REPRODUCE LOCALLY. Include form number and date on all reproductions. OMB No. 0581-0178

SC-168 (Rev. 5/2017) Destroy previous editions.

UNITED STATES DEPARTMENT OF AGRICULTURE

AGRICULTURAL MARKETING SERVICE

SPECIALTY CROPS PROGRAM

COOPERATIVE OFFICIAL BALLOT

ON PROPOSED AMENDMENT OF THE MARKETING ORDER, AS AMENDED,

REGULATING THE HANDLING OF DRIED PRUNES PRODUCED IN CALIFORNIA

I hereby certify that I am an officer of, and have been authorized by:

____________________________________________________________________________________

Name and Address of Cooperative Association

to furnish the following information and cast this Ballot on behalf of such cooperative association. There are 

____ producers who: (a) are members of, stockholders in, or under contract with this cooperative association; 

(b) are now engaged in the handling of dried prunes, and also were engaged during the period of August 1, 

20___, through July 31, 20___; and (c) during the same period so handled ______ tons of dried prunes.

DOES THE COOPERATIVE ASSOCIATION FAVOR ISSUANCE, BY THE SECRETARY OF 

AGRICULTURE, OF THE PROPOSED AMENDMENT OF THE MARKETING ORDER REGULATING 

THE HANDLING OF DRIED PRUNES PRODUCED IN CALIFORNIA?

INDICATE THE VOTE OF THE ASSOCIATION BY PLACING AN “X” IN THE APPROPRIATE 

SPACE BELOW:

YES □ NO □

_____________________________________________

Name of Cooperative Association

Corporate seal: _____________________________________________

if none, so state Signature of Authorized Official

_____________________________________________

Title

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.