AD-2025 Volunteer Attendence Record

This form is available electronically. Form Approved - OMB No. 0560-0232

		AD-2025 (04-28-04)			U.S. DEPARTMENT OF AGRICULTURE Farm and Foreign Agriculture Service VOLUNTEER ATTENDANCE RECORD (Attendance Records must be maintained by the requesting office)
		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.
		1. NAME OF VOLUNTEER (Please type or print last, first and middle name):											2. Social Security No.	3. Month	4. Fiscal Year
		     											     	  	    
A. DATE (MM-DD-YYYY)			B. ARRIVAL TIME			C. DEPARTURE TIME		D. NUMBER OF HOURS			E. LOCATION
	     			     			     		  			     
	     			     			     		  			     
	     			     			     		  			     
	     			     			     		  			     
	     			     			     		  			     
	     			     			     		  			     
	     			     			     		  			     
	     			     			     		  			     
	     			     			     		  			     
	     			     			     		  			     
	     			     			     		  			     
	     			     			     		  			     
	     			     			     		  			     
	     			     			     		  			     
	     			     			     		  			     
	     			     			     		  			     
	     			     			     		  			     
	     			     			     		  			     
	     			     			     		  			     
	     			     			     		  			     
	     			     			     		  			     
		F. Total Hours								   
		5A. Volunteer Signature											5B. Date Signed (MM-DD-YYYY)      
		AD-2025 (Page 2 of 2) (04-28-04)
		6. To be completed by responsible Agency official:
		6A. Responsible official signature											6B. Date Signed (MM-DD-YYYY)      
		6C. Name of requesting office      											6D. Check Applicable Agency: FSA FAS RMA

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.