OMB No. 0581-0178

F/H Form 1(b) (Exp. 3/31/2024) Destroy previous editions.

HAZELNUT MARKETING BOARD

21595-A Dolores Way NE

Aurora, OR 97002-9738

Tel: (503) 678-6823

Fax: (503) 678-6825 EXPORT INSHELL SHIPMENTS

Handler ___________________________________ Period _____________________________________

Date of 

Shipment

Invoice/ 

Ship. No.

Inspection 

Number

Giant & 

J/G Jumbo Large Medium Total

* Net Unit 

Price 

Rec’d

Country

CURRENT YEAR CROP

Total Current Period

Last Period Yr-To-Date

Total Yr-To-Date

Within 0utside

PRIOR YEAR CROP Production Area

Total Current Period

Last Period Yr-To-Date

Total Yr-To-Date

* Please show different sizes in a shipment as separate line items so meaningful cost data can be reported.

This report is required by law (7 U.S.C 608(d), 7 CFR 982.66 and 7 CFR 982.466). Failure to report can result in a fine of not 

less than $50 or more than $5,000 for each such violation and each day during which such violation continues shall be deemed a 

separate violation.

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 15 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: program.intake@usda.gov. USDA is an equal opportunity provider, employer, and lender.