ACP-4 FMO Exempt Handler Notification

Administrative Committee for Pistachios OMB No. 0581-0215

1318 E. Shaw Avenue, Suite 420

Fresno, CA 93710-7912

Ph (559) 221-8294 Fax (559) 221-8044

Email: Info@pistachio.org

ACP Form 4 – FMO Exempt Handler Notification

This form is submitted to the Administrative Committee for Pistachios if, as a Handler, you receive 1000 Pounds or less (assessed weight) of pistachios in a given production year.

Section A: Handler must complete this form and mail to the ACP by November 15^th of each production year. Handler is responsible for keeping a copy of the completed form for their own records for 3 years following the production year in which the pistachios were shipped.

H andler Name:

A ddress:

C ity: State: Zip Code:

A ssessed weight handled: Lbs.

P roduction Year:

H andler signature: Date:

N ame: Title:

The making of any false statements 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, United States Code, which provides for a penalty of a fine of $250,000 for individuals and $500,000 for organizations or imprisonment of not more than five years, 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 0581-0215. The time required to complete this information collection is estimated to average 6 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.

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual’s income is derived from any public assistance program (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at (202) 720-2600 (voice and TDD). To file a complaint of discrimination, write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer. To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, Room 326-W, Whitten Building, 1400 Independence Avenue, SW, Washington, DC 20250-9410 or call 202-720-5964 (voice and TDD). USDA is an equal opportunity provider and employer.

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