AD-1161 Hmong DAIM NTAWV THOV COV NYIAJ

Long Term Contracting

AD-1161_Hmong

Long Term Contracting (State and Local Government)

OMB: 0578-0013

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Qhov no yog rau CCC

1. Los NRCS; khij lub thawv kom tsim nyog..
Koos Haum ua Liaj ua Teb nyob MeskasTeb

DAIM NTAWV THOV COV NYIAJ
Ntaub ntawv yuav tsum los ntawm daim ntawv AD-1155, kev txuag npaj
raws sij hawm ntawm haujlwm, ua daim ntawv no.
Nplua rau tej lus cuav lossis nkag – raug nplua tsis pub tshaj $10,000
los yog feem raug kaw tsis pub tshaj 5 xyoo, los yog ob leeg (18 USC
1001)

OMB No. 0578-0013

Qhov no yog rau NRCS

2. LUB XEEV

3. QHOV KEV PAB CUAM LUB NPE

4. Daim ntawv cog naj npawb.

5.NYIAJ THEM NAB NPAWB

6. CHAWS NYOB

7. LUB ZOG

8. DAIM KEV CAI TSWJHWM KEV TXUAG TXOJ KEV TAU
A.
Daim ntawv
cog lus nab
Kab npawb
1
2
3
4
5

B.
Teb

C.
Xyaum thiab
chav tsev keeb

D.
Hnub pib

E.
Hnub tiav

F.
Siv chav
nyob tiav

G.
Twg

H.
Nqi nruab nrab

I.
Feem
nqi

J.
Nyiaj
khwv
tau

9. LWM YAM KEV PAB THEM NQI (APPRAISAL, DAIM NTAWV NTSUAM XYUAS, COV NYIAJ THEM POOB HAUJLWM EASEMENT,
1
ETC.)
2
3
4
5

10. NYIAJ TAU LOS:
11. FAIB COV NYIAJ THEM POOB HAUJLWM NTAWM KOOM
Tug neeg kom tes ua 1
A. Ua rau lub xeev los yog tsoom fwv teb chaws dais Yog
twg?
Tsis
yog
ib feem ntawm cov nyiaj them no
Kab
(1)
Y

Tug neeg kom tes ua 2
H.

B. Yog pes tsawg?
% Sib pub
(2)

N
O
Kab
YE
(1)
S

Nyiaj pub (3)

I. Yog pes tsawg?
% Sib pub
(2)

Nyiaj sib pub (3)

C. Txiav (NRCS los yog FSA) Kev tso cai rau
ES
J.
cov
ntaub ntawv los sis kev pab
K.
D. Nuj nqis them tseem fwv
L.
E. Lub xeev thiab tsoom fwv teb chaws pab
M.
F. Lwm yam
N.
G. Net payment due participant Vas cov nyiaj
them
neeg
12. Tug neeg kom tes daim ntawv povthawj
Kuv (peb) lees tias cov lus qhia saum toj no yeej muaj tseeb thiab yog; thiab tias lub keeb unit(s) uas tsoom fwv teb chaws kim feem thov ris thiab tau raws li cov
specifications thiab cov cai saum toj no-numbered daim ntawv cog lus /; tias yog tias tshaj ib leeg contributed rau hauv ntaub hauv keeb unit(s), raws li hais los saum
no, cov nqi feem yuav raug faib nyob rau hauv kev faib ua feem ntawm tus neeg uas lawv contributed cov ntaub ntawm lub keeb chav nyob (s). Kuv (peb) tseem lees
tias tsab ntawv teev npe no muaj cov tsis Individuals them raws li koj muaj lwm yam kev pab cuam ntawm U.S. Department of Agriculture.
Tug neeg kom tes ua 1
A. Kev ua se nab npawb. B. SS

