HON-FHR First Handlers Report for Honey Packers & Importers

OMB No. 0581-0093

FIRST HANDLER’S REPORT FOR HONEY PACKERS AND IMPORTERS RESEARCH, PROMOTION, CONSUMER EDUCATION, AND INDUSTRY INFORMATION ORDER

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 from the applicable commodity legislation for research and promotion programs. Furnishing

the requested information is necessary for the administration of this program. Submission of Tax Identification Number (TIN) or importer identification number is mandatory and will be used to determine affiliation or entity identity.

Name: _________________________________________________________________________________________

Company Name: ___________________________________________ Tax ID# or SS#: ____________________

Address: _____________________________________________________________________________________

City: ___________________ State: ____________ Zip Code: ____________ Email: ______________________

Phone No.: ______________________ Fax No.:________________ Website: _____________________________

PERIOD COVERED BY THIS REPORT: DATE OF LAST REPORT:

FOR ADDITIONAL SPACE, YOU MAY ATTACH YOUR OWN SEPARATE SHEETS. For questions about completing this report call (800) XXX-XXXX

SECTION 1: First Handler - this section represents all assessable honey or honey products.

1.) LIST POUNDS OF HONEY OR HONEY PRODUCTS OF YOUR OWN PRODUCTION HANDLED: ____________________

2.) LIST POUNDS OF HONEY OR HONEY PRODUCTS PURCHASED FROM PRODUCERS:

List the name and address of each producer along with the corresponding pounds purchased from each producer.

________________________________________________________________________ _________________

________________________________________________________________________ _________________

________________________________________________________________________ _________________

________________________________________________________________________ _________________

TOTAL ALL POUNDS FROM 1 AND 2 ABOVE. ___________________

TOTAL AMOUNT OF ASSESSMENTS DUE: Assessment of $0.XXX per pound is due with this report. $ ________________________

SECTION 2: Complete this section only if you have purchased honey or honey products, both domestic or imported, where the assessment has already been paid to the National Honey Board.

1. LIST POUNDS OF HONEY OR HONEY PRODUCTS PURCHASED FROM OTHER FIRST HANDLERS OR IMPORTERS:

List each handler’s name and address along with the corresponding pounds. These are honey or honey products purchased on which the assessment has already been paid by the supplier or collected by U.S. Customs.

________________________________________________________________________ _________________

________________________________________________________________________ _________________

________________________________________________________________________ _________________

2. LIST POUNDS OF HONEY OR HONEY PRODUCTS YOU HAVE IMPORTED ___________________

(Assessments collected by U.S. Customs)

CERTIFICATION: I certify that the above information is true and correct to the best of my knowledge and the attached payment represents $0.015 per pound on all honey or honey

products listed in section 1 handled during this reporting period for which I am required to pay the assessments as the first handler. The assessments on the pounds reported in
section 2 have been reported and remitted by others for my account. I will submit verification of the above upon request.

____________________________________________________________________________________________________________________________________
SIGNATURE DATE

________________________________________________________________

TITLE

Please Mail To: National Honey Board or email to XXXXX

This report is required by law [7 U.S.C. §7416, 7 CFR Part 1212.52 and 7 CFR Part 1212.70]. Failure to report can result in a fine of not less than $1,200 or more than $12,000 for each such violation. Each such violation shall be deemed a separate violation. The making of any false statement or representation on this form, knowing it to be false, is a violation of Title 18, §1001 United States Code, which provides for the penalty of a fine of $10,000, imprisonment of not more than 5 years, or both.

NOTE: 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.

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.

HON-FHR (Expiration Date XX/XX/20XX) See reverse for burden/non-discrimination statement