FORM APPROVED BY OMB No. 0581-0125
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UNITED STATES DEPARTMENT OF AGRICULTURE
Agricultural Marketing Service Specialty Crops Program
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Good Agricultural Practice & Good Handling Practices Audit Program (GAP&GHP) Identity Preservation Program (IP) Partners in Quality Audit Program (PIQ) & Other Audit Programs |
AGREEMENT FOR PARTICIPATION IN AUDIT VERIFICATION PROGRAMS |
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Company Information |
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I a duly authorized representative of (Insert Name)
(Name of Company) (Street Address, City, State, and Zip Code)
hereinafter referred to as the applicant, do hereby agree to be audited under the a voluntary USDA, AMS, Specialty Crops Inspection Division audit program. The audit shall include verification of the company’s farm(s), packing facilities, storage facilities, wholesale distribution centers or other locations as applicable to the audit scope(s). |
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SC-651 (rev. 06-2016) Page 1 of 2
FORM APPROVED BY OMB No. 0581-0125
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Approved By: |
Should AMS personnel be at a facility for other purposes and notice issues that would jeopardize the company’s standing on the specific audit program, AMS has the obligation to bring this to the attention of the company representative and, depending on the severity, withdraw certification.
Name of Applicant (Print): Title:
Signature: Date:
USDA Agricultural Marketing Service, Fruit & Vegetable Programs/ Federal or Federal-State Inspection Program Supervisor
Name of Representative (Print): Title:
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 0581-0125. The time required to complete this information collection is estimated average 8.5 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.
In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, gender identity (including gender expression), sexual orientation, disability, age, marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident. Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the responsible Agency or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English. To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at http://www.ascr.usda.gov/complaint_filing_cust.html and at any USDA office or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by:
USDA is an equal opportunity provider, employer, and lender.
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SC-651 (rev. 06-2016) Page 2 of 2
File Type | application/msword |
File Title | FORM APPROVED BY OMB No |
Author | jfrey |
Last Modified By | Pish, Marylin - AMS |
File Modified | 2016-06-09 |
File Created | 2016-06-09 |