FSA-409A Measurement Service Request Register - Appendix

Measurement Service Record

FSA0409A_proposal 1

OMB: 0560-0260

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Form Approved – OMB No. 0560-0260

This form is available electronically. Expiration date (03/XX/2019)


FSA-409A U. S. DEPARTMENT OF AGRICULTURE

(proposal 1) Farm Service Agency


MEASUREMENT SERVICE REQUEST REGISTER

1. COUNTY

     

2. STATE

     

This form is used to aid in accounting for measurement service requests in counties where a large volume of requests are received.

NOTE:

Public Burden Statement (Paperwork Reduction Act):  Public reporting burden for this collection is estimated to average 15 minutes per response, including reviewing instructions, gathering and maintaining the data needed, completing (providing the information), and reviewing the collection of information. You are not required to respond to the collection or FSA may not conduct or sponsor a collection of information unless it displays a valid OMB control number of 0560-0260.

3.

FARM NUMBER



4.

FARM OPERATOR


5.

DATE MEASUREMENT

SERVICE REQUEST

RECEIVED

6.

DATE MEASUREMENT

SERVICE PERFORMED

7.

DATE OPERATOR

IS NOTIFIED OF

DETERMINATION

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

    

     

     

     


File Typeapplication/msword
File TitleFSA-409A, Measurement Service Request Register.
AuthorFSA
Last Modified BySYSTEM
File Modified2019-03-20
File Created2019-03-20

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