B. Total Contract
Payment:
A. Total Cost-Share or Payment
by Year
The above statements are made in accordance with the Privacy Act of 1974 (5 U.S.C 522a). Furnishing this information is voluntary; however, failure to furnish correct, complete information will result in the withholding or
withdrawal of such technical or financial assistance. The information may be furnished to other USDA agencies, the Internal Revenue Service, the Department of Justice, or other State or Federal law enforcement agencies,
or in response to orders of a court, magistrate, or administrative tribunal.
15
16
17
18
19
20
21
22
23
1. To be completed by NRCS; check appropriate box:
This transaction is for CCC.
This transaction is for NRCS.
The signature by the NRCS representative signifies a CCC or NRCS transaction as indicated above.
U. S. DEPARTMENT OF AGRICULTURE
CONSERVATION PLAN
SCHEDULE OF OPERATIONS
Former CCC-1252B, NRCS-LTP-11B
3. NAME
4. COUNTY
5. STATE
6. CONTRACT OR
AGREEMENT NO.
7. TOTAL ACRES UNDER
CONTRACT
ITEM
NO.
FIELD
PLANNED CONSERVATION
TREATMENT
(Record of Decisions)
ESTIMATED
AMOUNT
(UNITS)
COST
BASIS
$
COST SHARE
OR PAYMENT
RATE
%
COMPLETION SCHEDULE AND ESTIMATED
COST-SHARE OR PAYMENT BY YEAR
(For Non-Cost Share Items Show Units)
REF.
NO.
8
9
10
11
12
13
34
Year
Year Year Year Year
Year Year
Year
Year
2. Page of
14
Year
B. Date
D. Date
F. Date
D. Date
B. Date
35. CERTIFICATION OF PARTICIPANTS
36. SIGNATURES OF REVIEWING OFFICIALS
E. SIGNATURE
C. SIGNATURE
A. SIGNATURE
A. District Conservationist – Technical Adequacy Certification
SIGNATURE
SIGNATURE
C. APPROVED BY (Conservation District Representative)
NOTES:
A. All items numbered in column 8 on form AD-1155 must be carried out as a part of this contract to prevent violation.
B. When established, the conservation practices listed in column 8 must be maintained by the participant at no cost to the government.
C. Enter total cost per unit in column 12 on form AD-1155 unless the method of cost-share is flat rate. When flat rate, enter the am