Appendix II - Model Small Business Nutrition Labeling Exemption Notice
Instructions for Completion
PLEASE TYPE OR PRINT CLEARLY AND FILL OUT COMPLETELY.
Name of Firm: Enter the legal name of your firm.
Firm Address: Enter the mailing address for the principal location of your firm. Also, provide
the telephone number, FAX number, and e-mail address.
Type of Firm: Place a check mark or "x" on each line that applies to your firm. For example, if
your firm manufactures all products that it sells, place a check mark after "Manufacturer."
12-Month Time Period for which Firm is Claiming an Exemption: Enter the specific time
period for which you are requesting an exemption for your products. The time period for
which you are claiming an exemption must be current with the date that you are
submitting your notice. The exemption notice should apply to the current year.
For products for which a notice has been filed for the previous year, update the previous dates
for the same dates of the upcoming year. For new products, the time period should start with
the date on which sales in the United States are expected to begin: e.g., "FROM 10/01/04 -
Average Number of Full-Time Equivalent Employees for Twelve-Month Period: Enter the
average number of full-time equivalent employees for your firm and all of its affiliates for the
year preceding the 12-month period for which an exemption is claimed in item 4 (Refer to the
sample small business exemption notice). For a new business, enter the number of employees
for the upcoming year. The average number should include all employees for your firm and its
affiliates, including the owner(s); officers; and all other personnel such as secretarial,
production, and distribution. Firms are affiliates of each other when (either directly or
indirectly) (1) one firm has the power to control the other, (2) a third party controls or has the
power to control both, or (3) an identity of interest exists such that affiliation may be found.
The average number of full-time equivalent employees