2016APPLICATIONINSTRUCTIONS

•TheGoodAgriculturalPractices(GAP)/GoodHandlingPractices(GHP)CertificationAssistance Programisacost-share/reimbursementprogramdesignedtoassisttheNewYorkState’s specialtycropindustrywiththecostofaGAP/GHPfoodsafetyaudit.

•FundingforthisprogramisprovidedbyUnitedStatesDepartmentofAgriculture(USDA) SpecialtyCropBlockGrantProgram.

•TheNewYorkStateDepartmentofAgricultureandMarkets(NYSDAM)willreimburseupto

$1000 ofthecostofhavingNYSDAM/USDA,oraqualifiedprivateauditingcompany,conductthird

partyaudit(s),includingwatertests,toverifyanestablishment’sfoodsafetyprogram.

•Fundingislimitedto$1000 perestablishmentforauditsand/orwatertest(s)conductedin2016.

Participatinggrowers/packers/handlerswillberesponsibleforpayinganybalancedueabove

$1000.

•Applicantsseekingreimbursementsforanon-USDAauditperformedbyaprivatecompanyin

2016willberequiredtoprovideasignedcertificationfromtheirbuyer(e.g.retailchain)stating

thatthebuyerrequiredorisrequiringtheaudit.Applicantswillalsoberequiredtoprovide documentationshowingtheauditwaspaid.

•Requestsfornon-USDAauditsperformedbyaprivatecompanyaresubjecttotheapprovalof

NYSDAMDivisionofFoodSafetyandInspection.

•Applicationsforauditsin2016mustbeapprovedbyNY State Department of Agriculture and

Markets.

•ApplicantswillbecontactedbytheDivisionofFoodSafetyInspectionwithintwoweeksof receiptoftheGAP/GHPApplicationForm.

•Fundsareavailableonafirst-come,first-servebasisuntilthefundsaredepletedorDecember

31, 2016.

• Reimbursement is available for two times (for two audits), applicants who have received the

reimbursement one time before are also eligible for second time reimbursement.

Updated 06-23-16

2016APPLICATIONFORM

To be completed bythe establishment audited/ to be audited:

Date:

Name of Applicant: Type of Operation (circle all that apply): grower packer handler

EstablishmentName:

Address:

City: State:

ZIP:

County

Phone:Fax:_ E-mail:

GAP/GHP audit(s) and/orwatertest(s)performed / willbeperformedby:

NYSDAM/USDA

OR

Private Company*

For audits performed either by NYSDAM/USDA or byqualifiedprivate companies, applicants areresponsible for payment in full. NYSDAM will then reimburse applicants up to$1000, pendingprior approval by NYSDAM

Name of Company:

Address: City: State: Zip:

Name ofcontact person:

Phone:

Email:

Buyer Certification (For private auditsonly, not required forNYSDAM/USDA audits):

I certify that my companyis requiring aGAP/GHP food safety audit in 2016 by (Name of audit company)

for purchase of New YorkState farmproducts provided by the applicant.

Signature of buyer: Date:

*Note:Requests for non-USDA auditsperformed bya private company are subject to the approval of

NYSDAM Division of Food Safety and Inspection.

OVER

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2016 GAP/GHP ApplicationForm, page 2

Applicant Certification:

IcertifythatIam aNewYorkStatefruitand/or vegetablegrower/packer/handler.Myestablishment has been / willbeauditedfor GAP/GHPin 2016.Iunderstandthat NewYorkStatewillprovidefundingforGAP/GHPaudit(s), includingwatertests,upto$1000ofthecostoftheaudit(s) andwatertest(s)on first-come first-serve basis,until the funds are depleted or December 31, 2016andIwillberesponsibleforany balance dueabove $1000.

Signature of Applicant: Date:

AUTHORIZATION FOR PAYMENT

Establishment (Applicant) Name: ______

REIMBURSEMENT/COST SHARE CALCULATION:

$______Total cost of audit(s) and water test

**For private audits paid receipts must accompany this application.

Name the check should be made out to:______
Federal ID or Social Security # (Required to receive payment)______

Signature of NYSDAM Official(For Private audits only): ______Date______

Mail/ Fax/ Email to:NewYorkStateDepartmentofAgricultureMarkets

DivisionofFoodSafetyInspection(Farm Products Unit)

GAPGHPCertificationAssistanceProgram

10BAirlineDrive

Albany,NewYork12235

FAX:518-485-8986

Email:

Questions? Call518-457-2090or800-554-4501

For Office Use Only
Food Safety Div. Fiscal Div.
______Date______Voucher#______Date Paid______
Reimbursement Amt.$______

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