SWL-AAE Softwood Lumber--Application for Exemption from Assessme

OMB No. 0581-0093

SOFTWOOD LUMBER BOARD

APPLICATION FOR EXEMPTION FROM ASSESSMENT: _____ (YEAR)

As stated in §1217.53 of the Softwood Lumber Research, Promotion, Consumer Education, and Industry Information Order (Exemption from assessments):

Any domestic manufacturer or importer who ships within the United States or imports to the United States less than 15 million board feet annually who desires to claim an exemption from assessments during a fiscal year as provided in §1217.53 shall apply to the Softwood Lumber Board (Board), on a form provided by the Board, for a certificate of exemption. Such domestic manufacturer or importer shall certify that the manufacturer’s or importer’s shipment or importation of softwood lumber shall be less than 15 million board feet for the fiscal year for which the exemption is claimed.

CERTIFICATION

(To Be Signed and Dated by Applicant)

I hereby certify that I manufactured and shipped within the United States or imported to the United States less than 15 million board feet of softwood lumber in _____ (prior year). I therefore request a certificate of exemption from the Softwood Lumber Board (Board) for the year ______.

Contact Name, Title: __________________________________________________________________________

Signature _____________________________________________________ Date: __________________________

Company Name : ______________________________________________________________________________

Street Address: ________________________________________________________________________________

City, State/Province, Country, Postal Code: __________________________________________________________

Email: _________________________________________________ Telephone No.: _________________________

For Importers: Importer ID# (as per Customs’ records):_________________________________________________

For Domestic Manufacturers (within the U.S.): Tax ID# or Employer ID#: _________________________________

Board feet of softwood lumber shipped/imported in 20XX (prior year): ____________________________________

Forecast of board feet of softwood lumber to be shipped/imported in 20XX: ________________________________

Supporting documentation to verify prior year’s shipments is REQUIRED for U.S. domestic manufacturers. This application will be rejected if the applicant is a U.S. domestic manufacturer and sufficient supporting documentation is not included. Suggested supporting documentation may include copies of production or shipment records or grading agency reports. The Softwood Lumber Board will reconcile import volumes with

U.S. Customs data, therefore supporting documentation is not required from importers.

Please email or mail your completed Certificate of Exemption from Application with supporting documentation to:

Softwood Lumber Board

Street

State, City, Zip Code

Telephone No.: (XXX) XXX-XXXX

Email:

OMB No. 0581-0093

NOTE: 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.

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.

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 15 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.

SWL-AAE (Expiration Date XX/XX/20XX) See reverse for burden/non-discrimination statement