OMB No. 0581-0178

RAC-100C (Exp. 3/31/2024) Destroy previous versions.

RAISIN ADMINISTRATIVE COMMITTEE

2445 Capitol Street, Suite 200

Fresno, California 93721

Phone: (559) 225-0520

EXPORT PROGRAM APPLICATION FOR CASH BACK

The undersigned Packer hereby requests a cash adjustment payment from the Raisin Administrative 

Committee (RAC) for the raisins exported pursuant to this application. It is understood that upon 

submission of all required documents by the packer, the RAC will pay the cash adjustment applicable to 

the raisins exported pursuant to the Export Replacement Offer in effect as of the date of shipment. This 

application is subject to all provisions as set forth in the applicable Export Replacement Offer as approved 

by the RAC and the Secretary of Agriculture (Secretary).

Varietal Type: ___________________________ (specify)

Pack Style No. per Case No. of Cases Packed Weight

Specify weight in pounds Total Packed Weight

Natural Condition Weight

Shrinkage Allowance 

Total Packed Weight (lbs) ÷

Cash Back Requested

Country Cash Back Rate /lb $

Country

Exporter/Importer

Intended Shipment Date

*See Instructions

Packer Reference Number

**See Instructions

Must agree with Reference No. on Truck & Ocean Bills of Lading

The making of any false statement or representations in any matter within the jurisdiction of any agency of the United States, 

knowing it to be false, is a violation of title 18, section 1001 of the United States Code, which provides for a penalty of a fine or 

imprisonment of not more than five years, or both.

Packer: FOR RAC USE ONLY

By:

Date: Date 

Check No.

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 10 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.
OMB No. 0581-0178

RAC-100C (Exp. 3/31/2024) Destroy previous versions.

INSTRUCTIONS FOR COMPLETING FORM RAC-100C

No cash adjustment payment will be made by the RAC for free tonnage raisins exported until an 

application is received from the Packer. (7 U.S.C. 608d, 7 CFR 989.67). The Packer must furnish all 

information provided for in the form except that specified under “FOR RAC USE ONLY.”

Varietal Type Use terminology specified in section 989.11 of Marketing Order No. 989,

as amended.

Pack Style Specify the packed configuration of the cases shipped, such as “30 lbs.,”

“48/15 oz.,” or “36/125 gm.”

No. per Case Specify the net fruit weight per case.

No. of Cases Specify the number of cases applied for as shipped for the specified pack 

style.

Packed Weight Multiply the net weight per case (No. per Case) by the number of cases 

shipped (No. Cases).

Total Packed Weight Add the computed packed weight for each pack style.

Natural Condition Weight Divide the Total Packed Weight by the shrinkage factor as specified in the 

export replacement offer.

“Cash Back” Requested Multiply the Natural Condition Weight by the “Cash Back” rate as 

specified in Exhibit A of the applicable Export Replacement Offer.

Country Specify the final country of destination for this shipment.

Exporter/Importer Specify the name of the Exporter/Importer to whom the raisins were 

shipped.

Intended Shipment Date Specify the date the shipment was made from the packing plant. 

*Documentation may be required to verify shipments.

Packer Reference No. Provide a reference number that has been used to identify this shipment. 

**Documentation may be required to verify quality and/or volume.

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.