Tug neeg kom tes ua 2

TIN C. Npe

G. Kev ua se nab npawb. H. SS

D. Chaws nyob
E. Kos npe

TIN I. Npe

J. Chaws nyob
F. Hnub

K. Kos npe

L. Hnub

TSAB NTAWV QHIA TXOG DAIM NTAWV OMB NROG
Raws li cov ntaub ntawv yuav txo tau kev cai txog rau xyoo 1995, qhov chaw ua hauj lwm tsis muaj cai los tswj, thiab tus tib neeg twg tsis thas teb cov lus noog txog ntaub ntawv yog tsis
muaj OMB tus lej qhia nws. Cov muaj OMB tus lej rau no qhia collections yog 0578-0018. Lub sij hawm yuav tsum tau los teb cov lus no sau los yog xam pom tias rau nruab nrab 30 feeb
ib lo lus teb, xws li kev muab cov lus qhia, searching muaj ntaub ntawv los, sib sau ua ke thiab ceev kom cov ntaub ntawv tsim nyog, thiab sau ntawv thiab muab cov ntaub ntawv sau.
NTAWV TSAB CAI TSIS PUB TWG PAUB
Cov nqe lus saum toj no yog ua raws li txoj cai Privacy Act of 1974 (5 U.S. C. 522a). Furnishing no yog nyob ntawm siab; Txawm li ntawd los, yog tsis leeg cov lus tseeb, tag
yuav raug txiav los thim tus kheej tej kev los yog cov nyiaj pab. Cov lus yuav tsum txhais lwm USDA, rau Internal Revenue Service, Department of Justice, los sis lwm lub xeev
los yog tsoom fwv teb chaws txoj cai lij choj, los yog nyob rau lo lus teb rau qhov kev txiav txim ntawm lub tsev hais plaub, kws, lossis kev tribunal thiab.
COV LUB TSIS PUB NTXUB NTAUG
Lub U.S. Department of Agriculture (USDA) txwv tsis pub muaj kev ntxub ntxaug nyob rau hauv tag nrho cov cov kev pab cuam thiab cov ceeb ntawm haiv neeg, xim, keeb
kwm teb chaws, pw ua ke, kev ntseeg, hnub nyoog, xiam hoob qhab, txog ib fab kev, sexual orientation, los yog ob leeg los yog tsev neeg raws li txoj cai. (Bases tsis tas txwv
tsis pub siv rau tag nrho cov kev pab cuam.) Cov neeg muaj mob xiam oob qhab uas yuav tsum tau lwm txoj kev sib txuas lus txog kev qhia (ua luam kom loj, ntawv, lwm yam)
yuav tsum hu mus rau USDA lub TARGET Center ntawm (202) 720-2600 (hnov suab thiab TDD). Sau daim ntawv tsis txaus siab rau kev ntxub ntxaug, sau ntawv mus rau
USDA, Director, Office of Civil Rights, Room 326-W, Whitten Building, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410 los sis hu rau (202) 720-5964.
Former CCC-1202, NRCS-FNM-141

Qhov kos npe los ntawm tus sawv cev rau NRCS signifies CCC los yog NRCS tham tseg saum toj no.

AD-1161
04-2002

13. SIV LOS NTAWM FSA LUB COMMITTEE XWB:
Kuv hais muaj tseeb raws li kuv paub thiab ntseeg tsab ntawv teev npe no muaj tsis Individuals uas them nyob rau hauv tej kev pab cuam
ntawm U.S. Department of Agriculture los FSA, thiab tus neeg no tsis muaj nyob rau ntawm cov ntaub ntawv thov nyiaj rau lub county tswj ua
qab indebted los tsoom fwv, tshwj raug piav rau sab nraud. Yog raws li qhov kev pab uas muaj feem xyuam, tus neeg muaj tsab ntawv AD1026 pov thawj uas raws li lub teb chaws erodible heev thiab wetland kev txuag cog cov zaub mov Security Act of 1985, raws li tau pom zoo
los lawm, thiab tsis tau txiav txim yuav tsum ua txhaum txoj txoj cai.
A. Kos npe

B. Hnub

14. Daim ntawv muaj cai los xaiv Conservationist
Kuv lees tias pab (chav keeb) ntau teev rau hauv daim
ntawv thov li saum toj no twb tau muab ris, thiab raws li
tus qauv qhia ntawv thiab specifications ntawm qhov saum
toj-numbered daim ntawv cog lus/sib cog lus.

15. Pom zoo muab ntawv pov thawj Officer
Lo cai vested nyob hauv kuv, kuv hais muaj tseeb tias yam
herein teev muaj tseeb thiab ntawn ntawv pom zoo rau kev
them nyiaj (s) xws rau cov yuav txhawb tau cov ntaub ntawv
cov ntaub ntawv.

A. Kos npe

A. Kos npe

Former CCC-1202, NRCS-FNM-141

B. Hnub

Qhov kos npe los ntawm tus sawv cev rau NRCS signifies CCC los yog NRCS tham tseg saum toj no.

B. Hnub

AD-1161
04-2002

DAIM NTAWV THOV RAU COV NYIAJ THEM POOB HAUJLWM

DAIM NTAWV OMB NROG TSAB NTAWV TAB KAUM
Tsoom fwv teb chaws cov koom haum tsis muaj cai los tswj, thiab tus tib neeg twg tsis thas teb cov lus, noog txog ntaub ntawv yog tias
nws qhia txog tam sim no muaj OMB tus lej. Pej xeem reporting tab kaum rau cov txheej lus no yog xam pom tias yuav siv li ntawm
30 feeb ib lo lus teb, nrog rau lub sij hawm rau nws muab cov lus qhia, searching cov ntaub ntawv uas twb muaj lawm los, tuaj ua thiab
tuav cov ntaub ntawv uas tsim nyog, thiab sau ntawv thiab muab cov noog txog ntaub ntawv. Xa lus txog no tab kaum kwv yees los
yog muaj lwm yam nam cov txheej lus, xws li cov tswv yim pab kom txhob tab kaum, Department of Agriculture, Clearance Officer,
OIRM (daim ntawv OMB nrog NO. 0578-0013), tsis txhob 7630, Washington, D.C. 20250-7630 no.

Former CCC-1202, NRCS-FNM-141

Qhov kos npe los ntawm tus sawv cev rau NRCS signifies CCC los yog NRCS tham tseg saum toj no.

AD-1161
04-2002


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