MA 201 Notification of Producer Change(s)

Report Forms Under Milk Marketing Order Programs (From Milk Handlers and Milk Marketing Cooperatives)

MA 201 Notification of Producer Changes 1-21-2020

OMB: 0581-0032

Document [pdf]
Download: pdf | pdf
Return to: Federal Milk Order No. 1—Northeast Marketing Area
302A Washington Avenue Ext.
Albany, NY 12203-7303
Submitting Handler ___________________________________________________
Tel: (518) 452-4410 —Fax (518) 464-6468
Email: [email protected] Website: www.fmmone.com

Notification of Producer Change(s)

Please Check Type of Change:
New Producer
Address or Name Change

Instructions: On or before the 9th day after the end of the month, each handler shall
report to the Market Administrator all producer changes in farm operators.

Going Out of Business
Dairy Farmer for Other Market Re-association

MA
Number

Patron
Number

Check if
Organic

MA 201
Form Approved, OMB No. 0581-0032;
Exp. XX/XXXX

Name:

Producer

Mailing Address
(if mailing address is different from farm address please provide both)
Address:

Name:

Address:

Name:

Address:

Name:

Address:

Name:

Address:

Name:

Address:

Delivery
Start Date
Stop Date

Name of Handler/Cooperative Involved in
Change or Division Number

MA Office Use
___________________________________________________________________________________________________________________________________________
Person Authorized to Sign for Handler
Title

_____________________
Date

Initials ___________ Date ________________

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 05810032. The time required to complete this information collection is estimated to average 0.5 hour 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 for communication of 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.


File Typeapplication/pdf
AuthorMDillon
File Modified2020-01-21
File Created2020-01-20

© 2024 OMB.report | Privacy Policy