OMB No. 0581-0178

F/H Form 1(a) (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 DOMESTIC INSHELL SHIPMENTS

Handler ___________________________________ Period _____________________________________

Date of 

Shipment

Invoice/Lot 

Number

Inspection 

Number Jumbo Large Medium Total Country

CURRENT YEAR

Total Current Period

Last Period Yr-To-Date

Total Yr-To-Date

Within 0utside

PRIOR YEAR Production Area

Total Current Period

Last Period Yr-To-Date

Total Yr-To-Date

NOTE: If an export shipment is made where conditions of sale do not meet the Hazelnut Marketing Board requirements, that 

shipment must be reported as a domestic sale. Please identify all such shipments and note the country the product is exported to 

in the Country column. If the shipment is made to or through another handler, provide the name of the handler to prevent 

duplication in reporting shipments.

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.