REPRODUCE LOCALLY. FORM APPROVED OMB NO. 0581-0093
U.S. DEPARTMENT OF AGRICULTURE AGRICULTURAL MARKETING SERVICE
NOMINATIONS TO THE NATIONAL SHEEP INDUSTRY IMPROVEMENT CENTER BOARD
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
0581-0093.
The
time
required
to
complete
this
information
collection
is
estimated
to
average
30
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.
STATE/UNIT
Pursuant to the Commodity Promotion, Research, and Information Act of 1996, the following names of sheep or goat producers are submitted as nominees to the National Sheep Industry Improvement Center Board from the indicated State.
NAMES(S) OF NOMINEE(S)
(List name(s) for each allotted position on the Board)
IF MORE SPACE IS NEEDED, USE ADDITIONAL FORMS.
A COMPLETED BACKGROUND INFORMATION SHEET SIGNED BY EACH NOMINEE MUST BE ATTACHED.
3. IDENTIFICATION OF PERSON AND ORGANIZATION/ASSOCIATION SUBMITTING THESE NOMINATIONS
A. NAME AND ADDRESS OF ORGANIZATION/ASSOCIATION
|
C. NAME AND TITLE (PRINT OR TYPE) |
|
D. EMAIL ADDRESS (name@provider.com) |
||
B. FACSIMILE NO. AND AREA CODE |
E. SIGNATURE |
DATE |
RETURN FORMS TO: Research and Promotion Division
Livestock and Poultry Program, AMS
U.S. Department of Agriculture, Room 2610-S
1400 Independence Avenue, SW., STOP 0251
Washington, D.C. 20250-0251
FAX: (202) 720-1125
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.
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | REPRODUCE LOCALLY |
Author | Leigh Ann Gallion |
File Modified | 0000-00-00 |
File Created | 2021-01-13 |