AD-1155 Conservation Plan Schedule of Operations

1. To be completed by NRCS; check appropriate box:

This transaction is for CCC.

U.S. DEPARTMENT OF AGRICULTURE

3. NAME

ITEM
NO.

8

9

PLANNED CONSERVATION
TREATMENT
(Record of Decisions)

10

2. Page

5. STATE

7. TOTAL ACRES UNDER
CONTRACT

ESTIMATED
AMOUNT
(UNITS)

11

OMB No. 0578-0013

CONSERVATION PLAN
SCHEDULE OF OPERATIONS
4. COUNTY

FIELD

This transaction is for NRCS.

COST
BASIS
$

12

COST SHARE
OR PAYMENT
RATE
%

13

6. CONTRACT OR
AGREEMENT NO.

of

COMPLETION SCHEDULE AND ESTIMATED
COST-SHARE OR PAYMENT BY YEAR
(For Non-Cost Share Items Show Units)
14

15

16

17

18

19

20

21

22

23

Year

Year

Year

Year

Year

Year

Year

Year

Year

Year

24

25

26

27

28

29

30

31

32

33

REF.
NO.

34

PRIVACY ACT STATEMENT
The above statements are made in accordance with the Privacy Act of 1974 (5 U.S.C 522a). Furnishing this information is voluntary; however, failure to furnish correct, complete information will result in the withholding or
withdrawal of such technical or financial assistance. The information may be furnished to other USDA agencies, the Internal Revenue Service, the Department of Justice, or other State or Federal law enforcement agencies,
or in response to orders of a court, magistrate, or administrative tribunal.
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, 1400 Independence Avenue, SW., Washington, DC 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD).
USDA is an equal opportunity provider and employer.

The signature by the NRCS representative signifies a CCC or NRCS transaction as indicated above.

AD-1155
rev. 08-2005

U.S. DEPARTMENT OF AGRICULTURE

OMB No. 0578-0013
AD-1155
Page 2

CONSERVATION PLAN
SCHEDULE OF OPERATIONS
OMB BURDEN STATEMENT
Federal Agencies may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Public reporting burden for
this collection of information is estimated to average 37.3 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. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this
burden, to Department of Agriculture, Clearance Officer, OIRM (OMB NO. 0578-0013), Stop 7630, Washington, D.C. 20250-7630.