CAC-301 905-Citrus Grown in FL. Admin. Regulation-Size 48 & Smal

OMB No. 0581-0189

CITRUS ADMINISTRATIVE COMMITTEE
PO Box 941058
Maitland, FL 32794
Phone: (321)-214-5252 or (407) 765-5940
[email protected]
HANDLER LOAN AND TRANSFER FORM
SIZE 48 AND SMALLER RED GRAPEFRUIT
The Citrus Administrative Committee (Committee) regulation governs the loan and/or transfer of size 48 and
smaller red grapefruit as regulated by a percentage of shipments. Each handler acquiring a loan or transfer of size
48 and/or 56 red grapefruit that are regulated by a percentage of shipments shall complete this form.
Handler Making Loan and/or Transfer
Handler Name: ________________________________________________________________________________
Phone No.: (_____) __________________________

Fax No.: (_____) ____________________________

Handler Acquiring Loan and/or Transfer
Handler Name: ________________________________________________________________________________
Phone No.: (_____) __________________________
1.

Circle regulation week of loan and/or transfer:
12
13
14
15
16
17

Fax No.: (_____) ____________________________

18

19

20

21

22

2.

Number of 4/5 bu. box (cartons) loaned: __________

3.

Number of 4/5 bu. box (cartons) transferred: __________

4.

Date of loan and/or transfer: ____________________________, 20___

5.

Regulation Week loan and/or transfer will be repaid1: _________________
1
There are no loans after the 21st regulation week. ALL LOANS must be repaid by the end of the 22nd
Regulation Week.

Sign and fax this form to the Committee. Forward a copy to the handler making the loan and/or transfer, and
retain a copy for your files. This form must be completed and received by the Committee no later than 12:00 noon
on the Wednesday following the regulation week for this loan and/or transfer.
I (we) certify to the Committee and the Secretary of Agriculture that this fruit is shipped in accordance with the
current Marketing Order regulations. I (we) realize that the making of a false statement, knowing it to be false is a
violation of title 18, section 1001, of the United States Code, among other statutes, which provide for fine and
imprisonment.
Acquiring Handler’s Name: _________________________

Signature: _________________________________

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
0581-0189. 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.

CAC Form 301 (Rev. 12/2018. Destroy previous editions.)

OMB No. 0581-0189

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.

CAC Form 301 (Rev. 12/2018. Destroy previous editions.)