ACP-153A Pooling Agreement Worksheet

This form is available electronically.

ACP-153A
(03-30-04)

1. SPECIAL PROJECT?

U.S. DEPARTMENT OF AGRICULTURE
Farm Service Agency

YES

2. PAGE

4. AGREEMENT NO.

OF

NO

6. COUNTY

5. STATE

POOLING AGREEMENT WORKSHEET

3. FISCAL YEAR

PART A - DESCRIPTION
7. IDENTIFICATION OF PROJECT AREA (Brief description with
attached ACP-308 Transmittal, if used)

8. PRACTICE NO.

9. TITLE

10. COLUMN H of AD-245

13. TOTAL COST

11. DEDUCTIONS

12. INELIGIBLE CONTRIBUTIONS

14. NET TOTAL (Item 13 minus Item 12)

PART B - FOR USE AFTER PROJECT IS COMPLETED
15.
FARM NO.

16.
CONTRIBUTIONS
($)

17.
FACTOR

18.
C/S
EARNED
($)

19.
PAYMENT
DEDUCTION
($)

20.
NET PAYMENT
($)

21.
CHECK NO.

22.
REMARKS

A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
M.
N.
O.
P.
Q.
R.
S.
T.
23. TOTALS

PART C - CERTIFICATION
I certify that the contributions listed in
column 16 were made by the
participants as shown.

24. AGENT'S SIGNATURE

25. DATE (MM-DD-YYYY)

The extent and cost-shares will be shown on one AD-245 for the entire agreement.
The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, gender, religion, age, disability,
political beliefs, sexual orientation, and marital or family status. (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 USDA, Director, Office of Civil Rights, Room 326-W, Whitten Building, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410 or call (202) 720-5964
(voice or TDD). USDA is an equal opportunity provider and employer.