SC-8 Background/Acceptance Statement for Public Members & Alt

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OMB No. 0581-0177

UNITED STATES DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
SPECIALTY CROPS PROGRAM

Background/Acceptance Statement for Public Members and Alternates
CONFIDENTIAL BACKGROUND STATEMENT
The following information will be used by the Secretary of Agriculture in selecting a representative to serve on
the ______________. The ________________ administers Federal Marketing Order No. ___, which regulates
the handling of ______________ grown in ________________________. Please provide information applicable to
the position to which nominated. This information is required to determine the nominee’s eligibility and willingness to
serve and will be treated confidentially
POSITION:
TERM OF OFFICE: _____________
□ MEMBER

□ ALTERNATE MEMBER
NAME: (as you would like it to appear on official correspondence)

EMAIL ADDRESS:

ADDRESS: (Street, City, County, State and Zip Code)

TELEPHONE NUMBER: (Include area code)

FAX NUMBER: (Include area code)

Are you or any member of your immediate family directly associated with the _________ industry, financially or
otherwise? □ YES
If so, please explain.

□ NO

Occupation: (including Employer's Name & Address):

Briefly state your qualifications.

NOTE: I am aware that the public member and alternate positions are non-salaried. I am aware that these

positions may require travel. (Authorized travel expenses are reimbursable.)

SC-8 (Rev. 07/2018. Destroy previous editions.)

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OMB No. 0581-0177

Members, in their official capacities, are prohibited from taking any action specifically designed to influence
legislation, including any attempt to influence public opinion concerning legislation. Members may not
communicate with any official of a State or Federal legislative body for the purpose of attempting to influence
legislation. Members are also prohibited from attempting to influence State or Federal government actions or
policies or those of foreign governments, except as specifically authorized under the marketing order or expressly
approved by the Secretary. Members are specifically precluded from authorizing the expenditure of marketing order
funds for the purpose of attempting to influence legislation or government actions. These same prohibitions apply to
managers, staff, and contractors, except that committee managers may consult with the Department of Agriculture
(USDA) employees during the pendency of informal rulemaking actions.
If marketing order member, subcommittee members or employees are sued individually or jointly for errors in
judgment, mistakes or other acts either of omission or commission (except for acts of dishonesty, willful
misconduct, or gross negligence) in the conduct of their duties under the marketing agreement or order, they may be
authorized legal defense by the Department of Justice (DOJ). Alternatively, legal defense may be provided through
private counsel, if recommended by USDA and approved by DOJ. USDA and DOJ enjoy an excellent working
relationship with respect to providing legal representation for members and employees, either by DOJ or through
authorized private counsel. USDA is committed to comprehensive legal defense policy for all committee members
and employees acting within the scope of their authorized duties and responsibilities.

Acceptance Statement: If selected, I accept the appointment and agree to serve during the
period for which I am appointed and until my successor has been selected and qualified. I
also agree that I will carry out assigned duties in administering the terms and provisions of
the marketing order to the best of my ability. When acting in my official capacity as a
representative, I shall engage in only those activities that are authorized under the
marketing order.
Name (print): _________________________________
Signature: ____________________________________

Date: _________________

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 OMB 0581-0177. The time required to complete this information collection is estimated to average 5
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.
SC-8 (Rev. 07/2018. Destroy previous editions.)