AD-1155A Conservation Plan Schedule of Operations

1. To be completed by NRCS; check appropriate box:

This transaction is for CCC.

U.S. DEPARTMENT OF AGRICULTURE

✔

OMB No. 0578-0013

This transaction is for NRCS.

2. Page

CONSERVATION PLAN
SCHEDULE OF OPERATIONS

3

of

4

The above statements are made in accordance with the 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. The 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 of a court, magistrate, or administrative tribunal.

3. NAME

4. COUNTY

Sammy Soil

ITEM
NO.

8

FIELD

9

1,2

5. STATE

Huron

PLANNED CONSERVATION
TREATMENT
(Record of Decisions)
10

ESTIMATED
AMOUNT
(UNITS)

11

OH
COST
BASIS
$

12

COST SHARE
OR PAYMENT
RATE
%
13

6. CONTRACT OR
AGREEMENT NO.

7. TOTAL ACRES UNDER
200
CONTRACT

755E342001234

COMPLETION SCHEDULE AND ESTIMATED
COST-SHARE OR PAYMENT BY YEAR
(For Non-Cost Share Items Show Units)
Year
2020

Year
2021

Year
2022

Year
2023

Year
2024

Year

Year

Year

Year

Year

23

REF.
NO.

24

25

26

27

28

29

30

31

32

33

34

14

15

16

17

18

19

20

21

22

A. Total Cost-Share or Payment
by Year
B. Total Contract
Payment:

NOTES:
A. All items numbered in column 8 on form AD-1155 must be carried out as a part of this contract to prevent violation.
B. When established, the conservation practices listed in column 8 must be maintained by the participant at no cost to the government.
C. Enter total cost per unit in column 12 on form AD-1155 unless the method of cost-share is flat rate. When flat rate, enter the amount per unit to be paid to the participant.
D. All cost share rates in column 13 are based on average cost with the following exceptions:
AA = Actual costs not to exceed average cost.
FR = Flat rate.
NC = Non cost-shared.
AM = Actual cost not to exceed a specified maximum.
AP = Annual payment.
NP = Non-Participant Payment
E. Modifications will be referenced by the number in column number 34 on form AD-1155.
F. By signing, the participant acknowledges receipt of this conservation plan including form AD-1155 and this form AD-1155A and agrees to comply with the terms and
conditions hereof.
35. CERTIFICATION OF PARTICIPANTS
A. SIGNATURE
C. SIGNATURE
E. SIGNATURE
B. Date
D. Date
F. Date
36. SIGNATURES OF REVIEWING OFFICIALS
A. District Conservationist – Technical Adequacy Certification
SIGNATURE

B. Date

C. APPROVED BY (Conservation District Representative)

D. Date

SIGNATURE
The signature by the NRCS representative signifies a CCC or NRCS transaction as indicated above.

AD-1155A

OMB No. 0578-0013

U.S. DEPARTMENT OF AGRICULTURE

AD-1155A

OMB Disclosure Statement
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 0578-0013. The time required to complete this information
collection is estimated to average 37.3 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.
Privacy Act Statement
The above statements are made in accordance with the Privacy Act of 1974 (5 U.S.C. Section 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. The 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 of a court, magistrate, or
administrative tribunal.
Non-Discrimination Statement
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 How to File a Program
Discrimination Complaint 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; (2) fax: (202) 690-7442; or (3) email:
[email protected].
USDA is an equal opportunity provider, employer, and lender.

The signature by the NRCS representative signifies a CCC or NRCS transaction as indicated above.