OMB No. 0581-0178

F/H Form 4 (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

DECLARATION OF INSHELL HAZELNUTS

The undersigned handler hereby designates that as of _____________________, 20____, the 

following lots of certified inshell hazelnuts are to be considered as handled on the domestic market by the 

Hazelnut Marketing Board (Board) and subject to such restricted obligation as may accrue from such 

handling:

Pounds Size Location

Date ________________________________ HANDLER ___________________________________

By __________________________________________

Title _________________________________________

Shipments from the above are to be reported at the end of the month shipped.

No handler may elect to have the certified merchantable hazelnuts, which have not been handled at the 

end of a marketing policy year, bear the restricted and assessment obligations of that year or of the 

marketing policy year in which handled unless a completed declaration is made to the Board (7 U.S.C. 

608(d), 7 CFR 982.50,7 CFR 982.450).

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 20 minutes per response, including the time for reviewing 

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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 

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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.