AMS-28 USDA Hemp Plan Producer Annual Report

REPRODUCE LOCALLY. USDA HEMP PLAN PRODUCER ANNUAL REPORT.

OMB No. 0581-NEW

UNITED STATES DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
USDA DOMESTIC HEMP PRODUCTION PROGRAM
USDA HEMP PLAN PRODUCER ANNUAL REPORT

Licensed producers must submit this information to the U.S. Department of Agriculture (USDA)
on December 15th of each year. Please include hemp production data from all production areas
and harvesting cycles throughout the year. Only include planting, production and harvest data
for hemp grown under the USDA plan. If you produce hemp under a State or Tribal plan, please
report that information to the appropriate State or Tribal authority. Please submit completed
form to:
By Mail:
USDA/AMS/Specialty Crops Program
Hemp Branch
470 L’Enfant Plaza S.W.
P.O. Box 23192
Washington, D.C. 20026

Or via Email at:
FarmBill.Hemp@usda.gov

Or via Fax at:
(202) 720-8938

The following statements are made in accordance with the Privacy Act of 1974 (5 U.S.C. § 552a) 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 OMB 0581-NEW. The time required to complete this information collection is estimated to average 20
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.
AMS-28 (11/2019) Exp: 05/2020

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REPRODUCE LOCALLY. USDA HEMP PLAN PRODUCER ANNUAL REPORT.

OMB No. 0581-NEW

USDA HEMP PLAN PRODUCER ANNUAL REPORT

Name of Producer (First, Middle, Last): ___________________
USDA License Number: _____________________
Address of Producer:
__________________________________________________________________________
Street
City
State
Zip Code

Signature: ______________________

Lot #

Location
Type
(Greenhouse, Indoor,
Field)

Date Submitted: ______________________

Geospatial
Location
(or other valid
land descriptor)

Total
Planted
Acreage

Total Acreage
Disposed

Total
Harvested
Acreage

Please use additional pages as needed to ensure that every lot is properly documented.

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.
AMS-28 (11/2019) Exp: 05/2020

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