AMS-27 USDA Hemp Plan Producer Disposal Form

REPRODUCE LOCALLY. USDA PRODUCER DISPOSAL AND REMEDIATION REPORT.

OMB No. 0581-0318

UNITED STATES DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
USDA DOMESTIC HEMP PRODUCTION PROGRAM
USDA PRODUCER DISPOSAL AND REMEDIATION REPORT
Producers licensed by USDA must submit this information when conducting on-farm disposal or
remediation as a result of a non-compliant test result exceeding the acceptable hemp THC level. This
form must be submitted no later than 30 days after the disposal or remediation occurs.
This form may be used to document disposals or remediations in multiple locations under the same
license.
This form shall be submitted to the USDA using a digital format compatible with USDA’s
information sharing systems, whenever possible. All information submitted must be accurate,
legible, and complete. If submission is not possible using a digital format, please submit form 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 Email at:
Forms.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 0581-0318. 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.
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-27 (XX/20XX) Exp: XX/20XX

Page 1 of 4

REPRODUCE LOCALLY. USDA PRODUCER DISPOSAL AND REMEDIATION REPORT.

OMB No. 0581-0318

Below is a description of each data point needed:
•
•
•

Farm Number, Tract Number, Field Number, Subfield Number: This information is
provided as part of the USDA Farm Service Agency (FSA) registration process.
Location Type: Greenhouse/Indoor production or Outdoor/Field
Size: This is the total growing area expressed in Acres for outdoor/field or Square Feet for
greenhouse/indoor. If outdoor land area is less than one acre, estimate land area and present
this figure as a decimal (1/2 acre = .5, 1/4 acre = .25, etc.)

Disposals:
•
•

Disposal Type: Check the appropriate box for the type of disposal completed in each growing
location. Plow under, Mulch, Disk, Burial, Burn, Chop, Other
Date of Disposal: This is the date the disposal was completed. Include a range, if needed.

Remediations:
•
•

•
•
•

Note: All remediated material must be resampled and retested.
Remediation Type: Check the appropriate box for the type of remediation that was completed
in each growing location. 1.) Separate and dispose of floral material or 2.) Blended biomass
Both options require a new THC compliance test to ensure that the remediated material is
compliant.
Date of Remediation: This is the date the remediation was completed. Include a range, if
needed.
Date of Remediation Sample: This is the date the remediated product was sampled for
compliance. An official sampling agent must be used.
Certificate of Analysis (COA) Attached:
o For a Disposal: An official COA from a laboratory compliance test result must be
attached showing a non-compliant test result.
o For a Remediation: An official COA from a laboratory compliance test result showing
the initial non-compliant test result and an official COA from a laboratory compliance
test result showing the follow-up, compliant test result of the remediated material must
be attached.

AMS-27 (XX/20XX) Exp: XX/20XX

Page 2 of 4

REPRODUCE LOCALLY. USDA PRODUCER DISPOSAL AND REMEDIATION REPORT.

OMB No. 0581-0318

Name of Licensee: ____________________________________ USDA License Number: _____________________
Primary Address: ________________________________
Street

____________________________

City

_____________

____________

State

Zip Code

Disposals
Farm Number

Tract Number

Field Number

Subfield
Number
(If applicable)

Location Type
(Greenhouse/,
Indoor, or Field/
Outdoor)

Size (Acres, or Sq
Ft.)

Disposal Type

(Plow under,
Mulch, Disk,
Burial, Burn,
Chop, Other)

Date of
Disposal

Attached
COA (Yes)

_______ Acres
or
_______ Sq Ft
_______ Acres
or
_______ Sq Ft
_______ Acres
or
_______ Sq Ft

Use additional lines as necessary.

AMS-27 (XX/20XX) Exp: XX/20XX

Page 3 of 4

REPRODUCE LOCALLY. USDA PRODUCER DISPOSAL AND REMEDIATION REPORT.

OMB No. 0581-0318

Remediations
Farm
Number

Tract
Number

Field
Number

Subfield
Number
(If applicable)

Location Type
(Greenhouse/
Indoor, or
Field/Outdoor)

Size (Acres, or Sq
Ft.)

Remediation Type

Date of
Remediation
(List range, if
necessary)

Separate and dispose
of floral material. Or.
Blend biomass.

Date
Remediation
Sample was
Taken

Attached
COA (Yes)

_______ Acres
or
_______ Sq Ft
_______ Acres
or
_______ Sq Ft
_______ Acres
or
_______ Sq Ft

Use additional lines as necessary.
By signing below, you are attesting to the accuracy of the information as provided in the chart(s) above.

______________________________________________________________________________________________________
Name of Licensee or Representative

AMS-27 (XX/20XX) Exp: XX/20XX

Signature

Date

Page 4 of 4