Form R&D-1 Form R&D-1

UNITED STATES DEPARTMENT OF AGRICULTURE

RISK MANAGEMENT AGENCY

OMB Approved 0563-0065

Administrative Contact _________________________________ Organization _________________________________________

Title ________________________________________________

Address____________________________________________________________________________________________________

Phone Number _______________________________________ E-Mail ________________________________________________

Principal Investigator _________________________________ Organization __________________________________________

Title _______________________________________________

Address____________________________________________________________________________________________________

Phone Number _______________________________________ E-Mail ________________________________________________

Short Proposal Title (15 words or less): _____________________________________________________________

_______________________________________________________________________________________________

Total Funding Requested (All years): _______________________________________________________________

Affected States: _________________________________________________________________________________

(No more than 250 words) Proposal Summary

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 0563-0065. The time required to complete this information collection is estimated to average .50 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. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0563-0065), Washington, DC 20503

Form R&D-1