State Plan (Narrative)

AMS Grant Programs

SCBGP State Plan Narrative 8-30-16

Specialty Crop Block Grant Program-Farm Bill (State)

OMB: 0581-0240

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0581-0240 can be found here:

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OMB No. 0581-0240

GRANT ADMINISTRATION TEMPLATE
The State department of agriculture must include the following information once at the beginning of the State Plan.

RECIPIENT INFORMATION
State Department of Agriculture:

Enter the State Department of Agriculture

STATE PLAN COORDINATOR
List the person at the State department of agriculture directly responsible for administering the state plan.

Coordinator Name:
Title:
Phone Number:
Email:

Enter the Coordinator’s Name
Enter the Coordinator’s Title
Enter the Coordinator’s Phone Number
Enter the Coordinator’s Email

OUTREACH
OUTREACH TO SPECIALTY CROP STAKEHOLDERS TO IDENTIFY FUNDING PRIORITIES
States are encouraged to conduct outreach to specialty crop stakeholders to receive and consider public comment to identify state
funding priority needs in solely enhancing the competitiveness of specialty crops prior to development of your request for proposals or
applications.

OUTREACH TO IDENTIFY FUNDING PRIORITIES
Provide the steps you took to conduct outreach to identify funding priorities.

IDENTIFIED FUNDING PRIORITIES
Provide the funding priority needs identified through your outreach to specialty crop stakeholders. Add more funding priorities by
copying and pasting the existing listing, or delete funding priorities that aren’t necessary.

Funding Priority 1
Funding Priority 2
Funding Priority 3
Add other funding priorities as necessary

OUTREACH NOT CONDUCTED (IF APPLICABLE)
If outreach was not conducted to identify funding priorities, provide an explanation why it was not conducted.

OUTREACH TO SOCIALLY DISADVANTAGED AND BEGINNING FARMERS

IDENTIFYING SOCIALLY DISADVANTAGED AND BEGINNING FARMERS
Describe the methods used to identify socially disadvantaged and beginning farmers within your state.

ENGAGING SOCIALLY DISADVANTAGED AND BEGINNING FARMERS
Describe the methods used to reach out to these groups to inform them about the SCBGP.

OUTREACH NOT CONDUCTED (IF APPLICABLE)
If outreach was not conducted to socially disadvantaged farmers and beginning farmers, provide an explanation why it was not
conducted.

COMPETITIVE REVIEW PROCESS
PROPOSAL SOLICITATION
Describe the methods you used to solicit proposals that met the identified specialty crop funding priority needs.

GRANT PROPOSALS RECEIVED
Number of Grant Proposals Received:

Enter the Number of Proposals

APPLICATION REVIEW PANEL
REVIEWER SELECTION
Describe how you selected reviewers to ensure the review panel consisted of technical experts from various fields, who were qualified
and able to perform high quality and fair reviews.

REPRESENTED FIELDS OF EXPERTISE
Provide the fields of expertise the review panel members represented (i.e., botanists, food nutrition experts, commodity association
representatives, etc.).

PREVENTING REAL OR PERCEIVED CONFLICT OF INTEREST
Describe how you documented and ensured reviewers were free from conflicts of interest (i.e., reviewers signed a conflict of interest
statement).

SHARING THE RESULTS OF COMPETITIVE PROCESS WITH APPLICANTS
Describe how you will provide or did provide results of the peer review panel to the grant applicants while ensuring the confidentiality
of the review panel members.

COMPETITIVE PROCESS NOT CONDUCTED (IF APPLICABLE)
If you did not conduct a competitive grant process, provide an explanation as to why you did not.

OVERALL STATE PLAN BUDGET SUMMARY
Please ensure the total budget equals the State’s available grant allocation and that the total indirect costs do not exceed 8 percent of
your total grant request.

Project Title

Direct

Indirect

Total

1
2
3
4
5
6
7
8
9
10
11
12
Grant Administration
Total

STATE DEPARTMENT OF AGRICULTURE OVERSIGHT
If you are using grant funds for direct administration of the grant agreement, provide the start and end dates for the use of these funds.

