OMB No. 0581-0178
RAISIN ADMINISTRATIVE COMMITTEE
2445 Capitol Street, Suite 200
Fresno, California 93721
Phone: (559) 225-0520 PROCESSOR’S REPORT OF ACQUISITION OF OFF-GRADE
Report No. _________________
The undersigned certifies to the Raisin Administrative Committee (RAC) and the Secretary of Agriculture of the United States that the following quantities of off-grade raisins, or raisin material, were received for the purpose indicated during the month of _____________________, 20___.
Tendered by (1) Name and Address |
Date Acquired (2) |
Varietal Type (3) |
Weight of Residuals (4) |
Weight of Off-Grade (5) |
Under Exemption (6) |
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TOTALS (7) |
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The making of any false statement or representations in any matter within the jurisdiction of any agency of the United States, knowing it to be false, is a violation of title 18, section 1001 of the United States Code, which provides for a penalty of a fine or imprisonment of not more than five years, or both.
Processor _____________________________________________ Date ___________________________________________________
By __________________________________________________ Title ___________________________________________________
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 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.
INSTRUCTIONS FOR COMPLETING FORM RAC-28
One copy of this report shall be submitted to the RAC not later than the seventh day of each month by 10:00 am and shall contain all raisins or raisin material acquired during the preceding month. The reports shall be numbered consecutively beginning at the start of each crop year and shall be certified by a responsible official of the reporting handler. Disposition of the raisins reported herein will be shown on Form RAC-28A.
Insert the name and address of the producer, packer or dehydrator from whom the material was received.
Show date acquired or received.
Indicate varietal type.
Show weight of raisin residuals including stemmer waste, tailings, or mixed waste.
Show weight of off-grade other than residuals.
If off-grade raisins were acquired under exemption (§ 989.173(b)(6)), indicate such by marking an “X” in this column.
Insert totals of residuals and off-grade received. If more than one sheet is used, totals should be brought forward.
Consult RAC staff on any points not clear to you.
This report is required by law (7 U.S.C. 608d, 7 CFR 989.173(b)(6)). Failure to report can result in a fine of $2,750 for each such violation, and each day during which such violation continues shall be deemed a separate violation.
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.
RAC-28 (Exp. x/xxxx) Destroy previous versions.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |