Form NRCS-CPA-1200 Conservation Program Application

US DEPARTMENT OF AGRICULTURE
NATURAL RESOURCES CONSERVATION SERVICE

NRCS-CPA-1200

CONSERVATION PROGRAM APPLICATION
Name:

Application Number:

Address:

Application Date:

AGENCY USE

County and State:

Telephone:

Watershed:

AGENCY USE
Subaccount:

AGENCY USE
Location (Legal Description, or Farm and Tract Number:

(Please note that not all questions apply to all Programs)
1. This is an application to participate in the:
Agricultural Management Assistance (AMA)

Environmental Quality Incentives Program (EQIP)

Conservation Security Program (CSP)

Wildlife Habitat Incentives Program (WHIP)

Grassland Reserve Program (GRP)

Healthy Forest Reserve Program (HFRP)

Wetland Reserve Program (WRP)

2.

Yes
No
Center Agency?

Do you have farm records established with the appropriate USDA Service

If no, you must establish them with the appropriate USDA Service Center Agency prior to submitting
this application.
3. Are you applying to participate in a conservation program as an (check one of the following):
Individual
a) Please enter your legal name and tax identification number:
Name:

Tax Number:

Entity (Corporation, Limited Partnership, Trust, Estate, etc.)
a) Please enter entity legal name and tax identification number:
Name:
b)

Yes

Tax Number:
No

Do you have appropriate documents including proof to sign for the entity?

Joint Operation (General Partnership, Joint Venture)
a) Please enter joint operation legal name and tax identification number:
Name:
b)

Tax Number:
Yes
operation?

No

Do you have appropriate documents including proof to sign for the joint

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US DEPARTMENT OF AGRICULTURE
NATURAL RESOURCES CONSERVATION SERVICE

NRCS-CPA-1200

4. A Dun & Bradstreet Data Universal Numbering System (DUNS) number is necessary for federal
grants or contracts equal to or more than $25,000.
If you do not have a number information is
available at http://fedgov.dnb.com/webform/displayHomePage.do
DUNS Number:
5. Is the land being offered for enrollment used for crop or livestock production?
Crop Production
Crop Type:
Livestock Production

Livestock Type:

6. The land offered under this application is (check all that apply):
Private Land
Public Land (Federal, State, or Local Government)
Tribal, Allotted, Ceded, or Indian Land
7. Certification of control of the land offered under the application:
Deed or other evidence of land ownership
Written lease agreement
Years of control are

through

Other agreement or legal conveyance (describe):
Years of control are
8.

Yes
program?

No

through

Is the land offered under this application enrolled in any other conservation

Program, Year, Tracts, Fields:
9. Are you either a Limited Resource Farmer or Rancher or a Beginning Farmer or Rancher?
Limited Resource Farmer
Beginning Farmer or Rancher
If you wish to apply in either of these categories, you must complete certification requirements. For more
information please go to this website: http://www.lrftool.sc.egov.usda.gov/.
All participants that certify eligibility as a Limited Resource Farmer or Rancher or Beginning Farmer will provide all
records necessary to justify their claim as requested by a Natural Resources Conservation Service (NRCS),
representative. It is the responsibility of the participant to provide accurate data to support all items addressed in this
application at the request of NRCS. False certifications are subject to criminal and civil fraud statutes.

10.

Yes
No If applying for the EQIP and if the application includes irrigation practices, has
the land been irrigated at least 2 of the last 5 years?

11.

Yes
No If applying for the EQIP, are you engaged in livestock or agricultural
production, and have you produced at least $1000 of agricultural products in a year? (Forest
agricultural producers may select yes as they are exempt from the $1,000 requirement )

On the farm(s) identified above, the Applicant agrees to participate in the identified program if the offer is accepted by the
NRCS. The undersigned person shall hereafter be referred to as the "Participant." The participant understands that
starting a practice prior to contract approval causes the practice to be ineligible for program financial assistance. The
participant will obtain the landowner’s signature on the contract or provide written authorization to install structural
practices.
The Participant agrees not to start any financially assisted practice or activity or engage the reimbursable services of a
certified Technical Service Provider before a Contract is executed by Commodity Credit Corporation (CCC). The
Participant may request, in writing, a waiver of this requirement for financially assisted practices by the NRCS State
Conservationist.

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US DEPARTMENT OF AGRICULTURE
NATURAL RESOURCES CONSERVATION SERVICE

NRCS-CPA-1200

All participants that certify eligibility as a Limited Resource Farmer or Rancher or Beginning Farmer will provide all
records necessary to justify their claim as requested by a NRCS representative. It is the responsibility of the participant to
provide accurate data to support all items addressed in this application at the request of NRCS. False certifications are
subject to criminal and civil fraud statutes.
The Participant acknowledges that highly erodible land conservation/wetland conservation, adjusted gross income
certifications, and member information for entities and joint operations are on file with the appropriate USDA Service
Center Agency.

12.

Yes

No

Applicant Signature

I have received a copy of the program appendix where appendix is applicable.
Date

Public Burden Statement
In accordance with the Privacy Act of 1974 (5 USC 552a) and 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 ____-____. The time required to complete this information collection is estimated
to average 45 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.

NONDISCRIMINATION STATEMENT
The U.S. Department of Agriculture (USDA) prohibits discrimination in all its program 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, 1400Independence Avenue, SW., Washington, DC 202509410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.

PRIVACY ACT STATEMENT
The following statement is made in accordance with the Privacy Act of 1974 (5 USC 552a). This information is used to track contract or
agreement progress. The authority for requesting the following information is 7 CFR 630 (Long Term Contracting); 7 CFR 1410 (CRP);
7 CFR 631 and 702 (IEQIP); 7 CFR 636 (WHIP); 7 CFR 622 (WPFPP); 7 CFR 1465 (AMA); 7 CFR 1469 (CSP); 7 CFR 625 (HFR); 7
CFR 1494 (FRPP); and 7 CFR 1467 (WRP). Furnishing information is voluntary and will be confidential; however, it is necessary in
order to receive assistance.

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