OMB No. 0581-0178 

The following statements are made in accordance with the Privacy Act of 1974 (5 U.S.C. 552a) and the Paperwork Reduction Act of 1995, as 

amended. The authority for requesting the information to be supplied on this form is the Agricultural Marketing Agreement Act of 1937, Secs. 1-19, 48 

Stat. 31, as amended, (7 U.S.C. 601-674). Furnishing the requested information is necessary for the administration of the marketing order 

program. Submission of the Tax Identification Number (TIN) is mandatory, and will be used to determine affiliation or entity identity. If a TIN is not 

disclosed, the information provided will not become invalid if another means of identifying the entity exists.

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 5 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.

RAC-5 (Exp. 3/31/2024) Destroy previous versions.

RAISIN ADMINISTRATIVE COMMITTEE 

2445 Capitol Street, Suite 200

Fresno, California 93721

Phone: (559) 225-0520

NOTIFICATION OF INTENTION TO HANDLE RAISINS

AND APPLICATION FOR INSPECTION POINT

The __________________________________________________ hereby gives notice that it intends to handle

raisins as a packer (§ 989.14), or handler (§ 989.15), as defined in Marketing Order No. 989 regulating raisins 

produced from grapes grown in California, and requests that the premises outlined in the description on file with the 

Raisin Administrative Committee (RAC) be designated as an inspection point for the 20___ crop year.

The undersigned declares the following concerning the ownership, organization and management of the company 

named:

Name of Company: ____________________________________________________________________________ 

Principal Address: _____________________________________________________________________________ 

Mailing Address: ______________________________________________________________________________ 

Phone Number: ___________________________________ Fax Number: _________________________________ 

Email Address: _______________________________________________________________________________ 

Type of Company: □ Corporation □ Partnership □ Cooperative □ Sole Proprietor

Tax Identification Number (TIN) ________________________________

Officers, owner, or managers:

Name Title

Name Title

Name Title

Location of plant(s) and receiving point(s) to be designated as inspection point(s):

____________________________________________________________________________________ 

____________________________________________________________________________________ 

□ Premises description on file with RAC still applicable. □ Premises description attached.

Signature RAC Approval

Title Title

Date Date

Application requires signatures of both above-named parties to be official.