Submit the original of the completed form in hard copy or facsimile to the appropriate USDA office.
Producers who have established electronic access credentials with USDA may electronically transmit this form to the USDA office, provided that the producer submitting the form is the only person required to sign the transaction.
Features for transmitting the form electronically are available to those producers with access credentials only. If you would like to establish online access credentials with USDA, follow the instructions provided at the USDA eForms web site.
Instruction |
|
1 Name |
Enter the applicant’ name.
|
2(a) Item of Development |
Enter a concise, accurate description of the planned development. |
2(b) Location |
Enter the location of each planned development. |
2(c) Estimated Completion Date |
Enter the date each planned development is expected to be completed. |
2(d) Total Cost |
Enter the total cost of each planned development. |
2(e) TOTAL COST |
Enter the total cost of all planned development added together. |
3(a) Type of Inspection |
Enter the type of inspection that will be completed on each planned development. |
3(b) Estimated Date |
Enter the date that each inspection is anticipated to be completed. |
3(c) Date Final Inspection Provided |
Enter the date that each inspection is completed. |
4A Signature |
Enter applicant’s signature.
If faxing or mailing the form, print the form and manually enter your signature. This form is approved for electronic transmission. If you have established credentials with USDA to submit forms electronically, use the buttons provided on the form for transmitting the form to the USDA servicing office. Electronic transmission may only be completed if you are the only person required to sign this form. |
4B Date |
Enter the date the form is signed by the applicant. |
Page
File Type | application/msword |
File Title | Template Users: Select the text for each of the instruction components below and type over it without changing the font type, |
Author | Preferred Customer |
Last Modified By | niki.chavez |
File Modified | 2007-04-13 |
File Created | 2007-04-12 |