Fillable CONSERVATION PROGRAM APPLICATION (USDA, Office of Communications)

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CONSERVATION PROGRAM APPLICATION (USDA, Office of Communications)

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U.S. Department of Agriculture NRCS-CPA-1200
Natural Resources Conservation Service
3/2019
CONSERVATION PROGRAM APPLICATION
1. Name: 2. Application Number: 3. Application Date:
4. Address: 5. County and State: 6. Email:
7. Telephone: 8. Watershed: 9. Subaccount:
10. Location (Legal Description or Farm and Tract Number):
11. Do you have farm records established with the appropriate USDA Service Center Agency?
Yes
No
If no, you must establish them with the appropriate USDA Service Center Agency prior to
submitting this application.
12.
This is an application to participate in the:
Agricultural
Management Assistance (AMA)
Environmental
Quality Incentives Program (EQIP)
Conservation Stewardship Program
(CSP)
CSP Renewal
Agriculture Conservation Easement Program
(ACEP) - Wetland Reserve Easements (WRE)
Regional Conservation Partnership Program
(RCPP)
EQIP
CSP
Regional Conservation Partnership
Program
(RCPP)
ACEP - (WRE)
Healthy Forest Reserve Program (HFRP)
13. Are you applying to participate in a conservation program as an (check one of the following):
Individual
a) Please enter your legal name and tax identification number:
Name: _________________________________________ Tax Number: __________________
Entity (Corporation, Limited Partnership, Trust, Estate, etc.)
a) Please enter entity legal name and tax identification number:
Name: __________________________________________ Tax Number: __________________
b) Do you have appropriate documents including proof to sign for the entity? Yes No
Joint Operation (General Partnership, Joint Venture)
a) Pleas
e enter joint operation legal name and tax identification number:
Name:
_________________________________________
Tax
Number: __________________
b) Do you have appropriate documents including proof to sign for the joint operation? Yes No
Page 1 of 4
Clear Form
U.S. Department of Agriculture NRCS-CPA-1200
Natural Resources Conservation Service
3/2019
14. Is the land being offered for enrollment used for crop (including forest-related) or livestock
production?
Crop Type: ___________________________________
Crop Production
Livestock Production
Livestock Type: ________________________________
15. The land offered under this application is (check all that apply):
Private Land
Public Land (Federal, State, or Local Government)
Tribal, Allotted, Ceded or Indian Land
16. You certify that Certification of control of the land offered under the application is evidenced by:
Deed or other evidence of land ownership (required for all ACEP-WRE applications)
Written lease agreement
Years of control are_________through_____________
Other agreement or legal conveyance (describe):
Years of control are _________through ____________ or,
Evidence of historical control of land since: __________
17. Is the land offered under this application enrolled in any other conservation program?
Yes
No
18. Do you meet the criteria for any of the following categories? (mark all that apply)
Limited Resource Farmer or Rancher
Beginning Farmer or Rancher
Socially Disadvantaged Farmer or Rancher
Veteran Farmer or Rancher
Not Applicable
If you wi
sh to apply in any of these categories, you must meet the self-certification requirements.
Definitions are provided below. For more information please go to this website:
https://lrftool.sc.egov.usda.gov/
Limited Resource Farmer or Rancher – The term “Limited Resource Farmer or Rancher” means a
participant:
• With direct or indirect gross farm sales not more than the current indexed value in each of the
previous two years, and
• Who has a total household income at or below the national poverty level for a family of four, or less
than 50 percent of county median household income in each of the previous two years.
A legal entity or joint operation can be a Limited Resource Farmer or Rancher only if all individual
members independently qualify. A Self-Determination Tool is available to the public and may be
completed on-line or printed and completed hardcopy at: https://lrftool.sc.egov.usda.gov/
Page 2 of 4
U.S. Department of Agriculture NRCS-CPA-1200
Natural Resources Conservation Service
3/2019
Beginning Farmer or Rancher– The term “Beginning Farmer or Rancher” means a participant who:
• Has not operated a farm or ranch, or who has operated a farm or ranch for not more than 10
consecutive years. This requirement applies to all members of a legal entity, and who
• Will materially and substantially participate in the operation of the farm or ranch.
In the case of a
contract with an individual, individually or with the immediate family, material and substantial
