AMS-22 Laboratory Test Results Report

REPRODUCE LOCALLY. LABORATORY TEST RESULTS REPORT.

OMB No. 0581-0318

UNITED STATES DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
USDA DOMESTIC HEMP PRODUCTION PROGRAM
LABORATORY TEST RESULTS REPORT
All laboratories providing compliance testing services to hemp producers must use this form to report all
test results to USDA. Gas Chromatography (GC), High Pressure Liquid Chromatography (HPLC) or
Liquid Chromatography (LC) analysis with THCA conversion or other USDA approved testing method
must be utilized in order to test for total THC concentration. Test results shall be reported to the U.S.
Department of Agriculture (USDA) in accordance with 7 CFR Part 990, USDA Domestic Hemp
Production Program. Laboratory Testing Guidelines are available at:
https://www.ams.usda.gov/sites/default/files/media/TestingGuidelinesforHemp.pdf.
This form shall be submitted to the USDA concurrently when the certificate of analysis is returned to
producer and/or State/Tribal regulatory body. Laboratories may submit test results for multiple producers
using this form.
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 through the USDA information sharing system is not possible, 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 30 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-22 (XX/20XX) Exp: XX/20XX

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REPRODUCE LOCALLY. LABORATORY TEST RESULTS REPORT.
Laboratory Name
Producer
ID or
Control #

Producer
Name

Laboratory City
Producer
Street

Laboratory State
Producer
City

Producer
State

OMB No. 0581-0318

Laboratory DEA
Registration #
Farm
Number

Tract
Number

Field
Number

Subfield
Number (if
applicable)

Testing
Date

Results
Reported
Date

Test Type: (Original

sample, Retained
sample,
Test of re-sampled
material, Remediation
sample)

Result
% THC

Measurement
of
Uncertainty

Use additional rows as necessary.

AMS-22 (XX/20XX) Exp: XX/20XX

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Pass
or
Fail

REPRODUCE LOCALLY. LABORATORY TEST RESULTS REPORT.

OMB No. 0581-0318

Column Heading

Field Description

Instructions on Field Format and Values

Producer ID or Control
Number

This field is the license or
authorization identifier of the
producer. It can be used to link
sample and test results to a specific
producer.
This field is the name of the
producer and can be used to link
the name of the producer to the
sample and/or test result.

Use the producer’s license or authorization number as assigned by the State, Indian
Tribe, or USDA. If that is not provided, use the control number or other identifier
that was assigned to the sample.

This field is the street address of
the producer.
This field is the city of the
producer.
This field is the state of the
producer.
This field is the name of the
laboratory issuing the test result.

Fill in the Building Number, Street Name, and Street Type as provided with the
sample.
Fill in the city name for the producer as provided with the sample.

Producer Name

Producer Street
Producer City
Producer State
Laboratory Name
Laboratory City
Laboratory State
Laboratory DEA
registration
Farm Number
Tract Number
Field Number

This field is the city of the
laboratory issuing the test result.
This field is the state of the
laboratory issuing the test result.
This field is the DEA registration
number of the laboratory issuing
the test result.

Producer names should match the name associated with the license or authorization
number as assigned by the State, Indian Tribe, or USDA. If the producer is a
business entity, research institution, or other organization, include the name of the
entity as provided on the sample.

Fill in the state name for the producer as provided with the sample.
Fill in the name of the laboratory. If the laboratory is registered with DEA, use the
laboratory name associated with the DEA registration number. DEA registration is
not required until 12/31/2022.
Fill in the city name for the laboratory.
Fill in the state name for the laboratory.
This should match the format (alpha-numeric) provided by the DEA.
DEA registration is not required until 12/31/2022.

These fields identify the land area
represented by the sample.

These values should match the USDA Farm Service Agency (FSA) data for each
growing location being tested. This information will be provided with the sample.

This field is the date the sample is
tested by the laboratory.

Use a consistent format (i.e. MMDDYYYY)

Subfield Number
Testing Date

AMS-22 (XX/20XX) Exp: XX/20XX

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REPRODUCE LOCALLY. LABORATORY TEST RESULTS REPORT.

Result Reported Date

Test Type

This field is the date when the
result, usually as part of a
“certificate of analysis,” is
reported to the producer and/or
State/Tribal Government by the
laboratory.
This field is to identify the type of
sample being tested.

Result % THC

This field is the concentration of
THC determined by the laboratory
expressed as a percentage.

Measurement of
Uncertainty

This field is to identify the
measurement of uncertainty of the
hemp test.

Pass or Fail

This field is to identify if the hemp
sample passes or fails a THC
compliance test based on the
definition of hemp under the law.

AMS-22 (XX/20XX) Exp: XX/20XX

OMB No. 0581-0318

Use a consistent format (i.e. MMDDYYYY)

Report as one of these four options:
“Original sample”: This is a test of the original material taken for compliance
purposes.
“Retained sample”: This is a test of material retained or separated from the
original sample. A laboratory may retain a portion of the original material in case of
equipment malfunction or other error or for retesting in the event of a failed result
from the original sample.
“Test of re-sampled material”: This is a test of material taken from the same lot
as the original sample on a subsequent date.
“Remediation sample”: This is a sample from a growing location that has failed
initial compliance testing of intact flower material. This sample will either be
presented as blended biomass or as stalks, stems, and leaves with no floral material
present.
Report percent (%) of THC on a dry weight basis to the nearest hundredths, or 2
decimal places (Ex. 0.039).
Percentage of THC on a dry weight basis means the percentage of THC, by weight,
after excluding all moisture from the sample.
Report measurement of uncertainty as a percent (%) + or - to the nearest
hundredths, or 2 decimal places (Ex. 0.09)
The measurement of uncertainty is the parameter associated with the accuracy of a
result, which is the interval around the value of the measurement that characterizes
the dispersion of the values.
Report as “Pass” or “Fail.”
Pass equates to “delta-9 tetrahydrocannabinol concentration of not more than 0.30
percent on a dry weight basis + or – the measurement of uncertainty.”
Fail equates to “concentration level of THC on a dry weight basis of higher than
0.30 percent + or – the measurement of uncertainty.”

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