No Form No. (959) So. TX Onion - Application for Registered Onion Ha

OMB No. 0581-0178

SOUTH TEXAS ONION COMMITTEE

901 Business Park Drive, Suite 500, Mission, TX 78572

Phone: (956) 584-9331 Fax: (956) 581-3912

APPLICATION FOR REGISTERED ONION HANDLER

Effective Date: ______________ Expiration Date: _______________

If you plan to HANDLE onions GROWN in the following South Texas counties, you must register as a Handler. Counties: Aransas, Atascosa, Bee, Brooks, Calhoun, Cameron, DeWitt, Dimmit, Duval, Frio, Goliad, Hidalgo, Jim Wells, Jim Hogg, Karnes, Kenedy, Kinney, Kleberg, LaSalle, Live Oak, Maverick, McMullen, Medina, Nueces, Refugio, San Patricio, Starr, Uvalde, Val Verde, Victoria, Webb, Willacy, Wilson, Zapata, Zavala.

PLEASE FURNISH THE INFORMATION REQUESTED BELOW, AND MAIL AS QUICKLY AS POSSIBLE!

TAX ID NO. or

FIRM OR INDIVIDUAL: ______________________________________ S. S. NO.: ___________________

MAILING ADDRESS: _________________________________________________________________________

PHYSICAL ADDRESS: ________________________________________________________________________

OFFICE PHONE: ____________________ SALES: _______________________ FAX: ________________

SALES STAFF: _______________________________________________________________________________

____________________________________________________________________________________________

LIST OF BRAND NAMES OR LABELS: __________________________________________________________

____________________________________________________________________________________________

TYPES OF CONTAINERS SHIPPED (CARTONS, BAGS, ETC. AND WEIGHT OF EACH CONTAINER).

_______________________________ ______________________________

_______________________________ ______________________________

_______________________________ ______________________________

_______________________________ ______________________________

_______________________________ ______________________________

WILL YOU BE INDIVIDUALLY LABELING YOUR PRODUCT? □ YES □ NO

SIGNATURE _____________________________ PRINT NAME _____________________________________

The following statements are made in accordance with the Privacy Act of 1974 (5 U.S.C. 552a) and the Paperwork Reduction Act of 1995. The authority for requesting this information to be supplied on this form is the Agricultural Marketing Agreement Act of 1937, Secs. 1-19, 48 Stat. 31, as amended, (7 U.S.C. 601-674). Furnishing the requested information is necessary for the administration of the marketing order program.

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 5 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.

(Exp. x/xxxx) Destroy previous editions.