Start Date:

Start Date

End Date:

End Date

GRANT ADMINISTRATION BUDGET NARRATIVE
All expenses described in this Budget Narrative must be associated with administration expenses for the SCBGP. Applicants should review
the Request for Applications section 4.7 Funding Restrictions prior to developing their budget narrative.
Please review previous State Plans to ensure that you are not requesting grant administration costs for the same activities for the same
period as previously awarded. The Specialty Crop Block Grant Program (SCBGP) will not fund duplicative costs. Your administrative
costs, which consist of indirect expenses associated with grant administration and individual project indirect costs, must not exceed 8
percent of your total grant request.

Budget Summary
Expense Category

Funds Requested

Personnel
Fringe Benefits
Travel
Equipment
Supplies
Contractual
3

Budget Summary
Expense Category

Funds Requested

Other
Direct Costs Subtotal
Indirect Costs
Total Budget
Budget Breakdown by Year
Year 2
Year 3

Year 1

Total

PERSONNEL
List the organization’s employees whose time and effort can be specifically identified and easily and accurately traced to project activities
that solely enhance the competitiveness of specialty crops. See the Request for Applications section 4.7.2 Allowable and Unallowable Costs
and Activities, Salaries and Wages, and Presenting Direct and Indirect Costs Consistently under section 4.7.1 for further guidance.

Name/Title

Level of Effort (# of
hours OR % FTE)

Funds
Requested

1
2
3
4
Personnel Subtotal

PERSONNEL JUSTIFICATION
For each individual listed in the above table, describe the activities to be completed by name/title including approximately when activities
will occur. Add more personnel by copying and pasting the existing listing or deleting personnel that aren’t necessary.

Personnel 1:
Personnel 2:
Personnel 3:
Add other Personnel as necessary

FRINGE BENEFITS
Provide the fringe benefit rates for each of the project’s salaried employees described in the Personnel section that will be paid with
SCBGP funds.

#
1
2
3
4

Name/Title

Fringe Benefit Rate

Fringe Subtotal

Funds Requested

TRAVEL
Explain the purpose for each Trip Request. Please note that travel costs are limited to those allowed by formal organizational policy; in
the case of air travel, project participants must use the lowest reasonable commercial airfares. For recipient organizations that have no
formal travel policy and for-profit recipients, allowable travel costs may not exceed those established by the Federal Travel Regulation,
issued by GSA, including the maximum per diem and subsistence rates prescribed in those regulations. This information is available at
http://www.gsa.gov. See the Request for Applications section 4.7.2 Allowable and Unallowable Costs and Activities, Travel, and Foreign
Travel for further guidance.

Trip Destination

Type of
Expense
(airfare, car
rental, hotel,
meals,
mileage, etc.)

Unit of
Measure
(days,
nights,
miles)

# of
Units

Cost
per
Unit

# of
Travelers
Claiming
the Expense

Funds
Requested

1
2
3
4
5
6
7
Travel Subtotal

TRAVEL JUSTIFICATION
For each trip listed in the above table describe the purpose of this trip and how it will achieve the objectives and outcomes of the project.
Be sure to include approximately when the trip will occur. Add more trips by copying and pasting the existing listing or delete trips that
aren’t necessary.

Trip 1 (Approximate Date of Travel MM/YYYY):
Trip 2(Approximate Date of Travel MM/YYYY):
Trip 3(Approximate Date of Travel MM/YYYY):
Add other Trips as necessary

CONFORMING WITH YOUR TRAVEL POLICY
By checking the box to the right, I confirm that my organization’s established travel policies will
be adhered to when completing the above-mentioned trips in accordance with 2 CFR 200.474.

☐

EQUIPMENT
Describe any special purpose equipment to be purchased or rented under the grant. ‘‘Special purpose equipment’’ is tangible,
nonexpendable, personal property having a useful life of more than one year and an acquisition cost that equals or exceeds $5,000 per
unit and is used only for research, medical, scientific, or other technical activities. See the Request for Applications section 4.7.2 Allowable
and Unallowable Costs and Activities, Equipment - Special Purpose for further guidance.
Rental of "general purpose equipment’’ must also be described in this section. Purchase of general purpose equipment is not allowable
under this grant. See Request for Applications section 4.7.2 Allowable and Unallowable Costs and Activities, Equipment - General Purpose
for definition, and Rental or Lease Costs of Buildings, Vehicles, Land and Equipment.

Rental or
Purchase

Item Description

Acquire
When?

