H-2 Producer Payroll Report

UNITED STATES DEPARTMENT OF AGRICULTURE
1930-220th St. SE, Ste. 102
Bothell, WA 98021
Phone: (425) 487-6009
Fax: (425) 487-2775
E-mail: [email protected]

AGRICULTURAL MARKETING SERVICE
DAIRY PROGRAMS
FEDERAL MILK ORDERS 124 & 131

4835 E Cactus Rd., Ste. 440
Scottsdale, AZ 85254
Phone: (602) 547-2909
Fax: (602) 547-2906
E-mail: [email protected]

H-2
Producer Payroll Report

Note: This cover page is for information purposes only and does not need to be submitted to the market administrator's office.

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

UNITED STATES DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
DAIRY PROGRAMS

Form H-2
1930-220th St. SE, Ste. 102

Form Approved, OMB 0581-0032
Exp. XX/XXXX

Bothell, WA 98021

4835 E Cactus Rd., Ste. 440

Phone: (425) 487-6009

Scottsdale, AZ 85254

FEDERAL MILK ORDERS 124 & 131

Fax: (425) 487-2775
E-mail: [email protected]

Phone: (602) 547-2909
Fax: (602) 547-2906
E-mail: [email protected]

PRODUCER PAYROLL REPORT
Handler

Month's Production Results

Producer No.

Tank No.

Total Pounds of Milk

Producer Name

Pounds of Butterfat

Address

Pounds of Protein 1/

City, State, Zip

Pounds of Other Solids 1/
Average Butterfat Test
Average Protein Test 1/
Average Other Solids Test 1/

Month & Year
Rate

Daily Weights

Value

PPD 1/; Uniform Skim 2/

$

$

1

16

Producer Protein Price 1/

$

$

2

17

Other Solids Price 1/

$

$

3

18

Butterfat Price

$

$

4

19

Value of Milk Production

5

20

6

21

Premiums

7

22

Bonus

$

$

8

23

Hardship

$

$

9

24

Total Premiums

$

10

25

11

26

Gross Payment for Month

$

12

27

13

28

Deductions

14

29

Hauling

$

$

15

30

Stops

$

$

31
Totals

Average Tests

$
Rate

Value

Rate

Value

Marketing Service

$

$

National DPC

$

$

State DPC

$

$

Other

$

$

Other

$

$

Total Deductions

$

B.F.
Pro 1/

Net Payment for Month

$

OS 1/

Less Partial Payment

$

Less A/P Advance

$

1st half

1/ FO 124 handlers only.
2/ FO 131 handlers only.

2nd half

Net Check

$

UNITED STATES DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
DAIRY PROGRAMS

1930-220th St. SE, Ste. 102
Bothell, WA 98021
Phone: (425) 487-6009

4835 E Cactus Rd., Ste. 440
Scottsdale, AZ 85254
Phone: (602) 547-2909

FEDERAL MILK ORDERS 124 & 131

Fax: (425) 487-2775
E-mail: [email protected]

Fax: (602) 547-2906
E-mail: [email protected]

PRODUCER PAYROLL REPORT
Handler
Producer No.

Tank No.

Producer Name
Address
City, State, Zip

Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31

Pounds

Total
1/ Percent Test.
2/ FO 124 handlers only.

Butterfat 1/

Protein 1/ 2/

Other Solids 1/ 2/