LP-6 Quarterly Report

OMB No. 0581-NEW

Payment Due On or Before: the last calendar day of the month following the end of the Quarterly Period

NATURAL GRASS SOD PROMOTION,
RESEARCH, AND INFORMATION ORDER (7 CFR 1240)

SALES REPORT
For Q1:

Q2:
Q3:
Q4:
for the year: 20
This is the Original: _____ or Revised: _____ report.

.

(Quarters are as follows: 1 = Jan, Feb, Mar; 2 = Apr, May, Jun; 3 = Jul, Aug, Sep; 4 = Oct, Nov, Dec)
The following statements are made in accordance with the Privacy Act of 1974 (5 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 or Employer Identification Number is mandatory and will be used to determine affiliation or entity identity.

Company Name:

Tax ID# or Employer ID#:

Address:
City:

State/Province:

Postal Code:

Contact Person:

Title:

Email:

Telephone Number:

LINE 1: Enter the total square feet of Natural Grass Sod Products
harvested and sold either individually or in combination with other
products, real property, or services in the United States during the
applicable quarter.
Assessment rate is one-tenth of one penny ($0.001) per square foot
of Natural Grass Sod Product.

1)

x

Payment must be made in U.S. Dollars

LINE 2: TOTAL ASSESSMENT DUE (U.S. Dollars):

LP-6 (Expiration Date XX/XX/XXX)

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2) $

$0.001

OMB No. 0581-NEW

I certify that the above information is true and correct to the best of my knowledge and the attached payment represents $0.001 per
square foot of natural grass sod products harvested and sold either individually or in combination with other products, real property,
or services in the United States during this reporting period for which I am required to pay the assessment. I also certify that I am
authorized to sign this report.
Print Name and Title of Person Completing this Report
Signature

Date

***MAKE SURE YOU SIGN THE FORM***
INSTRUCTIONS:
Please make your assessment check payable to the Natural Grass Sod Board and mail this form with your check to the address below:

Natural Grass Sod Board
[ADDRESS]
[CITY—STATE—ZIP]
Alternatively, for bank wire or ACH instructions, please email: [email protected]
U.S. natural grass sod producers are required to pay assessments and file this report no later than the last calendar day of the month
following the end of the Quarterly Period. Quarter 1 covers January, February and March. Quarter 2 covers April, May, and June.
Quarter 3 covers July, August, and September. Quarter 4 covers October, November, and December. Assessments for natural grass
sod products sold during Quarter 1 are due by April 30; for Quarter 2 by July 31; for Quarter 3 by October 31; and for Quarter 4 by
January 31. All reports are held in strict confidence by the staff of the Board and the U.S. Department of Agriculture.
This report is required by law 7 U.S.C. 7416, 7 CFR Part 12XX and 7 CFR Part XXXX. Failure to report can result in a fine of not less than $1,000 or more than $10,000 for each such
violation. Each such violation shall be deemed a separate violation. The making of any false statement or representation on this form, knowing it to be false, is a violation of Title 18,
Section 1001 United States Code, which provides for the penalty of a fine of $10,000 or imprisonment of not more than 5 years, or both.

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-NEW. 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.
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-6 (Expiration Date XX/XX/XXXX

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