LP-9 Certification of Producer Directed Payment of Cattle Ass

_{OMB No. 0581-0093}

BEEF CHECKOFF PROGRAM

A promotion and research program designed to increase demand for beef.

The Beef Checkoff Program was created by the Beef Promotion and Research Act of 1985 (7 U.S.C. §§2901-2911) and the

Beef Promotion and Research Order (7 CFR 1260.101-640). Information is required by 7 CFR 1260.201. Failure to report can result in a fine. All information reported is confidential under 7 CFR 1260.203.

CERTIFICATION OF PRODUCER DIRECTED PAYMENT OF CATTLE ASSESSMENTS

PREPAYMENT OF BEEF CHECKOFF ASSESSMENTS. This is a voluntary action allowing any producer who is retaining ownership and shipping cattle of their own product out of State for feeding, finishing, backgrounding, or grazing to prepay the beef checkoff assessment to the qualified State beef council in the State where the cattle originated. By prepaying the assessment, producers help fund the qualified State beef council in the State where the cattle originated rather than the State where the cattle were shipped. At least half of the $1-per-head assessment is always sent to the Cattlemen’s Beef Promotion and Research Board to fund the national beef checkoff programs.

Date:

Producer's Name: ___________________________________________ ^{SSN or TIN:} Address: City: State: Zip:

Phone No.: Email:

Destination Facility:

Address: City: State: Zip:

“I am electing to direct payment of and remit assessments in the amount of $ to the Qualified State

Beef Council (QSBC) of , my State of residence, on head of cattle that I have

State Head

produced and am transporting under retained ownership on to a feedyard or similar

Date

location in the State of .”

State

I certify that these cattle are of my own production; I am transporting these cattle under retained ownership in compliance with

7 CFR 1260.311 to a feedyard or similar location in another State; and these cattle shall remain in the feedyard or similar location for a period of not less than 30 days.

I further certify that, upon remitting the producer directed assessment on these cattle, I shall send a copy of this certification form to my QSBC. I understand that a copy of this "Certification of Producer Directed Payment of Cattle Assessments" must be provided to the purchaser (collecting person) at the time of sale to document that the $1-per-head assessment has been paid or I will be

required to pay the assessment again.

Signature of Owner (Producer):

Composite groups of cattle (use if cattle are divided): These cattle were divided into separate groups and sold as follows:

Buyer/ Date Sold/ Head Buyer/ Date Sold/ Head Buyer/ Date Sold/ Head Buyer/ Dale Sold/ Head

^{Buyer/ Date Sold/ Head Buyer/ Date Sold/ Head Buyer/ Date Sold/ Head} Buyer/ Date Sold/ Head

_{Signature of Feeder:}

Collection of your social security number is authorized by Executive Order No. 9397 and will

be used only for positive identification. Furnishing this information is voluntary.

FORWARD WHITE COPY WITH REMITTANCE. SEND YELLOW COPY WITH CATTLE.

RETAIN GOLD COPY FOR YOUR FILES. PINK COPY FOR FEEDERS FILES.

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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 12 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.

OMB No. 0581-0093

CERTIFICATION OF PRODUCER DIRECTED PAYMENT OF CATTLE ASSESSMENTS

This is a voluntary program allowing any producer who is retaining ownership and shipping cattle of his own production out of State for feeding, finishing, backgrounding, or grazing to elect to prepay the checkoff assessment to the State beef council in his State of residence.

Copies made on a copier are ONLY allowed when a FEEDER divides a producer's cattle into other groups upon leaving the feeder.

□ For the Producer:

1. Cattle of a producer's own production shall be those cattle which meet ALL of the following requirements: a) the cattle shall be the offspring of a producer's own cowherd; b) the cattle shall have been continuously and exclusively under the producer's ownership; and c) the cattle are transported to a feedlot or other facility with such owner continuously owning the cattle through the entire feeding phase.

2. If a percentage interest in the cattle is transferred while in the feedlot or other facility, the full assessment is due when sold to the packer or other buyer. There is no refund for death loss.

3. The producer must submit the original form (white copy) and payment of the assessment to the State beef council in his state of residence AT THE TIME or BEFORE cattle are shipped.

4. Ensure forms accompany the cattle. The dollar or document rule shall apply. If there is no document presented at the time they are sold out of the feedlot the assessment will be collected.

5. A separate original form must be filled out by the producer for cattle going to different locations within a State, i.e. different feedyards, even if owned by the same company. One form may be used for multiple loads of cattle going to the same location on the same day.

□ For the Feeder:

Forms must accompany cattle upon arrival. Late forms or copies are not to be accepted.

1. If the cattle are sold as an intact group, the yellow form will go with the cattle to the packer or other ultimate buyer. If the cattle are split up and sold with different lots or as separate units, the feeder shall enter the groups in the spaces provided on the pink form and make enough copies to send a copy with each group. The copy shall indicate only the prepaid cattle in the group.

2. The feeder is the only one allowed to make and use copies of the form as long as the number of copies does not exceed the number of groups of cattle and the number of cattle in the groups does not exceed the total on the original prepayment form.

3. The feeder will report prepaid cattle on your monthly remittance form to the State beef council. List them as a separate category of non-assessed cattle by number of head and form number(s) on the prepay form or make copies and send in with your monthly report. The feeder will retain the pink copy of the original in his records for 3 years.

□ For the Packer or Ultimate Purchaser:

1. The packer or ultimate purchaser must collect the beef checkoff assessment unless the original or approved copy of the numbered prepayment form accompanies the cattle. Report prepaid cattle on your monthly remittance form to the State beef council as a separate category of non-assessed cattle by number of head and form number(s) on the prepay form or make copies and send in with your monthly report. Retain the yellow form for your records.

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