BLU-GRF U.S. Highbush Blueberry Council Grower Report

OMB No. 0581-0093

U.S. HIGHBUSH BLUEBERRY COUNCIL

BLUEBERRY PROMOTION, RESEARCH, AND INFORMATION ORDER (7 CFR 1218)

If Payment is made: Mail Report and Payment to:

USHBC #1

C/O XXX Bank

Street

City, STATE Zip

If No Payment is due: Fax Report to

USHBC Office at xxx-xxx-xxxx

GROWER REPORT FOR 20XX

please read the instructions on the reverse side before completing report

ASSESSMENTS ARE DUE NOVEMBER 30, 20XX

PART A: GROWER REPORT FOR 20xx SUBMITTED BY-

__________________________________________________________________________________________

(Print Name of Individual Completing This Report) (Tax Payer ID # or Employer ID#)

____________________________________________________________________________________________*

(Print Name of Business/Company) (Telephone No., Include Area Code) (Email address)

______________________________________________________________________________________________

(Address) (City) (State) (Zip)

*Please select Y / N to be included in the USHBC Amerilert emergency email notification system for urgent messages, reminders, or other important news (enter email address above)

PART B: GROWER ASSESSMENT CALCULATION TABLE

LINE 1: TOTAL POUNDS OF BLUEBERRIES PRODUCED DURING 20XX Include all your sales to processors (handlers), fresh market stand sales, u-pick sales, exports to processors, or handlers outside of the united states, deliveries to shippers, retailers, etc.	POUNDS
LINE 2: TOTAL POUNDS OF BLUEBERRIES DELIVERED TO FIRST HANDLERS (PROCESSORS) FOR WHICH ASSESSMENTS HAVE BEEN COLLECTED BY THE HANDLER AND WILL BE SENT BY THE HANDLER TO USHBC	(-) POUNDS
LINE 3: TOTAL POUNDS OF EXEMPTED ORGANIC BLUEBERRIES PRODUCED DURING 201XX (please indicate USHBC Organic Exemption Certification number: )	(-) POUNDS
LINE 4: TOTAL POUNDS OF BLUEBERRIES SOLD TO NON-HANDLERS AND FOR WHICH I WILL NOW PAY AN ASSESSMENT TO USHBC Calculation: LINE 1 Minus LINE 2 minus LINE 3 = LINE 4	(=) POUNDS
LINE 5: TOTAL ASSESSMENT AMOUNT DUE TO USHBC (Assessment Rate of $XX Per Ton = $0.00 X Per Pound) Calculation: Total From LINE 4 X $0.00X = TOTAL ASSESSMENT DUE (LINE 5)	(x .00X) $
LINE 6: LATE PAYMENT FEE CALCULATION payment made after November 30 charged one time late payment fee of 5 percent on total assessment due, plus monthly interest charge of 1 percent per month on the total assessment and late payment charge. enter your total late payment fee here:	(+) $
LINE 7: TOTAL GROWER PAYMENT TO USHBC Calculation: LINE 5 + LINE 6 = Total Payment Due From Grower (LINE 7)	(=) $

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PART C: REPORT OF GROWER DELIVERIES TO HANDLERS

Growers: List the Names and Addresses FOR ALL Handlers (Processors) to whom you sold blueberries and for which an USHBC assessment has been collected by the handler (copy form or continue on another sheet if necessary).

name of handler	address		pounds delivered
Total Pounds of Blueberries Delivered to Handlers For Which Assessments Have Been Collected By Handler (Note: Total Pounds Listed Here Must Match Total Pounds Reported in Part B, LINE 2 Above)		TOTAL=

CERTIFICATION:

I certify that the above information is true and correct to the best of my knowledge and that for any blueberries I sold outside of Handlers, during the reporting period, as noted in the line 4 above, the attached remittance represents $XX per ton. I also certify that I am authorized to sign this report.

_____________________________________________ __________________________________________________

NAME (PRINT) SIGNATURE

___________________________________________________ _________________________________________________________

TITLE DATE

Any false statement or misrepresentation on this form may result in a fine of not more than $10,000, or imprisonment for not more than 5 years, or both (18 U.S.C. §1001).

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INSTRUCTIONS

The Grower Report is to be received from all growers annually. All blueberry growers are required to complete Part A, Part B, and Part C of this report, and sign the certification statement at the bottom of each report. The U.S. Highbush Blueberry Council (USHBC) must receive the original of the report, with signature, by no later than November 30 of each calendar year. Note: If no payment is required from the grower, a signed and completed copy of this form can be faxed to the USHBC office at XXX-XXX-XXXX.

Also note that a grower assumes the responsibility of a grower/handler on any of their product that the grower sells on their own (Line 4 of this report). Assessment required from a grower on this product must also be received by November 30 of each calendar year. A late payment charge will be imposed on any grower who fails to remit the total amount due by December 31. The staff of the USHBC holds all reports in strict confidence.

Assessment Exemption: Any grower producing less than 2,000 pounds of blueberries annually can apply to USHBC for exemption from assessment.

Organic Assessment Exemption: Any grower producing organic blueberries can apply annually to USHBC for exemption from assessment on their organic production.

Submission of Reports and Payments: Reports and payments are to be sent to the USHBC at the following address:

USHBC #1, c/o XXX Bank, Street, City, State Zip

Handler Definition: The definition of First Handler is stated in section 1218.7 of the Blueberry Promotion, Research, and Information Order (Part 1218) as follows:

“First Handler means any person, excluding a common or contract carrier, receiving blueberries from producers and who as owner, agent or otherwise ships or causes blueberries to be shipped as specified in the Order. This definition includes those engaged in the business of buying, selling, and or/offering for sale; receiving; packing; grading; marketing; or distributing blueberries in commercial quantities. This definition includes a retailer, except a retailer who purchases or acquires from, or handles on behalf of any producer, blueberries. The term first handler includes a producer who handles or markets blueberries of the producer’s own production.”

Responsibility for Assessment Collection: As stated in section 1218.52 of the Blueberry Promotion, Research, and Information Order (Part 1218), “The collection of assessments on domestic blueberries will be the responsibility of the first handler receiving the blueberries. In the case of the producer acting as its own first handler, the producer will be required to collect and remit its individual assessments.”

Late Payment Fees

As noted in section 1218.52, Item E of the Order, “All final payments for a crop year are to be received no later than November 30 of that year. A late payment charge shall be imposed on any handler who fails to remit to USHBC the total amount for which any such handler is liable on or before the due date established by USHBC. In addition to the late payment charge, an interest charge shall be imposed on the outstanding amount for which the handler is liable.”

USHBC will levy a one-time late payment charge of 5 percent on the outstanding amount due and an interest charge of

1 percent per month on the total outstanding balance plus the late payment charge.

Contact the USHBC office at (XXX) XXX-XXXX (phone) or (XXX) XXX-XXXX (fax) with any questions concerning this report,

grower exemptions or USHBC assessment requirements.

Mailing Address: USHBC, Street, City, State Zip

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NOTE: The following statements are made in accordance with the Privacy Act of 1974 (U.S.C. §522a) and the Paperwork Reduction Act of 1995, as amended. The authority for requesting this information to be supplied on this form is the Commodity Promotion, Research, and Information Act of 1996, Pub. L. 104-127, 110 Stat. 1032 (7 U.S.C. §§7411-7425). Furnishing the requested information is necessary for the administration of this program. Submission of Tax Identification Number (TIN) or Employer Identification Number (EIN) is mandatory, and will be used to determine affiliation or entity identification.

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, 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.

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