SC-261 Blueberry Referendum Ballot

National Research, Promotion, and Consumer Information Programs

Referendum Ballot SC-261 4-3-17

National Research, Promotion & Consumer Information Programs (Voluntary)

OMB: 0581-0093

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FORM APPROVED OMB NO. 0581-0093

United States Department of Agriculture

Agricultural Marketing Service


OFFICIAL REFERENDUM BALLOT


BLUEBERRY PROMOTION, RESEARCH, AND INFORMATION ORDER


Complete Sections I, II, and II of this ballot. Mail your completed ballot. To be counted, completed ballots must be received by the U.S. Department of Agriculture on ____ XX, 20XX and before 4:30 p.m. Eastern Time.

I. ELIGIBILITY

1. I am currently a cultivated (highbush) blueberry PRODUCER _____ or IMPORTER ______ (Check one), and I paid assessments during the period Month 20XX to Month 20XX.


  1. I produced or imported __________ pounds of blueberries between Month 20XX and Month 20XX.


Preprinted totals for producers include blueberries produced and reported by a producer. Totals for importers include blueberry imports reported by U.S. Customs. If corrections need to be made, please cross out and legibly write in the correct information. Submit documentation to support these changes along with your ballot to USDA.

Note: Only one vote will be counted for each eligible producer and importer. Incomplete ballots may be INVALID and may not be counted in the referendum.


II. VOTE

Instructions: Mark one box only.

Do you favor the continuance of [amendment to] the Blueberry Promotion, Research, and Information Order?

YES NO_____





PLACE LABEL HERE


III. CERTIFICAITON AND SIGNATURE

ALL BALLOTS MUST BE SIGNED AND DATED BELOW IN ORDER TO BE COUNTED.


I CERTIFY that I am the person authorized to cast this ballot and that the information contained on this ballot is true, complete, and correct to the best of my knowledge and belief, and is made in good faith. If this ballot is being cast on behalf of any group of individuals, partnership, corporation, or other business entity engaged in the production or importation of blueberries, I also CERTIFY that I have the authority to cast this ballot.


X ____________________________________ ______________________

SIGNATURE DATE



_______________________________________ (______)_________-_________

COMPANY NAME BUSINESS TELEPHONE NUMBER




IV. MAILING

Return ballot in the enclosed, postage-paid envelope.

SC-261 (rev. 03/17) Destroy previous editions.





FALSIFICATION OF INFORMATION OR MISREPRESENTATION OF IDENTITY ON THIS GOVERNMENT DOCUMENT MAY RESULT IN A FINE OF NOT MORE THAN $10,000, OR IMPRISONMENT FOR NOT MORE THAN FIVE YEARS, OR BOTH. (18 U.S.C. 1001)



According to the Paperwork Reduction Act of 1995, an agency may or 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 the information collection is 0581-0093. The time required to complete this information collection is estimated to average 15 minutes 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.




SC-261 (rev. 03/17) Destroy previous editions.


File Typeapplication/msword
File TitleFORM APPROVED OMB NO
Authorchumphre
Last Modified ByPish, Marylin - AMS
File Modified2017-04-03
File Created2017-04-03

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