Information is required by 7 CFR 1150.171. Failure to report can result in a fine. Information is held confidential (7 CFR 1150.173). Approved OMB No. 0581-0093

FAILURE TO REPORT OR REMIT AMOUNT DUE CAN RESULT IN A $1,100 FINE. 

ID Number 

Name 

Address 

Report of amount due on milk marketed by producers during Month Year 

1. Milk from producers ......................................................................................................... lbs. 

2. Milk From own production (Exclude raw milk sold to other plants) .................................. lbs. 

3. Total of lines 1 and 2 ........................................................................................................ lbs. 

4. Gross amount due for marketings during the month (line 3 x $.0015) 

 (The rate of $.0015 per pound is equal to 15 cents per hundredweight.) ........................$ 

5. Deduct contributions – up to $.0010 x pounds from line 3 – made to 

 qualified dairy product promotion programs. 

If you enter an amount, complete the form on the reverse side 

 of the blue copy of this report. ......................................................................................$ 

6. Net amount due for marketings during the month (line 4 minus line 5) ............................$ 

7. Add or subtract adjustments for prior months (Explain) ...................................................$ 

8. Amount remitted with this report (line 6 plus or minus line 7) ..........................................$ 

I declare under the penalties provided by law, that this report has been examined by me and to the best of my knowledge and belief is a true and 

complete report. I also certify that I am authorized to sign this report. 

DATE RESPONDING OFFICIAL’S NAME (Print) 

TITLE (Print) SIGNATURE 

Form DA-20 (06/07) Note: For inquiries regarding your assessment account, please telephone (847) 803-9794. 

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 USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington, DC 20250-9410 or call (800) 795-3272 (voice) or 202-720-6382 (TDD). 

USDA is an equal opportunity provider and employer. 

MAIL THIS COPY WITH YOUR REMITTANCE 

NATIONAL DAIRY PROMOTION AND RESEARCH BOARD 

MONTHLY REPORT AND REMITTANCE OF AMOUNT DUE 

FOR ALL MILK MARKETED COMMERCIALLY 

BY PRODUCERS 

(Under Dairy and Tobacco Adjustment Act of 1983)

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. 

The report and a check payable to the National Dairy Promotion 

and Research Board or NDPRB in the amount shown on line 8 

must be mailed by the last day of the month after the month in 

which the milk was marketed to: 

National Dairy Promotion and Research Board 

35092 Eagle Way 

Chicago, IL 60678-1350 
Part A - Qualified Promotion Program Deduction 

In the space below1, record the name of each qualified dairy product promotion program to which you made contributions and the 

amount paid to each such organization for the month that this report represents. DO NOT LIST AMOUNTS PAID TO THE 

NDPRB. 

Name Of Qualified 

Promotion Program 

Amount 

Contributed 

Program

Code 

(For NDPRB 

Use Only) 

 _________________________________________ $______________________ __________ 

 _________________________________________ $______________________ __________

 _________________________________________ $______________________ __________

 _________________________________________ $______________________ __________ 

 _________________________________________ $______________________ __________ 

 _________________________________________ $______________________ __________ 

 _________________________________________ $______________________ __________ 

Total $______________________ 

Part B - Exempt Organic Milk Deduction

In the space below2, record the name of the producer, the payroll number, the pounds of exempt organic milk, the rate of the 

exemption (minimum rate is $0.0005 per pound) and the value of the exemption. 

Name of Producer 

Payroll 

Number 

Pounds of 

Exempt Milk

Exemption

Rate 

(Per cwt.) Value 

For 

NDPRB 

Use Only 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

 Total ______________ $____________ 

1

 You may attach a separate listing or computer printout showing Part A information if you prefer.

2

 You may attach a separate listing or computer printout showing Part B information if you prefer.