TM-10CG Application for Accreditation

REPRODUCE LOCALLY. Include form number and edition date on all reproductions.
FORM APPROVED - OMB No. 0581-0191
U.S. DEPARTMENT OF AGRICULTURE
Please send electronic version to: [email protected] and mail original to:
AGRICULTURAL MARKETING SERVICE
Deputy Administrator, National Organic Program
USDA, Agricultural Marketing Service
1400 Independence Ave., SW, Room 2648 So., Ag Stop 0268
APPLICATION FOR ACCREDITATION
Washington, DC 20250-0268
NOTE: The following statements are made in accordance with the Privacy Act of 1974 (U.S.C. 522a) and the Paperwork Reduction Act of 1995, as amended. The
authority for requesting this information to be supplied on this form is the Agricultural Marketing Agreement Act of 1937, Secs. 1-19, 48 Stat. 31, as amended, (7 U.S.C.
601-674). Furnishing the requested information is necessary for the administration of this program. Submission of the Tax identification Number (TIN) or Employer
Identification Number (EIN) is mandatory, and will be used to determine affiliation or entity identity. Please note that background statements will not become invalid if a
TIN or EIN is not disclosed.
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 0581-0191. The time required to complete this form is estimated to
average .25 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.
The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs 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, S.W., Washington, D.C. 20250-9410, or call (800) 795-3272
(voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.
The undersigned hereby applies for accreditation to the National Organic Program, U.S. Department of Agriculture.
Business Name, Mailing Address, and Primary Office Location (if different)
Name of person responsible for day-to-day operations:
Title of person responsible for day-to-day operations:
Tax ID#

EMail address:

Telephone Number:
Fax Number:

PLEASE ESTIMATE THE ANNUAL ANTICIPATED NUMBER OF CERTIFICATIONS FOR EACH TYPE OF ACCREDITATION
CROPS
LIVESTOCK
WILD CROP
HANDLING
LEGAL STATUS (Check one)
GOVERNMENT
OTHER ( (Specify)
FOR-PROFIT
NOT FOR PROFIT
BUSINESS
BUSINESS
I, (We), affirm that, if granted accreditation, I (we) will carry out the provisions of 7 CFR Part 205 including:
1.
Accepting the certification decisions made by another certifying agent accredited or accepted by USDA;
2.
Refraining from making false or misleading claims about my (our) accreditation status, the USDA accreditation program for certifying agents, or the nature or
qualities of products labeled as organically produced;
3.
Conducting an annual performance evaluation of all persons who review applications for certification, perform on-site inspections, review certification documents,
evaluate qualifications for certification, make recommendations concerning certification, or make certification decisions and implement measures to correct any
deficiencies in certification services;
4.
Having an annual internal program review conducted of certification activities by the certifying agent's staff, an outside auditor, or a consultant who has the
expertise to conduct such reviews and implement measures to correct any noncompliance’s with the Organic Foods Production Act of 1990 (Act) and the
provisions of 7 CFR Part 205;
5.
Paying and submitting fees to AMS;
6.
Complying with, implementing, and carrying out any other terms and conditions determined by the Administrator to be necessary;
7.
(Items 7, 8, and 9 apply only to private entities)
Holding the Secretary harmless for any failure on my (our) part to carry out the provisions of the Act and 7 CFR Part 205;
8.
Furnishing reasonable security, in an amount and according to such terms as the Administrator may by regulation prescribe, for the purpose of protecting the rights
of production and handling operations that I (we) certify under the Act and 7 CFR Part 205;
9.
Transferring to USDA and making available to the applicable State organic program’s governing State official all records or copies of records concerning my (our)
certification activities in the event that I (we) dissolve or lose my (our) accreditation. Such transfer does not apply to a merger, sale, or other transfer of ownership
of a certifying agent.
SIGNATURE OF APPLICANT OR REPRESENTATIVE
PRINT OR TYPE NAME OF SIGNEE
TITLE OF APPLICANT OR REPRESENTATIVE

DATE

PLEASE ATTACH:
1) A list of each organizational unit, such as chapters or a subsidiary office including the name, office location, mailing address, and contact numbers (telephone,
facsimile, and Internet address), and the name of a contact person for each unit; 2) A copy of the fee schedule for all services to be provided under these regulations by the
applicant; 3) For a government entity, a copy of the official’s authority to conduct certification services under 7 CFR Part 205; 4) For a private entity, documentation
showing the entity’s status and organizational purpose, such as articles of incorporation and by-laws or ownership or membership provisions, and it’s date of
establishment; 5) A list of each State or foreign country in which the applicant currently certifies production and handling operations and a list of each State or foreign
country in which the applicant intends to certify production and handling operations; 6) The requirements of 7 CFR Part 205, § 205.504, Evidence of expertise and
ability.

FOR USE BY USDA
DATE OF RECEIPT

TM-10CG (11-16)

NAME OF RECIPIENT

SIGNATURE OF RECIPIENT