MA-100A Producer Weight Record

PRODUCER WEIGHT RECORD

MA IOOA

BULK FARM TANK
FEDERAL ORDER 30

P R O D UC ER
NU MB E R

CONV ERTED
P OUNDS

G A U GE
ROD

TE MP .

M ILK P IC KE D UP
D AT E
TIME

,;

HAULER'S INITIAL

PLANT

MA-100A

_

MA-100A RECEIPT OF PRODUCER MILK (PINK TICKETS)
The MA-100 Receipt of Producer Milk Tickets is used in conjunction
with the MA-100A Producer Weight Record Bulk Farm Tank Tickets.
The same disclaimer is used for MA-100 and MA-100A tickets. The
following changes will be made when the lab orders new MA-100 Pink
Tickets.
1) The words: “Form Approved, OMB 0581-0032" in the upper righthand corner of the front page of the form;
2) The words: “Exp. XX/XXXX” printed beneath and after (1)
3) The Burden and Non-discrimination Statements appear on the front
page of each form, on a separate page, or on the reverse side of the
first page of the form. These paragraphs must appear in a minimum
font size of 8. The following are the current Burden and Nondiscrimination Statements:
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 05810032. 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. OMB approval
expires for this form on March 31, 2020.
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.
MA-100A

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) 8778339. 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. 202509410; (2) fax: (202) 690-7442; or (3) email:
[email protected].
USDA is an equal opportunity provider, employer, and
lender.

MA-100A