Fillable USDA Hemp License Application

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UNITED STATES DEPARTMENT OF AGRICULTURE USDA Hemp License Application

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REPRODUCE LOCALLY. USDA HEMP LICENSE APPLICATION FORM. OMB No. 0581-0318
AMS-26 (12/2019) Exp: 06/2020 Page 1 of 3
UNITED STATES DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
USDA DOMESTIC HEMP PRODUCTION PROGRAM
USDA HEMP LICENSE APPLICATION
Instructions:
The U.S. Department of Agriculture (USDA) will accept applications from August 1st to
October 31st of each year. All applications, whether new or for renewal, must comply with the
requirements as described in 7 CFR Part 990. Once USDA approves an application, USDA will
issue a producer license. Licenses are valid until December 31st of the third year from the date
issued and do not automatically renew. Licenses must be renewed every three years and must
include an updated criminal history report.
As part of the application process, individual applicants and key participants of a business must
also submit a completed Federal Bureau of Investigation’s (FBI) Identity History Summary
(https://www.fbi.gov/services/cjis/identity-history-summary-checks). USDA will not accept
criminal history reports completed more than 60 days before the submission of an application.
USDA will approve or deny license applications within 60 calendar days, and applicants will be
notified of the result either by letter or email.
All information submitted must be accurate, legible, and complete. Complete and submit this
application along with your completed FBI Identity History Summary to:
By Mail:
USDA/AMS/Specialty Crops Program
Hemp Branch
470 L’Enfant Plaza S.W.
Post Office Box 23192
Washington, D.C. 20026
Or via Fax at:
(202) 720-8938
REPRODUCE LOCALLY. USDA HEMP LICENSE APPLICATION FORM. OMB No. 0581-0318
AMS-26 (12/2019) Exp: 06/2020 Page 2 of 3
□ New Application □ Renewal Application
1) Personal Information.
Applicant Name: (First, Middle, Last)
Mailing Address: (Street, City, State, Zip Code)
Email Address:
Telephone Number:
2) Business Entity. (Only complete this section if applicant represents a business entity)
Entity Name and EIN Number:
Principal Business Address: (Street, City, State, Zip
Code)
Business Email Address:
Telephone Number:
Name (First, Middle, Last) and Title of Key Participants: (Each Key Participant must include a completed FBI
Identity History Summary. Key Participants are persons who have a direct or indirect financial interest in the
entity producing hemp, such as an owner or partner in a partnership. A key participant also includes persons at
executive levels including chief executive officer, chief operating officer and chief financial officer.)
1)
2)
3)
Please attach any additional names to this application.
3) Criminal History Report (Include for both new applications and renewal applications)
Include a completed FBI Identity History Summary for each applicant and/or key participant of
the business entity. More information on this process is available of the FBI website:
https://www.fbi.gov/services/cjis/identity-history-summary-checks. The FBI Identity History
Summary must be current and have been completed within 60 days of submission of this
application. If the FBI Identity History Summary reveals that the applicant or a key participant
has a felony conviction related to a controlled substance under State or Federal law that occurred
within 10 years of the application, the applicant will not be licensed under the USDA Domestic
Hemp Production Program.
REPRODUCE LOCALLY. USDA HEMP LICENSE APPLICATION FORM. OMB No. 0581-0318
AMS-26 (12/2019) Exp: 06/2020 Page 3 of 3
4) Who has legal authority and ownership of the land on which you intend to grow hemp?
______________________________________________________________________________________
______________________________________________________________________________________
By signing below, all applicants agree to abide by all rules and regulations of the USDA
Domestic Hemp Production Program, 7 CFR Part 990, and certify the accuracy of the
information provided in this application is accurate and truthful.
_____________________________________________________________________________________
Print Name (First, Middle, Last) Title Date Signature
_____________________________________________________________________________________
Print Name (First, Middle, Last) Title Date Signature
_____________________________________________________________________________________
Print Name (First, Middle, Last) Title Date Signature
_____________________________________________________________________________________
Print Name (First, Middle, Last) Title Date Signature
The following statements are made in accordance with the Privacy Act of 1974 (U.S.C.522a) and the
Paperwork Reduction Act of 1995. The authority for requesting this information to be supplied on this form
is the 7 CFR Part 990 Domestic Hemp Program (Program). The purpose of collecting this information is for
USDA to administer the Program and the information provided on this form will be used to monitor
Program participants. Failure to provide the information requested on this form may result in ineligibility to
participate in the Program.
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 0581-0318. The time required to complete this information collection is estimated to average 10 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.
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 http://www.ascr.usda.gov/complaint_filing_cust.html
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.
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USDA Hemp License Application

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Completed 28 July 2020

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