OMB No. 0578-0013
Page 1 of 5
1. State & County Code
2. a. Farm Number(s)
b. Tract Number(s)
3. Contract Number
4. Primary Fund Code
CCC-1200
7/2003
U.S. DEPARTMENT OF AGRICULTURE
COMMODITY CREDIT CORPORATION
5. HUA Number
CONSERVATION PROGRAM APPLICATION/CONTRACT
6. Total Treated Acres
THIS is an APPLICATION to participate in the:
7. PROGRAM
(Check One)
a. Agricultural Management Assistance
Program (AMA)
b. Conservation Security Program
(CSP)
c. Environmental Quality Incentives
Program (EQIP)
On the farm identified above the Applicant agrees to participate in the identified program if the offer is accepted by Commodity Credit Corporation
(CCC). The undersigned person shall hereafter be referred to as “the Applicant.” The Applicant understands that starting a practice prior to CCC
approval causes the practice to be ineligible for program financial assistance and the applicant will obtain the landowners signature on the contract
to install structural practices. By signing this application, the applicant acknowledges, receipt of the following forms: CCC-1200, the ccc-
1200 appendix and any addenda thereto, which are incorporated by reference herein and made a part of the contract.
SIGNATURE OF APPLICANT
DATE
(signature of individual or authorized representative of entity or joint operation)
7a. Limited Resource Producer and Beginning Farmer Certification
I __________________________________ certify that I am a: □ LIMITED RESOURCE PRODUCER(EQIP);
□ BEGINNING FARMER/RANCHER (EQIP, CSP), as per the following guidelines:
Limited Resource Farmer or Rancher:
A Limited Resource Farmer or Rancher has the following
characteristics:
(a) A person with direct or indirect gross farm sales not more
than $10