CPR-4 Report of Billings To and/or Payments from Pool Handlers

Return to: Federal Milk Order No. 1—Northeast Marketing Area
333 North Fairfax Street
Mailing Address: P.O. Box 25828
Alexandria, VA 22313-5828
Tel: (703) 549-7000 —Fax (703) 549-7003
Email: [email protected] Website: www.fmmone.com

CPR-4
Form Approved, OMB No. 0581-0032;
Exp. XX/XXXX

REPORT OF BILLINGS TO AND/OR PAYMENTS FROM POOL HANDLERS*
NAME OF COOPERATIVE ASSOCIATION:
NAME OR PURCHASER

DATE:
DELIVERY
PERIOD

DATE
BILLED

AMOUNT
BILLED

AMOUNT RECEIVED
AND DEPOSITED

DATE
RECEIVED

*Include all amounts billed and/or received since previous report.
Report is due on the 20th of each month.
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 0.5 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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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 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
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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.