Funds
Requested

1
2
3
4
Equipment Subtotal

EQUIPMENT JUSTIFICATION
For each Equipment item listed in the above table describe how this equipment will be used to achieve the objectives and outcomes of
the project. Add more equipment by copying and pasting the existing listing or delete equipment that isn’t necessary.

Equipment 1:
Equipment 2:
Equipment 3:
Add other Equipment as necessary

SUPPLIES
List the materials, supplies, and fabricated parts costing less than $5,000 per unit and describe how they will support the purpose and
goal of the proposal and solely enhance the competitiveness of specialty crops. See Request for Applications section 4.7.2 Allowable and
Unallowable Costs and Activities, Supplies and Materials, Including Costs of Computing Devices for further information.

Item Description

Per-Unit
Cost

# of Units/Pieces
Purchased

Acquire
When?

Funds Requested

Supplies Subtotal

SUPPLIES JUSTIFICATION
Describe the purpose of each supply listed in the table above purchased and how it is necessary for the completion of the project’s
objective(s) and outcome(s).

CONTRACTUAL/CONSULTANT
Contractual/consultant costs are the expenses associated with purchasing goods and/or procuring services performed by an individual
or organization other than the applicant in the form of a procurement relationship. If there is more than one contractor or consultant,
each must be described separately. (Repeat this section for each contract/consultant.)

ITEMIZED CONTRACTOR(S)/CONSULTANT(S)
Provide a list of contractors/consultants, detailing out the name, hourly/flat rate, and overall cost of the services performed. Please note
that any statutory limitations on indirect costs also apply to contractors and consultants.

#
1
2
3
4

Name/Organization

Hourly Rate/Flat Rate

Funds Requested

Contractual/Consultant Subtotal

CONTRACTUAL JUSTIFICATION
Provide for each of your real or anticipated contractors listed above a description of the project activities each will accomplish to meet
the objectives and outcomes of the project. Each section should also include a justification for why contractual/consultant services are
to be used to meet the anticipated outcomes and objectives. Include timelines for each activity. If contractor employee and consultant
hourly rates of pay exceed the salary of a GS-15 step 10 Federal employee in your area (for more information please go to
http://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/2016/general-schedule/), provide a justification for the
expenses. This limit does not include fringe benefits, travel, indirect costs, or other expenses. See Request for Applications section 4.7.2
Allowable and Unallowable Costs and Activities, Contractual and Consultant Costs for acceptable justifications.

Contractor/Consultant 1:
Contractor/Consultant 2:
Contractor/Consultant 3:
Add other Contractors/Consultants as necessary

CONFORMING WITH YOUR PROCUREMENT STANDARDS
By checking the box to the right, I confirm that my organization followed the same policies and
procedures used for procurements from non-federal sources, which reflect applicable State and local
laws and regulations and conform to the Federal laws and standards identified in 2 CFR Part 200.317
through.326, as applicable. If the contractor(s)/consultant(s) are not already selected, my
organization will follow the same requirements.

☐

OTHER
Include any expenses not covered in any of the previous budget categories. Be sure to break down costs into cost/unit. Expenses in this
section include, but are not limited to, meetings and conferences, communications, rental expenses, advertisements, publication costs,
and data collection.
If you budget meal costs for reasons other than meals associated with travel per diem, provide an adequate justification to support that
these costs are not entertainment costs. See Request for Applications section 4.7.2 Allowable and Unallowable Costs and Activities, Meals
for further guidance.

Item Description

Per-Unit
Cost

Number
of Units

Other Subtotal

Acquire
When?

Funds Requested

OTHER JUSTIFICATION
Describe the purpose of each item listed in the table above and how it is necessary for the completion of the project’s objective(s) and
outcome(s).

INDIRECT COSTS
The indirect cost rate must not exceed 8 percent of your total grant request.
Indirect costs are any costs that are incurred for common or joint objectives that therefore, cannot be readily identified with an individual
project, program, or organizational activity. They generally include facilities operation and maintenance costs, depreciation, and
administrative expenses. See Request for Applications section 4.7.1 Limit on Administrative Costs and Presenting Direct and Indirect
Costs Consistently for further guidance.

Indirect Cost Rate

Funds Requested

Indirect Subtotal

SCBGP PROJECT PROFILE TEMPLATE
The State Plan should include a series of project profiles that detail the necessary information to fulfill the goals and
objectives of each project. The acceptable font size for the narrative is 11 or 12 pitch with all margins at 1 inch. The
following information must be included in each project profile.

