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 PRODUCERS OR IMPORTERS TO SERVE ON THE NATIONAL DAIRY PROMOTION AND 

RESEARCH BOARD 

(Under the Dairy Production Stabilization Act of 1983 and the Dairy Promotion and Research Order (7 CFR 1150.101 et seq.)) 

The Dairy Promotion and Research Order (Order) provides that producer and farm organizations, and importer and importer organizations may nominate milk producers or 

dairy product importers to serve on the National Dairy Promotion and Research Board. Each producer and importer organization may submit to the Secretary nomination(s) 

for each appointment to be made as defined in Sections 1150.131 and 1150.133 of the Order in which the organization represents producers or importers. The nominee must 

be a milk producer located in the region such person is to represent, or a dairy product importer as defined in Section 1150.121 of the Order. 

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

NAME OF NOMINEE PLEASE IDENTIFY: 

 Producer Nominee -- Region number ______ 

Importer Nominee 

If any nominee(s) is named as a result of a caucus of organizations representing milk producers in the same region or importers, identify the nominee(s) and list for each the 

names and addresses of the organizations participating in the caucus. 

NOMINEE(S) NAMES AND MAILING ADDRESSES OF ORGANIZATIONS 

NAME AND MAILING ADDRESS OF ORGANIZATION SUBMITTING THIS NOMINATION FORM 

NAME OF RESPONDING OFFICIAL (PRINT) SIGNATURE 

TITLE OF RESPONDING OFFICIAL (PRINT) 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, USA

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

According to the Paperwork Reduction Act of 1995, an agency my 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 members of the Board. Response is voluntary (7 CFR 1150.133). 

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, USA, or call (800) 795-

3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.