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pdfUnited States Department of Agriculture
Agricultural Marketing Service
Dairy Programs
Appalachian Marketing Area - Federal Order 5
Form Approved, O.M.B. No. 0581-0032
Exp. XX/XXXX
Handler
Month
CALCULATI ON OF TRANSPORTATI ON CREDI T
( Other Source M ilk )
Date Supplemental M ilk Received at Pool Plant
Supplemental Load of M ilk for which a Transportation Credit is being requested
Distance between Receiving Pool Plant and Transferor Plant
- Receiving Pool Plant ( City & State )
- Transferor Plant
( City & State )
The outlined area below will be completed by the M arket Administrator's Office
DESCRI PTI ON
ORDER
CI TATI ON
1
Distance between Receiving Pool Plant and Transferor Plant
82 (d) (2) (i)
2
Multiply - Mileage Computed in (d)(2)(i) by Mileage Rate Factor for the Month
82 (d) (2) (ii)
3
Class I Price Adjustment
82 (d) (2) (iii)
4
- Class I Price @ Receiving Plant
82 (d) (2) (iii)
5
- Class I Price @ Transferor Plant
82 (d) (2) (iii)
6
Subtract - Class 1 Price @ Transferor Plant from Class 1 Price @ Receiving Plant
82 (d) (2) (iii)
7
Subtract - Positive Difference Computed in (d)(2)(iii) from Computed (d)(2)(ii) Amount
82 (d) (2) (iv)
8
Multiply - The Remainder Computed in (d)(2)(iv) by the Hundredweight of Milk
82 (d) (2) (v)
Described in Paragraph (d)(2) of this Section
9
OTHER SOURCE TRANSPORTATI ON CREDI T
*
10
Please attach the Hauler Weight Ticket or appropriate summary to substantiate Pounds claimed for Transportation Credit.
TOTAL OTHER SOURCE TRANSPORTATI ON CREDI T
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 1.5 hour(s) 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.
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