OMB No. 0581-0178

CDAC-3 (Exp. 3/31/2024) Destroy previous editions.

Send original and one signed copy to:

CALIFORNIA DATE ADMINISTRATIVE COMMITTEE

P.O. Box 1736

Indio, CA 92202-1736

Tel: (760) 347-4510 Fax: (760) 347-6374

APPLICATION TO BE PLACED ON THE LIST OF APPROVED DATE PRODUCT MANUFACTURERS

Application is made herewith to be placed on the California Date Administrative Committee (Committee)list of 

approved date product manufacturers for the purpose of using, or if not a handler of dates, acquiring and using, 

restricted and other marketable dates in the manufacture of products in which the dates lose their whole or pitted 

form.

In consideration of approval of this application, the undersigned agrees that all dates obtained for manufacturing into 

products will be used for that purpose. None will be resold or disposed of as whole or pitted dates, and within 24 

hours of each completion of disposition of a lot of dates, a report of such will be filed with the Committee on form 

CDAC-8. In addition, at the end of each crop year, but no later than October 31, an annual report of operations will 

be filed on form CDAC-4.

The undersigned states that dates will be used to manufacture the following products:

___________________________________________________________________________________

___________________________________________________________________________________

The quantity of dates to be used for the twelve months, from October through September, is estimated to be 

___________pounds of the _________________________________________________ variety(ies).

All manufacturing of dates will occur at (plant location): _______________________________________________

I hereby certify to the U.S. Department of Agriculture and to the Committeethat the information contained in this 

report is complete and accurate, and that the above agreement as to usage and reporting is acceptable.

Firm/Applicant: ______________________________________ By: ______________________________

Address: ____________________________________________ Title: _____________________________

City: _______________________________ State: _______ Zip Code: ____________

Date: ______________________________

The making of false statement or representation on this form, knowing it to be false, is a violation of title 18 section 1000 of the

United States Code, which provides for the penalty of a fine or imprisonment, or both. This report is required by law (7 USC 

608(d), 7 CFR 987.51, 987.151). Failure to report can result in a fine for each violation and each day during which such violation 

continues shall be deemed a separate violation.

Approval is subject to future revocationfor cause by the Committee.

CALIFORNIA DATE ADMINISTRATIVE COMMITTEE

By: __________________________________________________ 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 0581-0178. 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.
OMB No. 0581-0178

CDAC-3 (Exp. 3/31/2024) Destroy previous editions.

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: program.intake@usda.gov. USDA is an equal opportunity provider, 

employer, and lender.