DA-21-R Fluid Milk Promotion Order Continuance Referendum (Proce

OFFICIAL REFERENDUM BALLOT: OMB NO. 0581-0093

United States Department of Agriculture Agricultural Marketing Service

Dairy Programs

FLUID MILK PROMOTION ORDER CONTINUANCE REFERENDUM

FLUID MILK PROCESSORS FLUID MILK PROMOTION ORDER

See the reverse of this form for instructions for completing the ballot. This ballot and the information provided will be kept confidential. (Please type or print.)

Processor Name Processor Address

City State Zip Code

BALLOT: DO YOU FAVOR CONTINUATION OF THE FLUID MILK PROMOTION ORDER?

(Place an “X” in only one space)

• YES, continue the Order

• NO, terminate the Order

I hereby CERTIFY that the name and address above are correct and that I am eligible to vote as set forth on the reverse side of this ballot. My signature below certifies that I have the authority to act on behalf of this organization.

Name (Please Type or Print) Signature

Title Date

FALSIFICATION OF INFORMATION ON THIS GOVERNMENT DOCUMENT MAY RESULT IN A FINE OF NOT MORE THAN

$10,000, IMPRISONMENT FOR NOT MORE THAN 5 YEARS, OR BOTH (18 U.S.C. §1001)

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According to the Paperwork Reduction Act of 1995, an agency my 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 6 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:

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(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.

OFFICIAL REFERENDUM BALLOT Instructions OMB NO. 0581-0093

Fluid Milk Promotion Order Continuance Referendum

The Fluid Milk Promotion Act of 1990 (Title XIX, subtitle H, of the Food, and Agriculture, Conservation, and Trade Act of 1990, Pub L. 1001-624) authorized the establishment of a national program for fluid milk promotion. This program is funded by a 20-cent per hundredweight assessment on fluid milk products processed and marketed commercially in consumer-type packages in the 48 contiguous United States and the District of Columbia by fluid milk processors, excluding deliveries directly to the residence of consumers. A board of 20 members, 15 who represent geographic regions and five at-large members, has been appointed by the Secretary of Agriculture to administer the Order.

The Act requires the Secretary to conduct a continuation referendum among fluid milk processors to determine if they approve the continuation or termination of the Fluid Milk Promotion Order. Continuation of the Order is contingent upon approval by at least 50 percent of the fluid milk processors voting. Those voting for approval also must have processed and marketed collectively 60 percent or more of the fluid milk products marketed in the United States by processors participating in the referendum.

1. Referendum Period. Voting will be conducted by mail beginning through . Ballots postmarked after will not be counted.

2. Processors Eligible to Vote Must Meet ALL of the Following Conditions:

   1. Be registered by .

   2. Have processed and marketed commercially at least 3 million pounds of fluid milk products in consumer-type packages in the United States during excluding deliveries directly to the residence of consumers.

   3. Be processing and marketing fluid milk products in consumer-type packages in the United States:

      1. At the time of voter registration, and

      2. At the time of voting.

3. Instructions for Completing the Ballot.

1. Vote in the space provided.

2. Type or print your name and title, sign, and date the ballot.

3. Correct the printed mailing address, if necessary.

4. Mail the ballot in the pre-addressed envelope so that it is postmarked during the period of through . If you do not have a pre-addressed envelope, mail the ballot to:

Referendum Agent

USDA, AMS, Dairy Programs Room XXXX-S, Mail Stop XXXX Street

City, State, Zip

If you have questions or need information on the referendum, call the Referendum Agent at (XXX) XXX-XXXX.

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