California FMMO Producer Payroll Rept.

UNITED STATES DEPARTMENT OF AGRICULTURE
Address: XXX
XXX
Phone: XXX
Fax: XXX
E-mail: XXX

AGRICULTURAL MARKETING SERVICE
DAIRY PROGRAM
XXX FEDERAL MILK ORDER XXX

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-NEW. 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, 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

UNITED STATES DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
DAIRY PROGRAM

Address: XXX
XXX
Phone: XXX

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

Fax: XXX

XXX FEDERAL MILK ORDER XXX

E-mail: XXX

CALIFORNIA FMMO PRODUCER PAYROLL REPORT
Handler
Producer No.

Month's Production Results
Tank No.

Total Pounds of Milk

Producer Name

Pounds of Butterfat

Address

Pounds of Protein

City, State, Zip

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

Organic
Month & Year
Rate

Value

Deductions

Rate

Value

PPD/Skim Blend

$

$

Hauling

$

$

Butterfat Price/Blend

$

$

Stops

$

$

Producer Protein Price

$

$

Marketing Service

$

$

Other Solids Price

$

$

National DPC

$

$

Somatic Cell Count

$

$

State DPC

$

$

$

Assignments

$

$

Value of Milk Production
Premiums
Bonus

Rate
$

Value
$

Coop Dues

$

$

Cap. Retain

$

$

CDFA Quota Assessment

$

$

rBST-Free

$

$

Other

$

$

Quality

$

$

Other

$

$

Volume

$

$

Other

$

$

Other

$

$

Other

$

$

Other

$

$

Total Deductions

$

Net Payment for Month

$

Less Partial Payment

$

Less A/P Advance

$

Other

$

$

Other

$

$

Other

$

$

Total Premiums

Gross Payment for Month

$

$

Net Check

$