Reproduce locally. Include form number and date on all reproductions. Approved OMB No. 0581-0093 

U.S. DEPARTMENT OF AGRICULTURE

AGRICULTURAL MARKETING SERVICE

DAIRY PROGRAMS

NOMINATION OF MILK PROCESSORS TO SERVE ON THE NATIONAL FLUID MILK PROCESSOR PROMOTION BOARD

(Under the Fluid Milk Promotion Act of 1990, as amended, and the Fluid Milk Promotion Order (7 CFR 1160.101 et seq.))

The Fluid Milk Promotion Order provides that individual fluid milk processors and other interested parties, including eligible organizations, may nominate milk processors 

to serve on the National Fluid Milk Processor Promotion Board. Fluid milk processors and other interested parties may nominate milk processors for regions in which 

they are located or market fluid milk, and for the at-large members. Eligible organizations may submit a slate of nominees for seats in all regions and for at-large 

members. Except for the member or members from the general public, nominees shall be active owners or employees of a fluid milk processor.

Attach a separate sheet if additional space is needed. Please submit a separate form for each nominee.

NAME, BUSINESS ADDRESS, AND TELEPHONE NUMBER OF NOMINEE

Regional Nominee --- _____ Number of Region

 

 At-large Processor Nominee

 

 General Public Nominee

NAME AND MAILING ADDRESS OF FLUID MILK PROCESSOR, INTERESTED PARTY OR ELIGIBLE ORGANIZATION SUBMITTING NOMINATION

NAME AND EMAIL OF RESPONDING OFFICIAL (PRINT or TYPE)

EMAIL:_______________________________________

SIGNATURE

TITLE OF RESPONDING OFFICIAL (PRINT or TYPE) DATE

 RETURN ORIGINAL TO: USDA, AMS, DAIRY PROGRAMS

 PROMOTION AND RESEARCH BRANCH

 STOP 0233, ROOM 2958-SOUTH

 1400 INDEPENDENCE AVENUE, S.W.

 WASHINGTON, D.C. 20250-0233

 

FORM DA-19-1 (6/07) (Destroy all previous editions) 

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 0581-0093. 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. Information is collected to obtain names of nominees for appointment as member of the Board. Response 

is voluntary (7 CFR 1160.202). 

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where 

applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual’s 

income is derived from any public assistance program (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication 

of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at (202) 720-2600 (voice and TDD). 

To file a complaint of discrimination, write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, or call (800) 795-3272 

(voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.