PROJECT TITLE
Provide a descriptive project title in 15 words or less in the space below.

DURATION OF PROJECT
Start Date:

Start Date

End Date:

End Date

PROJECT PARTNER AND SUMMARY
Include a project summary of 250 words or less suitable for dissemination to the public. A Project Summary provides a very brief (one
sentence, if possible) description of your project. A Project Summary includes:
1.
2.
3.

The name of the applicant organization that if awarded a grant will establish an agreement or contractual relationship with
the State department of agriculture to lead and execute the project,
A concise outline the project’s outcome(s), and
A description of the general tasks to be completed during the project period to fulfill this goal.

FOR EXAMPLE:
The ABC University will mitigate the spread of citrus greening (Huanglongbing) by developing scientifically-based
practical measures to implement in a quarantine area and disseminating results to stakeholders through grower
meetings and field days.

PROJECT PURPOSE
PROVIDE THE SPECIFIC ISSUE, PROBLEM OR NEED THAT THE PROJECT WILL ADDRESS

PROVIDE A LISTING OF THE OBJECTIVES THAT THIS PROJECT HOPES TO ACHIEVE
Add more objectives by copying and pasting the existing listing or delete objectives that aren’t necessary.

Objective 1
Objective 2
Objective 3
Objective 4
Add other objectives as necessary

PROJECT BENEFICIARIES
Estimate the number of project beneficiaries:

Enter the Number of Beneficiaries

Does this project directly benefit socially disadvantaged farmers as defined in the RFA? Yes

☐

No ☐

Does this project directly benefit beginning farmers as defined in the RFA?

☐

No ☐

Yes

STATEMENT OF SOLELY ENHANCING SPECIALTY CROPS
By checking the box to the right, I confirm that this project solely enhances the competitiveness
of specialty crops in accordance with and defined by 7 U.S.C. 1621. Further information regarding
the definition of a specialty crop can be found at www.ams.usda.gov/services/grants/scbgp.

☐

CONTINUATION PROJECT INFORMATION
If your project is continuing the efforts of a previously funded SCBGP project, address the following:

DESCRIBE HOW THIS PROJECT WILL DIFFER FROM AND BUILD ON THE PREVIOUS EFFORTS
PROVIDE A SUMMARY (3 TO 5 SENTENCES) OF THE OUTCOMES OF THE PREVIOUS EFFORTS
PROVIDE LESSONS LEARNED ON POTENTIAL PROJECT IMPROVEMENTS
What was previously learned from implementing this project, including potential improvements?

How are the lessons learned and improvements being incorporated into the project to make the ongoing
project more effective and successful at meeting goals and outcomes?

DESCRIBE THE LIKELIHOOD OF THE PROJECT BECOMING SELF-SUSTAINING AND NOT
INDEFINITELY DEPENDENT ON GRANT FUNDS
OTHER SUPPORT FROM FEDERAL OR STATE GRANT PROGRAMS
The SCBGP will not fund duplicative projects. Did you submit this project to a Federal or State grant program other than
the SCBGP for funding and/or is a Federal or State grant program other than the SCBGP funding the project currently?
Yes

☐

IF YOUR PROJECT IS RECEIVING OR WILL POTENTIALLY RECEIVE FUNDS FROM ANOTHER
FEDERAL OR STATE GRANT PROGRAM
Identify the Federal or State grant program(s).

Describe how the SCBGP project differs from or supplements the other grant program(s) efforts.

EXTERNAL PROJECT SUPPORT
Describe the specialty crop stakeholders who support this project and why (other than the applicant and organizations involved in the
project).

EXPECTED MEASURABLE OUTCOMES
SELECT THE APPROPRIATE OUTCOME(S) AND INDICATOR(S)/SUB-INDICATOR(S)
You must choose at least one of the eight outcomes listed in the SCBGP Performance Measures, which were approved by the Office of
Management and Budget (OMB) to evaluate the performance of the SCBGP on a national level.

OUTCOME MEASURE(S)
Select the outcome measure(s) that are applicable for this project from the listing below.

