AD-2024 Sponsored Volunteer Program Service Agreement

This form is available electronically. Form Approved - OMB No. 0560-0232
AD-2024 U.S. DEPARTMENT OF AGRICULTURE (04-28-04) Farm and Foreign Agricultural Service SPONSORED VOLUNTEER PROGRAM SERVICE AGREEMENT
NOTE: The following statement is made in accordance with the Privacy Act of 1974 (5 USC 552a) and the Paperwork Reduction Act of 1995, as amended. The authority for requesting the following information is 7 U.S.C. 2272 (Sec. 1526) Food and Agriculture Action of 1981. The information will be used to inform volunteers of the nature of appointment with respect to service credit for leave or other employee benefits. Furnishing the requested information is voluntary. Failure to furnish the requested information will result in your application not being processed to participate in this program. This information may be provided to other agencies, IRS, Department of Justice, or other State and Federal law enforcement agencies, and in response to a court magistrate or administrative tribunal. The provisions of criminal and civil fraud statutes, including 18 USC 286, 287, 371, 641, 651, 1001; 15 USC 714m; and 31 USC 3729, may be applicable to the information provided. 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 0560-0232. The time required to complete this information collection is estimated to average 15 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. RETURN THIS COMPLETED FORM TO THE APPROPRIATE AGENCY.
If the volunteer is sponsored by a group or organization, that group or organization must complete this agreement before volunteer begins services.
1. NAME OF SPONSOR/ORGANIZATION (Print)
     
2. ADDRESS (Street, City, State, Zip Code)					3. TELEPHONE NUMBER (Include Area Code)
     					     
4. DUTY STATION (Address)				5. SELECT AGENCY WORK IS TO BE PERFORMED (Choose only one)
     				FAS FSA RMA Complete a separate form for each Agency.
6. DESCRIPTION OF WORK TO BE PERFORMED:
     
7. The above‑described work will be contribute to what is identified in Item 6. Except as provided below, the work performed by the participants will not confer on them or on our employees or officers the status of federal employees.
8. We will provide the Agency with a listing of participants and hours and days contributed to accomplish the work in Item 6 above.
9. We will obtain parental or guardian consent for each individual under 18 years of age and will comply with child labor laws.
10.	     		is hereby designated to serve as our liaison with the Agency identified
in Item 5 in day‑to‑day operations under this agreement.
11. We understand that the Agency identified in Item 5 or we, may cancel this agreement at any time by notifying the other party.
12A. SIGNATURE OF SPONSOR/ORGANIZATION							12B. DATE (MM-DD-YYYY)
							     
13. Agency identified in Item 5 acceptance of services described below:
A. Provide such materials, equipment, and facilities as are available and needed in performing the work described above.
B. Incidental expenses, such as transportation and meals may be paid by the Agency when these expenses are related to the performance of work for the Agency.
C. Consider sponsored participants as federal employees for the purpose of tort claims and compensation for work injuries, to the extent not covered by the sponsor. Authorization by Pub. L. 97‑98.
D. Authorize sponsored participants to operate federal motor vehicles when necessary provided the individual holds a valid state driver’s license.
14A. SIGNATURE (Agency)		14B. TITLE				14C. UNIT		14D. DATE (MM-DD-YYYY)
		     				     		     

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.

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16. REMARKS
     
17. The Sponsor/Organization desire to make available the volunteer services of the following person(s) to assist with the Agency identified in Item 6.
A. Volunteer 1:
(1) Name of Volunteer (First, Middle, Last)	(2) Home Address		(3) Date of Birth (MM- DD-YYYY)	(4) SSN.	(5) Telephone No. (Area Code)
     	     		     	     	     
(6) Duties to Perform
     
(7) Effective Date (MM-DD-YYYY)		(8) Fiscal Year
     		     
B. Volunteer 2:
(1) Name of Volunteer (First, Middle, Last)	(2) Home Address		(3) Date of Birth (MM- DD-YYYY)	(4) SSN.	(5) Telephone No. (Area Code)
     	     		     	     	     
(6) Duties to Perform
     
(7) Effective Date (MM-DD-YYYY)		(8) Fiscal Year
     		     

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C. Volunteer 3:
(1) Name of Volunteer (First, Middle, Last)		(2) Home Address			(3) Date of Birth (MM- DD-YYYY)	(4) SSN.	(5) Telephone No. (Area Code)
     		     			     	     	     
(6) Duties to Perform
     
(7) Effective Date (MM-DD-YYYY)				(8) Fiscal Year
     				     
D. Volunteer 4:
(1) Name of Volunteer (First, Middle, Last)		(2) Home Address			(3) Date of Birth (MM-DD-YYYY)	(4) SSN.	(5) Telephone No. (Area Code)
     		     			     	     	     
(6) Duties to Perform
     
(7) Effective Date (MM-DD-YYYY)				(8) Fiscal Year
     				     
E. Volunteer 5:
(1) Name of Volunteer (First, Middle, Last)		(2) Home Address			(3) Date of Birth (MM-DD-YYYY)	(4) SSN.	(5) Telephone No. (Area Code)
     		     			     	     	     
(6) Duties to Perform
     
(7) Effective Date (MM-DD-YYYY)			(8) Fiscal Year
     			     
F. Volunteer 6:
(1) Name of Volunteer (First, Middle, Last)		(2) Home Address			(3) Date of Birth (MM-DD-YYYY)	(4) SSN.	(5) Telephone No. (Area Code)
     		     			     	     	     
(6) Duties to Perform
     
(7) Effective Date (MM-DD-YYYY)			(8) Fiscal Year
     			     

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G. Volunteer 7:
(1) Name of Volunteer (First, Middle, Last)			(2) Home Address		(3) Date of Birth (MM-DD-YYYY)		(4) SSN.	(5) Telephone No. (Area Code)
     			     		     		     	     
(6) Duties to Perform
     
(7) Effective Date (MM-DD-YYYY)				(8) Fiscal Year
     				     
H. Volunteer 8:
(1) Name of Volunteer (First, Middle, Last)			(2) Home Address		Date of Birth (MM-DD-YYYY)		(4) SSN.	(5) Telephone No. (Area Code)
     			     		     		     	     
(6) Duties to Perform
     
(7) Effective Date (MM-DD-YYYY)				(8) Fiscal Year
     				     
I. Volunteer 9:
(1) Name of Volunteer (First, Middle, Last)			(2) Home Address		Date of Birth (MM-DD-YYYY)		(4) SSN.	(5) Telephone No. (Area Code)
     			     		     		     	     
(6) Duties to Perform
     
(7) Effective Date (MM-DD-YYYY)				(8) Fiscal Year
     				     
18. TERMINATION OF AGREEMENT
18A. AGREEMENT TERMINATED ON (Month, Day, Year )		18B. SIGNATURE OF RESPONSIBLE OFFICIAL				18C. SIGNATURE OF VOLUNTEER/STUDENT