Form 4 Report of Inter-Handler Transfers of Pecans

OMB No. 0581-0291
REPORT OF INTER-HANDLER TRANSFER OF PECANS
APC Form F4 - Instructions
This report is submitted pursuant to 7 CFR 986.77 and 986.78 and is subject to audit verification by the American Pecan
Council (7 CFR 986.79).
The completed form must be delivered to the American Pecan Council no later than the tenth day of the month.
Please note: If completing electronically, you need only to insert data in the blank WHITE cells. The form will
calculated any information in the SHADED cells. Once the information is entered, the column will be calculated
automatically. If completing the form by hand, please calculate the total.
The following are instruction for completin APC Form 4 - Report of Inter-Handler Transfer of Pecans:
Month: Enter the month being reported upon.
Handler Number: Leave blank. APC staff will complete this section.
Inter-Handler Transfers (in pounds):

1. Enter the weight of inshell pecans transferred for each type of pecan transferred.
2. If completing the form by hand, total the amount of assessment for each type transferred.
3. Check the box indicating which handler is responsible for paying the assessment.
UPON COMPLETION: Read the Certification Statement at the bottom of the form and write in/type the
Handler/Company name. Sign and date the form in the spaces provided. Each party to the transfer is to retain a copy of
the form and then fax or email it to the American Pecan Council.
§986.81   Confidential information. All reports and records submitted by handlers to the Council staff, which include
data or information constituting a trade secret or disclosing the trade position, or financial condition or business
operations of the handler, shall be kept in the custody of one or more employees of the Council and shall be disclosed to
no person except the Secretary of Agriculture.

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 OMB 0581-0291. The
time required to complete this information colllection is estimated to average 10 minutes per response, including the time for reviewing the
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and review the collection of information.

APC Form 4 (Exp. 12/2022. Destroy previous versions.)

OMB No. 0581-0291

REPORT OF INTER-HANDLER TRANSFERS OF PECANS - FORM 4

This report is submitted is submitted pursuant to 7 CFR 986.62 and the reporting requirements of 986.77 and 986.78, and is subject to audit verification by
the American Pecan Council (7 CFR 986.79).
Month: _____________

Type of Pecans

Crop Year: _____________

Handler Number: _____________ (office use)

INTER-HANDLER TRANSFERS (in pounds)
Inshell Pounds
Assessment/Amount
Assessment Rate
Transferred
Owed

Improved

0.03

$0.00

Native/Seedling

0.02

$0.00

Substandard

0.02

$0.00

TOTALS

0.00

$0.00

Who is responsible for paying the assessment (check appropriate box):
Transferring Handler

Receiving Handler

This report of pecans transferred between handlers is submitted in compliance with the requirements of 7 CFR 986.62. In executing this form, both
handlers respectively certify to the Council, and to the U.S. Department of Agriculture, the correctness and completeness of their statements.
To be completed by Transferring Handler
_______________________________________
(Name of Handler/Company)
___________________________________
Signature
Date: ___________________

To be completed by Receiving Handler
___________________________________________
(Name of Handler/Company)
_____________________________________
Signature
Date: ______________________

The making of any false statements or representations in any matter within the jurisdiction of any agency of the United States, knowing it to be false, is a
violation of title 18, section 1001, of the United States Code, which provides for a penalty of a fine for individuals and for organizations or imprsonment, or
both.
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.

APC Form 4 (Exp. 12/2022. Destroy previous versions.)