☐
☐
☐
☐

Outcome 1: Enhance the competitiveness of specialty crops through increased sales (required for
marketing projects)
Outcome 2: Enhance the competitiveness of specialty crops through increased consumption
Outcome 3: Enhance the competitiveness of specialty crops through increased access
Outcome 4: Enhance the competitiveness of specialty crops though greater capacity of sustainable
practices of specialty crop production resulting in increased yield, reduced inputs, increased efficiency,
increased economic return, and/or conservation of resources
Outcome 5: Enhance the competitiveness of specialty crops through more sustainable, diverse, and
resilient specialty crop systems
Outcome 6: Enhance the competitiveness of specialty crops through increasing the number of viable
technologies to improve food safety
Outcome 7: Enhance the competitiveness of specialty crops through increased understanding of the
ecology of threats to food safety from microbial and chemical sources
Outcome 8: Enhance the competitiveness of specialty crops through enhancing or improving the
economy as a result of specialty crop development

OUTCOME INDICATOR(S)
Provide at least one indicator listed in the SCBGP Performance Measures and the related quantifiable result. If you have multiple
outcomes and/or indicators, repeat this for each outcome/indicator.

FOR EXAMPLE:
Outcome 2, Indicator 1.a.
Of the 150 total number of children and youth reached, 132 will gain knowledge about eating more specialty crops.
3

MISCELLANEOUS OUTCOME MEASURE
In the unlikely event that the outcomes and indicators above the selected outcomes are not relevant to your project, you must develop a
project-specific outcome(s) and indicator(s) which will be subject to approval by AMS.

DATA COLLECTION TO REPORT ON OUTCOMES AND INDICATORS
Explain how you will collect the required data to report on the outcome and indicator in the space below.

BUDGET NARRATIVE
All expenses described in this Budget Narrative must be associated with expenses that will be covered by the SCBGP. If any matching
funds will be used and a description of their use is required by the State department of agriculture, the expenses to be covered with
matching funds must be described separately. Applicants should review the Request for Applications section 4.7 Funding Restrictions
prior to developing their budget narrative.

Budget Summary
Expense Category

Funds Requested

Personnel
Fringe Benefits
Travel
Equipment
Supplies
Contractual
Other
Direct Costs Subtotal
Indirect Costs
Total Budget

PERSONNEL
List the organization’s employees whose time and effort can be specifically identified and easily and accurately traced to project
activities that solely enhance the competitiveness of specialty crops. See the Request for Applications section 4.7.2 Allowable and
Unallowable Costs and Activities, Salaries and Wages, and Presenting Direct and Indirect Costs Consistently under section 4.7.1 for
further guidance.

Level of Effort (# of
hours OR % FTE)

Name/Title

1
2
3
4
Personnel Subtotal

PERSONNEL JUSTIFICATION

Funds
Requested

For each individual listed in the above table, describe the activities to be completed by name/title including approximately when
activities will occur. Add more personnel by copying and pasting the existing listing or deleting personnel that aren’t necessary.

Personnel 1:
Personnel 2:
Personnel 3:
Add other Personnel as necessary

FRINGE BENEFITS
Provide the fringe benefit rates for each of the project’s salaried employees described in the Personnel section that will be paid with
SCBGP funds.

#
1
2
3
4

Name/Title

Fringe Benefit Rate

Funds Requested

Fringe Subtotal

TRAVEL
Explain the purpose for each Trip Request. Please note that travel costs are limited to those allowed by formal organizational policy; in
the case of air travel, project participants must use the lowest reasonable commercial airfares. For recipient organizations that have
no formal travel policy and for-profit recipients, allowable travel costs may not exceed those established by the Federal Travel
Regulation, issued by GSA, including the maximum per diem and subsistence rates prescribed in those regulations. This information is
available at http://www.gsa.gov. See the Request for Applications section 4.7.2 Allowable and Unallowable Costs and Activities, Travel,
and Foreign Travel for further guidance.

Trip Destination

Type of
Expense
(airfare, car
rental, hotel,
meals,
mileage, etc.)

Unit of
Measure
(days,
nights,
miles)

# of
Units

Cost
per
Unit

# of
Travelers
Claiming
the Expense

Funds
Requested

1
2
3
4
5
6
7
Travel Subtotal

TRAVEL JUSTIFICATION
For each trip listed in the above table describe the purpose of this trip and how it will achieve the objectives and outcomes of the
project. Be sure to include approximately when the trip will occur. Add more trips by copying and pasting the existing listing or delete
trips that aren’t necessary.

