Fillable Hemp Reporting Package All reports submitted electronically must (New York State)

Fill Online, Printable, Fillable, Blank Hemp Reporting Package All reports submitted electronically must (New York State) Form

Use Fill to complete blank online NEW YORK STATE pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Hemp Reporting Package All reports submitted electronically must (New York State)

On average this form takes 140 minutes to complete

The Hemp Reporting Package All reports submitted electronically must (New York State) form is 9 pages long and contains:

  • 0 signatures
  • 2 check-boxes
  • 560 other fields

Country of origin: US
File type: PDF

Free fillable forms for New York State

BROWSE NEW YORK STATE FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
1
Hemp Reporting Package
All hemp license holders under the NYS Hemp Program must submit the reports below by the specified deadlines in
accordance with the following directions. Failure to submit any of the reports by their respective due dates will compromise the
licensee’s ability to amend, renew, and/or maintain an authorization. Any incomplete or illegible reports will be returned.
All reports submitted electronically must be sent as PDF files.
Compliance Reporting Schedule
Report Due
Required if you don’t
grow this year?
Required for Nursery or
Seed Retail licenses?
Required for
Research licenses?
Planting Report
Within 20 days of each planting
Yes
Yes
Yes
Pre-Harvest Report
30 days before each harvest
No
No
No
Post-Harvest Report
Within 15 days of each harvest
No
No
Yes
Disposal Report
Within 10 days of disposal date
If any hemp is disposed
If any hemp is disposed
If any hemp is disposed
Remediation Report
10 business days before remediation date
No
No
No
Theft Report
Within 5 days of filing police report
If any hemp is stolen
If any hemp is stolen
If any hemp is stolen
Non-Compliant Report
Within 5 days of receiving high results
If high THC result
No
If high THC result
Additional Report Required for Nursery Grower and Seed Retail License
Monthly Sales Report
1
st
of the month
No
Yes
No
NYS Site IDs are the ID numbers assigned to each location by the state. Write NYS Site IDs as they appear on your Authorized
Sites list
FSA Lot #s are the (Farm#-Tract#-Field#-Subfield#) as they appear on the FSA-578 form submitted to the FSA
**For all reports, each row should be for a single variety with the specific area of that variety, NOT a total of the site.**
Area should be in acres for outdoor sites and square feet for indoor sites. Use the appropriate sub-column for your measurements.
1. Planting Report
• This report is required even if you are not growing. If you are not growing this season, check the ‘not growing’ box at the
bottom of the form.
• This form must be submitted for each planting of seeds, unrooted cuttings, or rooted plants.
o If you start seeds in a greenhouse (or other location) and plan to move them to a field (or other location), you must submit a
report for the greenhouse planting with ‘Transfer’ in the “Date of Harvest” column and then submit a second report for the
field planting at the time of transfer.
o If you perform multiple plantings at one location (ex: in a greenhouse), a report is required each time.
• Nursery/microgreen growers with reoccurring sales/harvests must submit one planting report per year and indicate the frequency
of their plantings/harvests in the “Date of Harvest” column. Nursery growers must include the age of the plants that will be sold.
o Ex: “5 microgreen harvests per week of 2022”; “Planting biweekly from May-July 2022 to sell 2-week-old seedlings”
Submit a map/aerial photograph of each site identified on this report and indicate varietal separation and access points.
Submit with this report a copy of the seed/plant label(s) or invoice(s) from purchase.
2. Pre-Harvest Report
• The harvest end date must be no later than 15 days after the harvest start date. Exceptions to this rule may be requested at the
time of submission. Additional or delayed harvests must be reported on another form.
• Contact your chosen private sampler and obtain their NYS Sampler Certification ID to include on this form. Also, choose which
private lab from the registered list will test your sample and include their information.
Submit a map/aerial photograph of each site identified on this report and indicate varietal separation and access points.
