No Form Number Beef (Monthly Report) (Paper)

B

OMB 0581-0093

eef Promotion and Research Board

A program designed to increase demand for beef

Information is required by (7 CFR 1260.201). Failure to report can result in a fine. Information is held confidential (7 CFR 1260.203)

MONTHLY REPORT REMITTANCE FOR ALL CATTLE PURCHASED OR MARKETED IN THE MONTH OF:

_______________________________, _______________

This report and assessments must be remitted by the fifteenth day of the month following the month in which the cattle were marketed. Late payments are subject to a 2% per month late payment charge.

Instructions: Please provide the following information on all cattle you or your company marketed by completing the following table:

CATTLE AND CALVES
State of origin		Total Number of head marketed		Number of head NOT assessed		Number of head per State Assessed
			-		=
			-		=
			-		=
			-		=
			-		=
			-		=
			-		=
			-		=
			-		=
			-		=
			-		=
		Total		Total		Total
Send report and check payable to:	(insert collecting handler address)						x $1.00 / Head
						Amount Due	$
Please retain a copy for your records.

I declare under the penalties provided by law, that this report has been examined by me and to the best of my knowledge is a true, correct and complete report. I also certify that I am authorized to sign this report.

Date;	Responding official’s Name (Print)
Title (Print)	Signature

“The following statements are made in accordance with the Privacy Act of 1974 (U.S.C. 522a) and the Paperwork Reduction Act of 1995, as amended. The authority for requesting this

information to be supplied on this form is the Commodity Promotion, Research, and Information Act of 1996, Pub. L. 104-127, 110 Stat.1032 (7 U.S.C. 7411-7425). Furnishing the requested

information is necessary for the administration of this program. Submission of Tax Identification Number (TIN) or Employer Identification Number (EIN) is mandatory, and will be used to

determine affiliation or entity identification”.

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 0581-0093. The time required to complete this information collection is estimated to average 1 hour 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.

Beef Promotion and Research Board

A program designed to increase demand for beef

COMPLETING A MONTHLY REMITTANCE FORM

This form should be completed each month and should include all cattle purchased during the previous month. You have until the 15th of the following month to send in the form and money. (EXAMPLE: If you buy cattle in January the form and a check is due February 15).

MONTH-- The month in which the cattle was purchased.

ID NO. -- Whatever number you use to file with the IRS (Federal Identification Number). Individuals should use their social security number.

COMPANY-- Company's name or, if you buy as an individual, your own name.

LATE CHARGE -- Failure to remit checkoff assessments by the due date will result in a late payment charge of 2% per month, compounded monthly, until all amounts due are paid.

STATE OF ORIGIN -- The state where the cattle resided for at least 30 days prior to the time they were bought or sold. If they came from another state within the last 30 days, write in the abbreviation of that state. Otherwise, write the abbreviation for your state. Example: If you buy cattle that have been in your state for only 20 days, the state of origin is the state they came from, not your state.

TOTAL NUMBER OF HEAD MARKET -- The total number of cattle you purchased.

NUMBER OF HEAD NOT ASSESSED -- Cattle for which you received a non-producer status from, a brand inspection certificate showing collection of the checkoff within 10 days of the transaction or cattle which you purchased from an auction market.

NUMBER OF HEAD ASSESSED PER STATE -- This is the number of animals on which you collected checkoff dollars. It is the total number of animals marketed minus those not assessed.

TOTAL -- Total for the entire month. Just add each column.

AMOUNT DUE -- The number in this box is the amount due. Send your check along with the white copy of this form to the:

(Insert Collecting handler address)

PENALTIES -- You can be subject to two penalties:

a) a civil penalty of up to $5,500 per violation.

b) for fraudulent use of a government form a fine up to $10,000 and imprisonment up to five years.

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.