected]

PH – 1
Information Report for Designation as Producer-Handler

Note: This cover page is for information purposes only and does not need to be submitted to the market administrator’s office.

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 0581-0032. The time required to complete this information collection is estimated to average 1 hour 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.
The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color,
national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation,
genetic information, political beliefs, reprisal, or because all or part of an individual's income is derived from any public assistance
program. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication
of program information (Braille, large print, audiotape, etc.) should contact USDA's TARGET Center at (202) 720-2600 (voice and
TDD). To file a complaint of discrimination, write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W.,
Washington, D.C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and
employer.

UNITED STATES DEPARTMENT OF AGRICULTURE
Form PH-1
1930 – 220th St. SE, Ste. 102

AGRICULTURAL MARKETING SERVICE
DAIRY PROGRAMS

Form Approved, OMB No. 0581-0032
4835 E Cactus Rd., Ste. 365

N

Bothell, WA 98021
Phone: (425) 487-6009

FEDERAL MILK ORDERS 124 & 131

N
N

Fax: (425) 487-2775
E-Mail: [email protected]

Scottsdale, AZ 85254
Phone: (602) 547-2909
Fax: (602) 547-2906
E-Mail: [email protected]

INFORMATION REPORT FOR DESIGNATION AS PRODUCER-HANDLER
IMPORTANT: Producer-handler means a person who operates a dairy farm and a distributing plant from which there is
route disposition within the marketing area during the month not to exceed 3 million pounds and who the market
administrator has designated a producer-handler after determining that all of the requirements of §1124.10 and/or
§1131.10 have been met. In addition, cancellation of producer-handler status can occur if a producer-handler markets
milk in any part as Class I milk to a non-pool distributing plant of any other handler. Farms associated with the producerhandler cannot be subject to inclusion and participation in a State-operated milk classification and pricing program that has
market wide pooling.
PRIVACY ACT STATEMENT. Producer-Handlers must meet the requirements of 7 CFR §1124.10 and/or §1131.10, in
order to qualify for the producer-handler exemption. Federal regulations, as set forth in 7 CFR §1000.25, state that the
Market Administrator is responsible for the administration of the marketing order. This authority includes the responsibility
to verify that entities claiming the exemption are in fact eligible for that status. The collection of this information is
authorized by 7 CFR §1000.25(c)(6). The information will be used, along with any accompanying documentation, to make
that determination and to insure compliance with the applicable federal order provisions. Furnishing your proprietary
information is voluntary. However, failure to provide any part of the information may result in a determination that you are
not eligible for the producer-handler exemption. This information is confidential, and subject to the limitations and
sanctions specified in the Privacy Act (5 USC §2105).
SECTION I – OWNERSHIP INFORMATION
1. Name of Handler:
2. Business Form:

Sole Proprietorship
Partnership
Limited Liability Company (LLC)
Corporation

3. Business Documentation: If the entity is a partnership, LLC, or corporation, obtain a current copy of the
partnership agreement, LLC organization documents, or corporate charter.
4. Participant(s): Persons owning shares in the LLC or corporation, or list all partners of the partnership.
Name:
Address:
Phone:

E-mail:

Name:
Address:
Phone:

E-mail:

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4. Participant(s): (Continued)
Name:
Address:
Phone:

E-mail:

Name:
Address:
Phone:

E-mail:

5. Business Address:
6. Contact information:
Phone Number:

Fax:

E-mail:
SECTION II – MILK PRODUCTION RESOURCES AND FACILITIES

List and describe in this section all the milk production resources and facilities, of the type shown1. Which you, your partner(s), or any of your stock holders own, operate, or control either directly,
indirectly, or partially; and
2. Any others in which you have an interest in any way, including contractual arrangement. Show in Part
A below those production resources and facilities which you wish determined to be your milk
production resources and facilities in connection with your designation as a producer-handler. Show
in Part B those that you claim should not be designated a part of your milk production resources and
facilities because they do not constitute an actual or potential source of milk supply for your operation
as a producer-handler. (Note: You must be able to prove each claim to the satisfaction of the Market
Administrator, and any listed items for which such a claim cannot be sustained will be designated a
part of your operation.)

