LP-84 Nomination for Appointment to the Lamb Board

APPROVED - OMB NO. 0581-0093

UNITED STATES DEPARTMENT OF AGRICULTURE

AGRICULTURAL MARKETING SERVICE

NOMINATION FOR APPOINTMENT TO THE LAMB

PROMOTION, RESEARCH, AND INFORMATION BOARD (BOARD)

Please mark an "X" in appropriate block:

Producer

Seedstock Producer

Feeder

_{First Handler}

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.

NOTE: Information is collected to obtain names of nominees for appointment as members of the Board. Response is voluntary. Pursuant to the Lamb Promotion, Research, and Information Order, the following names are submitted as nominees.

NAME(S) OF NOMINEE(S)

(List name(s) for each allotted position on the Board)

IF MORE SPACE IS NEEDED, USE ADDITIONAL FORMS. A COMPLETED ADVISORY COMMITTEE BACKGROUND INFORMATION FORM SIGNED BY EACH NOMINEE MUST BE ATTACHED.

WHEN NOMINATIONS ARE THE RESULT OF A CAUCUS, LIST THE CERTIFICATION NUMBERS OF ORGANIZATIONS OR ASSOCIATIONS PARTICIPATING IN THE CAUCUS.

A.	E.	I.
B.	F.	J.
C.	G.	K.
D.	H.	L.

IDENTIFICATION OF PERSON AND ORGANIZATION/ASSOCIATION SUBMITTING THESE NOMINATIONS

NAME, ADDRESS, AND EMAIL	CERTIFICATION NO.	NAME AND TITLE (Type or print)
	TELEPHONE NO.	SIGNATURE	DATE

RETURN ORIGINAL OF THIS FORM AND THE ADVISORY COMMITTEE BACKGROUND INFORMATION FORM TO:

Research and Promotion Division FAX – (202) 720-1125

Livestock and Poultry Program, AMS, USDA

Street

City, State Zip

LP-84 (Expiration Date XX/XX/XXXX) See reverse for burden/non-discrimination statement

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.

LP-84 (Expiration Date XX/XX/XXXX)