AMS-33 Agreement Face Sheet

OMB 0581-NEW

United States Department of Agriculture

Agricultural Marketing Service

AGREEMENT FACE SHEET

1. Accounting Code: XXXXXXXXXX		2. Vendor I.D. (EIN): XX-XXXXXX			3. DUNS Number: XX-XX-XXXX
4. Agreement Number: 12-25-X-XXXX	Amendment Number:	5. Type of Instrument: Grant			6. CFDA Number: 10.XXX
7. Title of Agreement:
8. Objective:
9. Statement of Work: This agreement shall be carried out by the organizational units or officials of the Federal Agency and the Grantee in the manner and subject to the conditions provided in the __ Terms and Conditions attached hereto and made a part of this agreement.
10. Legal Authority:
11. Federal Agency (Name and Address): Agricultural Marketing Service United States Department of Agriculture Washington, DC 20250				12. Grantee:
13. Federal Agency Project Manager: , Project Manager Telephone: (XXX) XXX-XXXX Email:				14. Grantee Project Coordinator: Telephone: (XXX) XXX-XXX Email:
15. Period of Performance: ##/##/#### through ##/##/####				16. Federal Agency Funding Amount: $XXX,XXX.XX		Non-Federal Matching Amount: $0
PROVISIONS
This Grant Award incorporates the following:
FOR THE UNITED STATES DEPARTMENT OF AGRICULTURE This agreement, subject to the provisions above, shall constitute an obligation of funds on behalf of the Government, unless amended or terminated by mutual consent of the parties in writing, or terminated by either party upon 60 days notice in writing.
17. Federal Agency Representative Approval: Associate Administrator Agricultural Marketing Service				18. Grantee Representative Approval (Please Print): Name: Title:
19. Federal Agency Representative Approval Signature:			Date:	20. Grantee Representative Approval Signature:			Date:

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 0581-NEW  The time required to complete this information collection is estimated to average 2 hours 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. 

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.

AMS-33