3. Post-Harvest Report
• This report is only required if you harvested your crop. If your crop was destroyed, please fill out a disposal report.
4. Disposal Report
• Disposal methods must be approved by the Department before destruction occurs.
Submit with this report verification of crop destruction for each site.
5. Remediation Report
• Remediation method must be approved by the Department before remediation occurs.
• Contact your chosen private sampler and obtain their NYS Sampler Certification ID to include on this form. Also, choose which
private lab from the registered list will test your sample and include their information.
6. Theft Report
• Report any missing or stolen hemp to the police as soon as possible.
• Obtain the official police document/report number for your case and include the information on this report.
7. Non-Compliant Report
• This form is only necessary when you receive a high THC result from a non-regulatory sample i.e. one not required by the state.
Submit with this report a copy of the Certificate of Analysis.
8. Monthly Sales Report **Required only for those with a Nursery Grower License or Seed Retail License.**
• Amount of product sold should be given in pounds for seed stock and in number of plants for nursery stock.
• All sales must be to state or federal authorized growers. Buyers’ Hemp License Numbers are required on this form.
SUBMIT COMPLETED REPORTS TO:
Division of Plant Industry
10B Airline Drive
Albany, NY 12235
Fax No. (518) 457-1204
IndustrialHempNYS@agriculture.ny.gov
(Only PDF files will be accepted electronically)
ATTACH ADDITIONAL SHEETS AS NECESSARY
2
2022 Hemp Planting Report Form
PLEASE REVIEW THE INSTRUCTIONS ON PAGE 1 PRIOR TO COMPLETING THIS FORM
Mailing Address:
Authorization Number: 36-____________
Person Responsible for Management of Hemp Production:
Email: Phone:
Growing address for this report: County:
Site ID *
What was
planted
(Seeds,
Unrooted Cuttings,
Rooted Plants)
V
ariety
(Types: Fiber, Grain, CBD, CBG,
Cross)
Source of Hemp
Area Planted
(Outdoor = Acres
Indoor = Sqft)
Date
Planted
Anticipated
Date of Harvest
(Write “Transfer” if
moving to another
growing location)
NYS SiteID
FSA Lot #
Name
Type
Name
State
Acres
Sqft
ex:1458
8736-6253-10-C
Seed
Lifter
CBD
Jane Doe Hemp Co.
NY
--
2000
6/1/22
Transfer
This Authorization is not growing hemp this year.
could result in suspension or termination of my license as outlined in 1 NYCRR §159.16, (3) understand that I am responsible for the routine testing of my crop to
ensure that the Total THC content does not exceed 0.3% on a dry weight basis, and (4) agree to include upon submission of this form a map of the planted area with
Completed by (print)
Completed by (sign) Date
* NYS Site IDs are the ID numbers assigned to each location by the state. Write NYS Site IDs as they appear on your Authorized Sites list.
FSA Lot #s are the Farm#-Tract#-Field#-Subfield# as they appear on the FSA-578 form you submitted to the FSA.
SUBMIT COMPLETED REPORTS TO:
Division of Plant Industry
10B Airline Drive
Albany, NY 12235
Fax No. (518) 457-1204
IndustrialHempNYS@agriculture.ny.gov
(Only PDF files will be accepted electronically)
ATTACH ADDITIONAL SHEETS AS NECESSARY
3
2022 Hemp Pre-Harvest Report Form
PLEASE REVIEW THE INSTRUCTIONS ON PAGE 1 PRIOR TO COMPLETING THIS FORM
Producer Information
Business/Institution Name (as it appears on your Authorization):
Mailing Address: Authorization Number: 36-__________
Person Responsible for Management of Hemp Production:
Email: Phone:
* NYS Site IDs are the ID numbers assigned to each location by the state. Write NYS Site IDs as they appear on your Authorized Sites list.
FSA Lot #s are the Farm#-Tract#-Field#-Subfield# as they appear on the FSA-578 form you submitted to the FSA.
Harvest Information
Growing address for this report: County:
Site ID *
(as Identified on Your Planting
Report Form)
Variety
Area to be
Harvested
(Outdoor = Acres
Indoor = Sqft)
Sam
pler
ID
THC Testing Laboratory
Start Date
of Harvest
End Date of
Harvest
Site ID of
Storage
Or Drying
Facility
NYS SiteID
FSA Lot #
Acres
Sqft
Name
State
NYS Site ID *
ex:2136 1258-2687-6-A Cherry Blossom 10 -- S003 Biotrax Testing Lab NY 9/15/22 9/16/22 2154
By signing below, I (1) understand that following submission of this report my hemp crop must be sampled by a certified sampling agent and those samples must be