Trip 1 (Approximate Date of Travel MM/YYYY):
Trip 2(Approximate Date of Travel MM/YYYY):
Trip 3(Approximate Date of Travel MM/YYYY):
Add other Trips as necessary

☐

EQUIPMENT
Describe any special purpose equipment to be purchased or rented under the grant. ‘‘Special purpose equipment’’ is tangible,
nonexpendable, personal property having a useful life of more than one year and an acquisition cost that equals or exceeds $5,000 per
unit and is used only for research, medical, scientific, or other technical activities. See the Request for Applications section 4.7.2
Allowable and Unallowable Costs and Activities, Equipment - Special Purpose for further guidance
Rental of "general purpose equipment’’ must also be described in this section. Purchase of general purpose equipment is not allowable
under this grant. See Request for Applications section 4.7.2 Allowable and Unallowable Costs and Activities, Equipment - General
Purpose for definition, and Rental or Lease Costs of Buildings, Vehicles, Land and Equipment.

Rental or
Purchase

Item Description

Acquire
When?

Funds
Requested

1
2
3
4
Equipment Subtotal

Equipment 1:
Equipment 2:
Equipment 3:
Add other Equipment as necessary

Item Description

Per-Unit
Cost

# of Units/Pieces
Purchased

Acquire
When?

Funds Requested

Supplies Subtotal

SUPPLIES JUSTIFICATION
Describe the purpose of each supply listed in the table above purchased and how it is necessary for the completion of the project’s
objective(s) and outcome(s).

ITEMIZED CONTRACTOR(S)/CONSULTANT(S)
Provide a list of contractors/consultants, detailing out the name, hourly/flat rate, and overall cost of the services performed. Please
note that any statutory limitations on indirect costs also apply to contractors and consultants.

#
1
2
3
4

Name/Organization

Hourly Rate/Flat Rate

Funds Requested

Contractual/Consultant Subtotal

Contractor/Consultant 1:
Contractor/Consultant 2:
Contractor/Consultant 3:
Add other Contractors/Consultants as necessary

☐

OTHER
Include any expenses not covered in any of the previous budget categories. Be sure to break down costs into cost/unit. Expenses in this
section include, but are not limited to, meetings and conferences, communications, rental expenses, advertisements, publication costs,
and data collection.
If you budget meal costs for reasons other than meals associated with travel per diem, provide an adequate justification to support
that these costs are not entertainment costs. See Request for Applications section 4.7.2 Allowable and Unallowable Costs and Activities,
Meals for further guidance.

Item Description

Per-Unit
Cost

Number
of Units

Acquire
When?

Funds Requested

Other Subtotal

OTHER JUSTIFICATION
Describe the purpose of each item listed in the table above purchased and how it is necessary for the completion of the project’s
objective(s) and outcome(s).

INDIRECT COSTS
The indirect cost rate must not exceed 8 percent of any project’s budget. Indirect costs are any costs that are incurred for common or
joint objectives that therefore, cannot be readily identified with an individual project, program, or organizational activity. They
generally include facilities operation and maintenance costs, depreciation, and administrative expenses. See Request for Applications
section 4.7.1 Limit on Administrative Costs and Presenting Direct and Indirect Costs Consistently for further guidance.

Indirect Cost Rate

Funds Requested

Indirect Subtotal

PROGRAM INCOME
Program income is gross income—earned by a recipient or subrecipient under a grant—directly generated by the grant-supported
activity, or earned only because of the grant agreement during the grant period of performance. Program income includes, but is not
limited to, income from fees for services performed; the sale of commodities or items fabricated under an award (this includes items
sold at cost if the cost of producing the item was funded in whole or partially with grant funds); registration fees for conferences, etc.

Source/Nature of Program
Income

Description of how you will reinvest the
program income into the project to solely
enhance the competitiveness of specialty crops

Program Income
Total

Estimated
Income

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 0581-0240. The time required
to complete this information collection is estimated to average 10 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.

USDA’S NONDISCRIMI NA T ION STATEMENT (EFFE CTIVE 2015)

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:
1)

mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C.
20250-9410;

fax: (202) 690-7442; or

email: [email protected].
USDA is an equal opportunity provider, employer, and lender.

File Type	application/pdf
Author	Greer, Jenny - AMS
File Modified	2016-08-31
File Created	2016-08-30