MA-B Brokerage Report

FEDERAL MILK ORDER No. 1
Handler Name

Albany:
302A Washington Avenue Ext.
Albany, NY 12203-7303
Tel: (518) 452-4410

Northeast Marketing Area
89 South Street
Boston, MA 02111-2671
Tel: (617) 737-7199

MA-B
Form Approved, OMB No. 0581-0032
Exp. XX/XXXX
Alexandria:
P.O. Box 25828
Alexandria, VA 22313-5828
Tel: (703) 549-7000

BROKERAGE REPORT

REPORT OF PRODUCT MOVEMENTS NOT OTHERWISE REPORTED

For Month of

20
DO NOT WRITE IN SHADED AREAS

Report on this form all movements of bulk fluid milk products and
fluid cream products made at your direction, for which you are not
required to submit a plant report or a bulk tank unit report to the
Market Administrator.
This report properly prepared and signed must be submitted to
the above address on or before the 10th of the month following the
month for which the report is prepared.

For Market Administrator Use Only

Operator 1

The information provided is complete and accurate to the best of my knowledge and belief.

Handler's Name:
Operator 2

Signed by:
(Person authorized to sign on behalf of handler)

Title:

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 0581-0032. The time required to complete
this information collection is estimated to average 0.25 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.
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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 for communication of 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:
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