sent to a private lab listed by the Department for THC testing prior to harvest, (2) understand my hemp crop cannot be harvested or sold until such samples are taken
and must remain in my possession after sampling until lab analysis results indicate that the Total THC concentrations are below the threshold of 0.3% Total THC on a
dry weight basis, and (3) agree to include upon submission of this form a map of the area to be harvested with the varieties clearly labeled.
Completed by (print) Date
Completed by (sign)
SUBMIT COMPLETED REPORTS TO:
Division of Plant Industry
10B Airline Drive
Albany, NY 12235
Fax No. (518) 457-1204
IndustrialHempNYS@agriculture.ny.gov
(Only PDF files will be accepted electronically)
ATTACH ADDITIONAL SHEETS AS NECESSARY
4
2022 Hemp Post-Harvest Report Form
PLEASE REVIEW THE INSTRUCTIONS ON PAGE 1 PRIOR TO COMPLETING THIS FORM
Producer Information
Business/Institution Name (as it appears on your Authorization):
Mailing Address: Authorization Number: 36-__________
Person Responsible for Management of Hemp Production:
Email: Phone:
Production Information
Growing address for this report:
County:
Site ID *
(as Identified on Your Pre-Harvest
Report Form)
Variety
Product
(Whole Plant, Flower,
Stalk)
Area Harvested
End Date of
Harvest
Site ID of
Storage/Drying
Facility
Intent
(Sell, Store, Process)
NYS SiteID
FSA Lot #
Area
Sqft
NYS Site ID *
ex:3205 689-458-1-D Sour Space Candy Whole plant 5 -- 9/24/22 3652 Sell to XYZ Processing
By signing below, I certify that (1) the harvested crops will be used in a legal manner and in accordance with the provisions of 1 NYCRR §159 and the program
guidance document and that (2) the information provided is accurate and complete.
Completed by (print)
Date
Completed by (sign)
* NYS Site IDs are the ID numbers assigned to each location by the state. Write NYS Site IDs as they appear on your Authorized Sites list.
FSA Lot #s are the Farm#-Tract#-Field#-Subfield# as they appear on the FSA-578 form you submitted to the FSA.
SUBMIT COMPLETED REPORTS TO:
Division of Plant Industry
10B Airline Drive
Albany, NY 12235
Fax No. (518) 457-1204
IndustrialHempNYS@agriculture.ny.gov
(Only PDF files will be accepted electronically)
ATTACH ADDITIONAL SHEETS AS NECESSARY
5
2022 Hemp Disposal Report Form
PLEASE REVIEW THE INSTRUCTIONS ON PAGE 1 PRIOR TO COMPLETING THIS FORM
Mailing Address:
Authorization Number: 36-____________
Person Responsible for Management of Hemp Production:
Email: Phone:
Growing address for this report: County:
Site ID *
Variety
Area of Disposal
(Outdoor = Acres
Indoor = Sqft)
Method of Disposal
(law enforcement removal, plow under,
disk, till, burn, bury, compost, mow)
Can have multiple methods
Date of
Disposal
Reason for Disposal
(If disposing because of THC levels,
write ‘High THC’)
NYS SiteID FSA Lot # Acres Sqft
ex:1365
1089-320-10-A
Hawaiian Haze
4
--
Mow, compost
07/04/22
Flooding killed all plants
has been properly transitioned into a non-retrievable or non-ingestible form, and (3) agree to include upon submission of this report proof of hemp crop destruction in a
Completed by (print)
Completed by (sign) Date
* NYS Site IDs are the ID numbers assigned to each location by the state. Write NYS Site IDs as they appear on your Authorized Sites list.
FSA Lot #s are the Farm#-Tract#-Field#-Subfield# as they appear on the FSA-578 form you submitted to the FSA.
SUBMIT COMPLETED REPORTS TO:
Division of Plant Industry
10B Airline Drive
Albany, NY 12235
Fax No. (518) 457-1204
IndustrialHempNYS@agriculture.ny.gov
(Only PDF files will be accepted electronically)
ATTACH ADDITIONAL SHEETS AS NECESSARY
6
2022 Hemp Remediation Report Form
PLEASE REVIEW THE INSTRUCTIONS ON PAGE 1 PRIOR TO COMPLETING THIS FORM
Mailing Address:
Authorization Number: 36-____________
Person Responsible for Management of Hemp Production:
Email: Phone:
Growing address for this report: County:
Site ID *
Variety
Method of
Remediation
(remove flowers, blend
into biomass)
Sampler
ID
THC Testing Laboratory
Area of
Remediation
(Outdoor = Acres
Indoor = Sqft)
Anticipated
Date of
Remediation
NYS SiteID
FSA Lot #
Name
State
Acres
Sqft
ex:1365
2896-45-3-A
Hawaiian Haze
Blend into biomass
S004
Contract Pharmacal Corp
NY
--
10000
10/04/22
remediation plan, (2) understand that following submission of this report my hemp crop must be re-sampled by a certified sampling agent and those samples must be
