COC-23 (932) Olives - Grower Authorization to Combine Lots

OMB No. 0581-0178

CALIFORNIA OLIVE COMMITTEE

GROWER AUTHORIZATION TO COMBINE LOTS

CROP YEAR: __________________ DATE: ______________________

(1) TO: California Olive Committee 770 E. Shaw Avenue, Suite 210 Fresno, CA 93710	(2) FROM: (3) EIN: _____________________
(4) DATE: _________________________ VARIETY: ______________________________________ REPORT ON FORM(S) COC-3 NO.: ____________________________________________________________ ___________________________________________________________________________________________

(5) SIGNATURE OF AUTHORIZATION:
PRODUCER	AGENT	COUNTY	NO. OF CONTAINERS	NET WEIGHT

AUTHORIZATION: The above signature of the producer or his duly appointed agent does hereby authorize the above-named handler to combine the lot of natural condition olives shown above with other lots of natural condition olives for the purpose of weighing and size-grading in accordance with section 932.15 (a)(i)(ii) of Olive Marketing Order No. 932. This information is used to verify the provisions of the order, 7 CFR 932.161. Making any false statements or representations in any matter within the jurisdiction of any agency of the United States, knowing it to be false, is a violation of title 18, section 1001, of the United States Code, which provides for a penalty of a fine or imprisonment, or both.

The following statements are made in accordance with the Privacy Act of 1974 (U.S.C. 552a) and the Paperwork Reduction Act of 1995, as amended. The authority for requesting the information to be supplied on this form is the Agricultural Marketing Agreement Act of 1937, Secs. 1-19, 48 Stat. 31, as amended, (7 U.S.C. 601-674).  Furnishing the requested information is necessary for the administration of the marketing order program.

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 0581-0178. The time required to complete this information collection is estimated to average 6 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.

COC-23 (Rev. 01/2017) Destroy previous versions.