(Proposal 2) / U.S. DEPARTMENT OF AGRICULTURE
Farm Service Agency / RETURN COMPLETED FORM TO FSA’S OUTREACH STAFF AT:
CURRENT AND PENDING SUPPORT
INSTRUCTIONS:
1. / Record information for active and pending projects, including the proposal. (Concurrent submission of a proposal to other organizations will not prejudice its review by FSA.
2. / All current efforts to which project director(s) and other senior personnel have committed a portion of their time must be listed, whether or not salary for the person involved is included in the budgets of the various projects.
3. / Provide analogous information for all proposed work which is being considered by, or which will be submitted in the near future to, other possible sponsors including other USDA programs.
A.
NAME
(List/PD #1first) / B.
SUPPORTING AGENCY AND AGENCY ACTIVE AWARD/PENDING PROPOSAL NUMBER / C.
TOTAL $ AMOUNT / D.
EFFECTIVE AND EXPIRATION DATES / E.
% OF TIME COMMITTED / F.
TITLE OF PROJECT
Active:
Pending:
G. I certify that the information supplied on this form is true to the best of my knowledge and belief:
(1). Preparer’s Signature / (2) Title of Preparer / (3) Date Prepared
H. I certify that I received this form on the date specified below:
(1). Outreach Staff Signature / (2) Title of Outreach Reach Staffer / (3) Date Received
The U.S. Department of Agriculture (USDA) prohibits discrimination in allof its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, political beliefs, genetic information, reprisal, or because all or part of an individual’s income is derived from any public assistance program. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at (202) 720-2600 (voice and TDD).
To file a complaint of discrimination, write to USDA, Assistant Secretary for Civil Rights, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, S.W.,Stop 9410, Washington, DC 20250-9410, or call toll-free at (866) 632-9992 (English) or (800) 877-8339 (TDD) or (866) 377-8642 (English Federal-relay) or (800) 845-6136 (Spanish Federal-relay). USDA is an equal opportunity provider and employer.