OMB No. 0581-0178

PMC 4.71B (Exp. 3/31/2024) Destroy previous editions.

PRUNE MARKETING COMMITTEE

3840 Rosin Court, Suite 170

Sacramento, CA 95834

USER'S CERTIFICATE OF NON-HUMAN USAGE OF DRIED UNDERSIZED PRUNES

P-S Inspection 

Certificate No.: _________________________________ Handler: ___________________________________

Note: To be completed and forwarded after undersized prunes have been used.

Manifest or

B/Lading No.

Net Prune

Weight

Prunes to be

Used for

Name of

Trucking Co.

Date

Received

Tractor

License No.

Trailer

License No.

CERTIFICATION: The undersigned hereby certifies to the United States Department of Agriculture and to the 

Prune Marketing Committee (Committee) that the above-described dried undersized prunes 

were used for the following purpose, _______________________________ on 

__________________, 20___, at (usage location) 

_____________________________________________________________________.

Name of user firm: _________________________________________________________

Address____________________________________________________________________

Date: _____________________________________________________________________

Signature & Title: ___________________________________ Date: ________________

INSTRUCTIONS: Complete immediately upon usage of the described dried undersized prunes. Return the 

original to the Committee. The Committee will forward a copy to your supplier. Also retain 

a copy for your records. 

IMPORTANT NOTICE: This report is required by law (7 U.S.C. 608(d). 7CFR 993.50, 993.150(g)(2)(iv).

FAILURE TO REPORT can result in a fine for each such violation and each day during which such violation 

continues shall be deemed a separate violation. The issuance of a false certificate, knowing it to be false, is a 

violation of title 18, section 1001 of the United States Code, which provides a penalty of a fine or imprisonment, or 

both.

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.