sent to a private lab listed by the Department for THC testing, and (3) understand my hemp crop cannot enter the stream of commerce until such samples are taken
and must remain in my possession after sampling until lab analysis results indicate that the Total THC concentrations are below the threshold of 0.3% Total THC on a
Completed by (print)
Completed by (sign) Date
* NYS Site IDs are the ID numbers assigned to each location by the state. Write NYS Site IDs as they appear on your Authorized Sites list.
FSA Lot #s are the Farm#-Tract#-Field#-Subfield# as they appear on the FSA-578 form you submitted to the FSA.
SUBMIT COMPLETED REPORTS TO:
Division of Plant Industry
10B Airline Drive
Albany, NY 12235
Fax No. (518) 457-1204
IndustrialHempNYS@agriculture.ny.gov
(Only PDF files will be accepted electronically)
ATTACH ADDITIONAL SHEETS AS NECESSARY
7
2022 Hemp Theft Report Form
PLEASE REVIEW THE INSTRUCTIONS ON PAGE 1 PRIOR TO COMPLETING THIS FORM
Mailing Address:
Authorization Number: 36-____________
Person Responsible for Management of Hemp Production:
Email: Phone:
Growing address for this report: County:
Site ID *
Variety
Area of Theft
(Outdoor = Acres
Indoor = Sqft)
Date of Theft Police Department
Police Report
Number
Date Filed
NYS SiteID
FSA Lot #
Acres
Sqft
ex:135
1458-246-1-C
Suver Haze
--
1200
07/15/21
Albany Police Department
SPIC10000037
07/16/21
By signing below, I certify that (1) the above listed hemp crop has been stolen and that (2) the theft was reported to law enforcement.
Completed by (print)
Completed by (sign) Date
* NYS Site IDs are the ID numbers assigned to each location by the state. Write NYS Site IDs as they appear on your Authorized Sites list.
FSA Lot #s are the Farm#-Tract#-Field#-Subfield# as they appear on the FSA-578 form you submitted to the FSA.
SUBMIT COMPLETED REPORTS TO:
Division of Plant Industry
10B Airline Drive
Albany, NY 12235
Fax No. (518) 457-1204
IndustrialHempNYS@agriculture.ny.gov
(Only PDF files will be accepted electronically)
ATTACH ADDITIONAL SHEETS AS NECESSARY
8
2022 Hemp Non-Compliant Report Form
PLEASE REVIEW THE INSTRUCTIONS ON PAGE 1 PRIOR TO COMPLETING THIS FORM
Mailing Address:
Authorization Number: 36-____________
Person Responsible for Management of Hemp Production:
Email: Phone:
Growing address for this report: County:
Site ID *
Variety
Sampler ID
(If sampled by
grower, write “self”)
Area of Lot
Sampled
(Outdoor = Acres
Indoor = Sqft)
Date Sampled
Total THC
Results
(% dry weight)
Measurement of
Uncertainty
(MU)
NYS SiteID
FSA Lot #
Acres
Sqft
ex:1286
246-5-3-C
Hawaiian Haze
S016
2
--
9/04/22
0.34%
0.05%
Completed by (print)
Completed by (sign) Date
* NYS Site IDs are the ID numbers assigned to each location by the state. Write NYS Site IDs as they appear on your Authorized Sites list.
FSA Lot #s are the Farm#-Tract#-Field#-Subfield# as they appear on the FSA-578 form you submitted to the FSA.
SUBMIT COMPLETED REPORTS TO:
Division of Plant Industry
10B Airline Drive
Albany, NY 12235
Fax No. (518) 457-1204
IndustrialHempNYS@agriculture.ny.gov
(Only PDF files will be accepted electronically)
ATTACH ADDITIONAL SHEETS AS NECESSARY
9
2022 Hemp Monthly Sales Report Form
PLEASE REVIEW THE INSTRUCTIONS ON PAGE 1 PRIOR TO COMPLETING THIS FORM
Retailer Information
Business/Institution Name (as it appears on your Authorization):
Mailing Address:
Authorization Number: 36-_________
Person Responsible for Management:
Email: Phone:
Sales Information
Date of
Sale
Product
(seeds or
plants)
Variety
(Types: Fiber, Grain, CBD, CBG,
Cross)
Amount
(Seed = lbs,
Nursery = Plants)
Buyer Name
Buyer
Authorization
Buyer Phone
Number
Buyer Address
Name
Type
#
lbs/ Plants
ex:05/24/22
Seeds
Anka
Fiber
1
Lb
John Doe
36_****
518-555-5555
123 Main St, Albany, NY 12235
This Authorization has not sold any hemp this month.
By signing below, I certify that all sales of hemp plant or seed material were to authorized hemp growers holding current and valid licenses in their states of
operation.
Completed by (print)
Completed by (sign) Date
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Hemp Reporting Package All reports submitted electronically must (New York State)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 26 March 2022

Message

View Audit Log
Print With Audit Log
Duplicate Document