PART A – ITEMS TO BE CONSIDERED A PART OF THE
DESIGNATED PRODUCTION RESOURCES AND FACILITIES

MILK PRODUCTION FACILITIES
Farm 1: Name used for that Property:
Number of Acres:

County

State

Legal Description or reference to Deed:
Lease Information:
Bovine Population:

Total Animals

Milking Cows

Buildings housing the herd: Number of buildings

Cow Capacity
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PART A - MILK PRODUCTION FACILITIES (Continued)
Farm 2: Name used for that Property:
Number of Acres:

County

State

Legal Description or reference to Deed:
Lease Information:
Bovine Population:

Total Animals

Milking Cows

Buildings housing the herd: Number of buildings

Cow Capacity

Farm 3: Name used for that Property:
Number of Acres:

County

State

Legal Description or reference to Deed:
Lease Information:
Bovine Population:

Total Animals

Milking Cows

Buildings housing the herd: Number of buildings

Cow Capacity

Farm 4: Name used for that Property:
Number of Acres:

County

State

Legal Description or reference to Deed:
Lease Information:
Bovine Population:

Total Animals

Milking Cows

Buildings housing the herd: Number of buildings

Cow Capacity

NOTE: If you operate more than 4 farms, identify the remainder on a separate piece of paper.

PART B – ITEMS NOT TO BE CONSIDERED A PART OF THE
DESIGNATED PRODUCTION RESOURCES AND FACILITIES

Farm 1: Name used for that Property:
Number of Acres:

County

State

Legal Description or reference to Deed:
Lease Information:
Bovine Population:

Total Animals

Milking Cows

Buildings housing the herd: Number of buildings

Cow Capacity

Page 4 of 6

PART B – OTHER MILK PRODUCTION FACILITIES (Continued)

Give reasons why you feel each of the items listed above should not be designated as part of your milk
production resources and facilities (Use a separate piece of paper if needed).

NOTE: If you operate more than 1 farm not to be considered a part of the designated production resources
and facilities, identify the remainder on a separate piece of paper.

SECTION III – MILK HANDLING, PROCESSING, AND DISTRIBUTION RESOURCES AND FACILITIES

List and describe in this section all resources and facilities of the types shown (including store outlets) used for
handling, processing, and distributing milk or milk products within the marketing area –
1. Which you own, operate, or control, either directly, indirectly, or partially, or
2. In which you in any way have an interest, including any contractual arrangement; and management or
control.
3. Any others with respect to which you directly or indirectly exercise any degree of management or
control.
Provide the requested information for each item listed. Show in the right hand column for any item of real
property whether you own, lease, rent, or otherwise control each. If your control is not through ownership,
lease, rental, describe on a separate piece of paper how your control is executed.

PROCESSING PLANT(S) INFORMATION
Processing Plant Location

Legal Description or

Owned, Leased, Rented,

(Street Address, City, State, Zip)

Reference to Deed

Or Other

STORE INFORMATION
Owned,
Legal Description

Number

Principal

Leased,

Store Location

or

of

Distribution

Rented, Or

(Street Address, City, State, Zip)

Reference to Deed

Routes

Area

Other

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DISTRIBUTOR INFORMATION
Legal Description

Principal

Distributor Location

or

Distribution Area

(Street Address, City, State, Zip)

Reference to Deed

Owned, Leased,
Rented, Or Other

Sales to Alaska or Outside the United States?

SECTON IV: AFFILIATED PERSONS

List below the names of all other persons who have or exercise any degree of direct, indirect, or partial
ownership, operation, or control of your operation either as a dairy farmer or a handler. Also list any person
(showing trade name if any) with whom you have any contractual arrangement with respect to your operation
either as a dairy farmer or a handler. Provide the information requested for each person.
Specify Item of
Name

Address

Relationship

Concern

Identify parties who are empowered to sign reports on behalf of the business:

Name

Area of Authority

Signature

Owner (Y/N)

I declare under penalties provided by law, that the information contained in this report (including any
accompanying schedules and statements) has been examined by me and to the best of my knowledge and
belief is true, correct, and complete. I also certify that I am authorized to sign this information report.

Prepared by:

On (Date)

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