participation requires that the individual provide substantial day-to-day labor and management of the farm or
ranch, consistent with the practices in the county or State where the farm is located.
In the case of a contract made with a legal entity, all members must materially and substantially participate
in the operation of the farm or ranch. Material and substantial participation requires that the members
provide some amount of the management, or labor and management necessary for day-to-day activities,
such that if the members did not provide these inputs, operation of the farm or ranch would be seriously
impaired.
Socially Disadvantaged Farmer or Rancher- The term “Socially Disadvantaged” means an individual or
entity who is a member of a socially disadvantaged group. For an entity, at least 50 percent ownership in the
farm business must be held by socially disadvantaged individuals. A socially disadvantaged group is a group
whose members have been subject to racial or ethnic prejudice because of their identity as members of a
group without regard to their individual qualities.
These groups consist of the following:
• American Indians or Alaskan Natives
• Asians
• Blacks or African Americans
• Native Hawaiians or other Pacific Islanders
• Hispanics.
Note: Gender alone i
s not a covered group for the purposes of NRCS conservation programs. The term
entities reflect a broad interpretation to include partnerships, couples, legal entities, etc.
Veteran Farmer or Rancher- The term “Veteran Farmer or Rancher” means a producer who served in
the United States Army, Navy, Marine Corps, Air Force, or Coast Guard, including the reserve
components thereof; was released from the service under conditions other than dishonorable; and--
• has not operated a farm or ranch, or has operated a farm or ranch for not more than 10 years; or
• who first obtained status as a veteran during the most recent 10-year period.
A legal entity
or joint operation can be a Veteran Farmer or Rancher only if all individual members
independently qualify.
19. Is any of the land offered for enrollment under this application:
Certified Organic by the National Organic Program (NOP)
Transitioning to become Certified Organic by the NOP
Exempt from Organic Certification as defined by the NOP
Not Applicable
Certificati
on in any of these categories is to assist with planning and will not automatically result in the
application being considered in any initiatives made available for organic-related production. Applicants must
specifically request to participate in an organic initiative. Note that the EQIP Organic Initiative has a lower
payment limitation ($140,000 over the period of fiscal years 2019-2023 per person or legal entity) than
payments made to a person or legal entity under General EQIP.
Page 3 of 4
U.S. Department of Agriculture NRCS-CPA-1200
Natural Resources Conservation Service
3/2019
On the farm(s) identified above, the Applicant agrees to participate in the identified program if the offer is
accepted by the NRCS. The undersigned shall hereafter be referred to as the "Participant." The participant
understands that starting a practice prior to contract approval causes the practice to be ineligible for
program financial assistance. The participant will provide written authorization to install structural or
vegetative practices. The Participant agrees not to start any financially assisted practice or activity or
engage the reimbursable services of a certified Technical Service Provider before a Contract is executed by
CCC. The Participant may request, in writing, a waiver of this requirement for financially assisted practices
by the NRCS State Conservationist.
All partici
pants that certify land control or certify eligibility as Limited Resource Farmer or Rancher,
Beginning Farmer or Rancher, or Veteran Farmer or Rancher, will provide all records necessary to justify
their claim as requested by a NRCS representative. It is the responsibility of the Participant to provide
accurate information to support all items addressed in this application at the request of NRCS. False
certifications are subject to criminal and civil fraud statutes.
The Partici
pant acknowledges that highly erodible land conservation/wetland conservation, adjusted gross
income certifications, and member information for entities and joint operations are on file with the FSA.
20. I have received a copy of the applicable conservation program contract appendix.
Yes
No
NON-DISCRIMINA
TION 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:
program.intake@usda.gov.
USDA is an equal opportunity provider, employer, and lender.
Page 4 of 4
Applicant Signature
Date
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CONSERVATION PROGRAM APPLICATION (USDA, Office of Communications)

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Completed 26 January 2021

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