AD-1156 Revision of Plan or Schedule of Operations or Modificati

1. To be completed by NRCS; check appropriate box:
U.S. DEPARTMENT OF AGRICULTURE

4. COUNTY

NOTE:

8

OMB No. 0578-0013

This transaction is for NRCS.

2. Page

REVISION OF PLAN OR SCHEDULE OF OPERATIONS
OR MODIFICATION OF A CONTRACT

3. NAME

ITEM
NO.

This transaction is for CCC.

5. STATE

6. CONTRACT OR
AGREEMENT NO.

of

7. REVISION OR
MODIFICATION NO.

The following statements are made in accordance with 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. This 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 a court, magistrate, or administrative tribunal.

FIELD

9

PLANNED TREATMENT
(Record of Decisions)

10

33. CERTIFICATION OF PARTICIPANTS
A. SIGNATURE
B. Date

PREVIOUS
ESTIMATED
COST-SHARE
OR PAYMENT

REVISED
AMOUNT
(UNITS)
$

11

12

C. SIGNATURE

34. SIGNATURES OF REVIEWING OFFICIALS
A. District Conservationist – Technical Adequacy Certification
SIGNATURE

B. Date

COST SHARE
OR PAYMENT
RATE
14
%
Year
13

23

D. Date

COMPLETION SCHEDULE AND ESTIMATED
COST-SHARE OR PAYMENT BY YEAR
(For Non-Cost Share Items Show Units)
15

16

17

18

19

20

21

22

Year

Year

Year

Year

Year

Year

Year

Year

24

25

26

27

28

29

30

31

E. SIGNATURE

C. APPROVED BY (Concurrence of NRCS Representative)

REF. NO.

32

F. Date

D. Date

SIGNATURE
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-1156
rev. 08-2005

U.S. DEPARTMENT OF AGRICULTURE

OMB No. 0578-0013
AD-1156
Page 2

REVISION OF PLAN OR SCHEDULE OF OPERATIONS
OR MODIFICATION OF A CONTRACT

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 37.5 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.