OMB No. 0581-0178

SC-124 (Rev. 5/2017) Destroy previous editions.

UNITED STATES DEPARTMENT OF AGRICULTURE

AGRICULTURAL MARKETING SERVICE

SPECIALTY CROPS PROGRAM

CONFIDENTIAL CALIFORNIA WALNUT BOARD NOMINEE QUESTIONNAIRE

GROWER AND HANDLER MEMBERS

NOTE: This information will be used by the Secretary of Agriculture in selecting grower and handler members and alternates to 

serve on the California Walnut Board (Board) under Marketing Order No. 984 (Order). Statutory authority to obtain this 

information is provided in 7 U.S.C. 608.

1. Name: ___________________________________________________________________________________

2. (a) Residence: _____________________________________________________________________________

(Street, City, State, and Zip Code)

(b) Mailing Address: (if same, so state) _________________________________________________________

(Street, City, State, and Zip Code)

(c) Telephone Number: (H) __________________ (W) __________________ (C) _________________

(d) E-mail Address: ________________________________________________________________________

3. (a) Number of years of experience in the walnut industry: _______________

4. (a) Have you previously served on the California Walnut Board? □ yes □ no If yes, how many years? ______

5. (a) Are you a producer of walnuts? □ yes □ no

(c) If yes, state acreage of the English varieties of walnuts you own or lease: ___________ acres

(d) Is your operation certified organic? □ yes □ no

6. (a) Did you produce walnuts during the current year? □ yes □ no

(b) If 6(a) is “yes,” state kernelweight pounds of the English varieties of walnuts you produced: ___________ 

pounds. Of these, how many kernelweight pounds (if any) were organic? ___________ pounds

7. If you are a walnut producer, employee, or officer of a walnut producer, state the name of your handler:

_________________________________________________________________________________________

8. If you are a walnut handler, employee, or officer of a walnut handler, state the following:

(a) Name of the handler(s): ___________________________________________________________________

(b) Your title and capacity: ___________________________________________________________________

(c) Number of years experience in the position: ___________________________________________________

(d) Please state the kernelweight poundage of the English varieties of walnuts handled by your firm during the

current crop year: ___________ pounds

9. When acting in my official capacity as a Board representative, I shall engage in only those activities that are authorized 

under the Order. I also understand that the Board cannot become involved in lobbying and political activities.

10. If marketing order committee (or board) or subcommittee members or committee employees are sued individually or jointly 

for errors in judgment, mistakes or other acts either of omission or commission (except for acts of dishonesty, willful 

misconduct, or gross negligence) in the conduct of their duties under the marketing agreement or Order, they may be 

authorized legal defense by the Department of Justice (DOJ). Alternatively, legal defense may be provided through private 

counsel, if recommended by the Department of Agriculture (USDA) and approved by DOJ. USDA and DOJ enjoy an 

excellent working relationship with respect to providing legal representation for Committee members and employees, either 

by DOJ or through authorized private counsel. USDA is committed to a comprehensive legal defense policy for all 

Committee members and employees acting within the scope of their authorized committee duties and responsibilities.

11. I hereby certify that I am willing to serve as a member or alternate member on the Board if selected by the Secretary of 

Agriculture.

____________________________________________________________________________________________

Type or print name as signed Signature Date

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.
OMB No. 0581-0178

SC-124 (Rev. 5/2017) Destroy previous editions.

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.