PMC 2.6 (993) CA Dried Prunes - Statement of Proposed Dispositio

OMB No. 0581-0178

STATEMENT OF PROPOSED DISPOSITION OF SUBSTANDARD PRUNES

Date: ___________________________

TO: Prune Marketing Committee PMC Approval Number: ____________

3840 Rosin Court, Suite 170

Sacramento, CA 95834

The undersigned hereby certifies to the United State Department of Agriculture and to the Prune Marketing Committee (Committee) for himself/herself and for and on behalf of _____________________________ (Handler) that the undersigned has purchased _________ pounds of substandard prunes on or about _______________, 20___, and that said prunes, subject to approval by the Committee, will be shipped to and converted by ___________________________________________________________________________ (Name and Address of Converter) into _________________________________________________ (usage).

Firm or Individual: _____________________________________________________________________

Address: _____________________________________________________________________________

By: ___________________________________________ Title: ___________________________

IMPORTANT NOTICE: The issuing of a false certificate, knowing it to be false, is a violation of title 18, section 1001 of the United States Code, which provides a penalty or imprisonment, or both.

This report is required by law (7 U.S.C. 608(d), 7CFR 993.50(e), 993.150(e)(1)(ii)).

FAILURE TO REPORT can result in a fine for each such violation and each day during which such violation continues will be deemed a separate violation.

This information is required to obtain authority from the Committee to dispose of substandard prunes and it will be used for that purpose.

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 0581-0178. The time required to complete this information collection is estimated to average 2 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.

PMC 2.6 (Exp. x/xxxx) Destroy previous editions.