DDP-C Eligible Distributor Certification Form

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Overview

Version
Instructions
Certification

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Sheet 1: Version

	#VALUE!		qa
	Form:
	Eligible Distributor Certification Form
	Version: 20210513	Replaces: N/A
AMS-Dairy Program	Owner: Management	Approved by: Managing Author
	/s/ Erin Taylor	/s/ Patrick S. Clark

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Sheet 2: Instructions

No.	Instructions for the Eligible Distributor Certification Form		INFORMATION>
1	It is important that this Workbook is not altered and that each record is completed fully in the [Certification] tab so that the approval process and/or reimbursements are not delayed.
2	The [Certification] tab must be signed and then emailed to your eligible dairy organization (EDO) partner so that the full submission package can be submitted to AMS. A separate Certification must be completed for each EDO you are partnering with.
3	Eligibility and Definitions: 1. To qualify as an eligible dairy organization, you must be a dairy farmer cooperative or a dairy processor that: (1) accounts to a Federal Milk Marketing Order; and (2) incurs a qualified expense described in 7 CFR § 1147.1. 2. To qualify as an eligible distributor, the distributor must be a public or private non-profit feeding organization distributing or coordinating distribution of donated eligible dairy products to recipient individuals and families.
4	Under these donation programs (Milk Donation Reimbursement Program and Dairy Donation Program), eligible dairy organizations that incur qualified expenses related to certain dairy product donations may apply for and receive specified reimbursements to help cover expenses. This program is intended to encourage the donation of dairy products to recipient individuals and families while reducing food waste.
5	For More Information: Click icon(s) located in Row 1 of this tab (starting in Column E) Website: www.ams.usda.gov/ddp Email: [email protected]

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Sheet 3: Certification

	Eligible Distributor Certification
	Please review pertinent donation programs' regulations to ensure eligibility.
	Email this form to your Eligible Dairy Organization (EDO) partner after completing and signing Certification statement below.
	By typing your name below, you are certifying that your organization meets the requirements laid out in the pertinent donation programs' regulations.
	You must type name in signed box, enter all contact information, company name, and all mailing address information in yellow shaded area below (Extension, Fax, and Address Line 2 may be omitted, if not needed).
SignedPln
DatePln
TitlePln
PhonePln
ExtensionPln		<Not a Required Field.
FaxPln		<Not a Required Field.
TaxIDPln
EmailPln
CompanyPln
Address1Pln
Address2Pln		<Not a Required Field.
CityPln
StatePln
ZipPln
DescriptionPln
PartnerPln
SubmissionPln		<For Internal Use Only.
	After completing this form and certifying, email this and the Certifications from the Eligible Distributor Partners to Dairy Program for approval.
	This form must be completed in order for your partnering eligible dairy organization to receive reimbursements under the Dairy Donation Program.