+-----------------------------------------------------------------------+
| **U.S. DEPARTMENT OF AGRICULTURE**                                    |
|                                                                       |
| Farm Service Agency                                                   |
+-----------------------------------------------------------------------+
| **FSA ADMINISTRATOR'S AWARDS NOMINATION FORM**                        |
+-----------------------------------------------------------------------+
| Please read the instructions below thoroughly before completing the   |
| FSA Administrator's Awards Nomination Form.                           |
+-----------------------------------------------------------------------+
| **INSTRUCTIONS**                                                      |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+
| -   Nominations will be accepted via email only. Please ensure that   |
|     the email trail (Electronic Approval) has final approval from the |
|     Deputy Administrator before submitting.                           |
|                                                                       |
| -   Ensure the validity of all nomination accomplishments.            |
|                                                                       |
| -   Screen nominations for equal employment opportunity violations    |
|     and disciplinary actions.                                         |
|                                                                       |
| -   Once submitted, FSA Administrator's Awards Nomination Form        |
|     recipients will be screened at the HRD level.                     |
|                                                                       |
| -   Send this form and any attachments (Microsoft Word) via email as  |
|     follows:                                                          |
|                                                                       |
| > **To:** <Stephaniesybil.brown@wdc.usda.gov>                         |
| >                                                                     |
| > **Subject:** 2008 FSA Administrator's Awards for Service to         |
| > Agriculture                                                         |
|                                                                       |
| -   To verify that the nomination was received please send return     |
|     receipt as follows:                                               |
|                                                                       |
| > To be notified about a single message before sending                |
|                                                                       |
| 1.  Click "View" than "Options".                                      |
|                                                                       |
| 2.  Once in "Options" under "Voting and tracking options", select the |
|     "Request a delivery receipt for this message" or the "Request a   |
|     read receipt for this message check box."                         |
|                                                                       |
| -   If further assistance is needed, please contact Stephanie Sybil   |
|     Brown, FSA, HRD at 202-401-0694.                                  |
+-----------------------------------------------------------------------+

FSA-187 (Proposal 1)

+-------------------------------------+---+--------+---+---+-----------+
| **This form is available            |   |        |   |   |           |
| electronically.**                   |   |        |   |   |           |
+-------------------------------------+---+--------+---+---+-----------+
| #### FSA                            |   |        | D |   |           |
| -187 U.S. DEPARTMENT OF AGRICULTURE |   |        | a |   |           |
|                                     |   |        | t |   |           |
| > (Proposal 1) Farm Service Agency  |   |        | e |   |           |
|                                     |   |        | P |   |           |
| #  FSA ADM                          |   |        | r |   |           |
| INISTRATOR'S AWARDS NOMINATION FORM |   |        | e |   |           |
|                                     |   |        | p |   |           |
|                                     |   |        | a |   |           |
|                                     |   |        | r |   |           |
|                                     |   |        | e |   |           |
|                                     |   |        | d |   |           |
|                                     |   |        | : |   |           |
+-------------------------------------+---+--------+---+---+-----------+
|                                     |   |        |   |   |           |
|                                     |   |        |   |   |           |
|                                     |   |        |   |   |           |
|                                     |   |        |   |   |           |
|                                     |   |        |   |   |           |
+-------------------------------------+---+--------+---+---+-----------+
| #### PART A -- GENERAL INFORMATI    |   |        |   |   |           |
| ON *(Complete for all nominations)* |   |        |   |   |           |
+-------------------------------------+---+--------+---+---+-----------+
| 1\. Name of Submitting Program      | 2 |        |   |   |           |
| Area/Work Unit                      | \ |        |   |   |           |
|                                     | . |        |   |   |           |
|                                     | R |        |   |   |           |
|                                     | e |        |   |   |           |
|                                     | c |        |   |   |           |
|                                     | o |        |   |   |           |
|                                     | g |        |   |   |           |
|                                     | n |        |   |   |           |
|                                     | i |        |   |   |           |
|                                     | t |        |   |   |           |
|                                     | i |        |   |   |           |
|                                     | o |        |   |   |           |
|                                     | n |        |   |   |           |
|                                     | T |        |   |   |           |
|                                     | y |        |   |   |           |
|                                     | p |        |   |   |           |
|                                     | e |        |   |   |           |
|                                     | * |        |   |   |           |
|                                     | ( |        |   |   |           |
|                                     | C |        |   |   |           |
|                                     | h |        |   |   |           |
|                                     | e |        |   |   |           |
|                                     | c |        |   |   |           |
|                                     | k |        |   |   |           |
|                                     | o |        |   |   |           |
|                                     | n |        |   |   |           |
|                                     | l |        |   |   |           |
|                                     | y |        |   |   |           |
|                                     | " |        |   |   |           |
|                                     | o |        |   |   |           |
|                                     | n |        |   |   |           |
|                                     | e |        |   |   |           |
|                                     | " |        |   |   |           |
|                                     | b |        |   |   |           |
|                                     | o |        |   |   |           |
|                                     | x |        |   |   |           |
|                                     | ) |        |   |   |           |
|                                     | * |        |   |   |           |
+-------------------------------------+---+--------+---+---+-----------+
|                                     |   | Indi   |   |   | Group     |
|                                     |   | vidual |   |   | (2-10)    |
|                                     |   |        |   |   |           |
|                                     |   | *(Also |   |   | *(Also    |
|                                     |   | Co     |   |   | Complete  |
|                                     |   | mplete |   |   | Part C)*  |
|                                     |   | Part   |   |   |           |
|                                     |   | B)*    |   |   |           |
+-------------------------------------+---+--------+---+---+-----------+
| 3\. Individual Nominee or Group     | 4 |        |   |   |           |
| Name                                | \ |        |   |   |           |
|                                     | . |        |   |   |           |
|                                     | P |        |   |   |           |
|                                     | e |        |   |   |           |
|                                     | r |        |   |   |           |
|                                     | i |        |   |   |           |
|                                     | o |        |   |   |           |
|                                     | d |        |   |   |           |
|                                     | C |        |   |   |           |
|                                     | o |        |   |   |           |
|                                     | v |        |   |   |           |
|                                     | e |        |   |   |           |
|                                     | r |        |   |   |           |
|                                     | e |        |   |   |           |
|                                     | d |        |   |   |           |
|                                     | * |        |   |   |           |
|                                     | ( |        |   |   |           |
|                                     | M |        |   |   |           |
|                                     | o |        |   |   |           |
|                                     | n |        |   |   |           |
|                                     | t |        |   |   |           |
|                                     | h |        |   |   |           |
|                                     | / |        |   |   |           |
|                                     | Y |        |   |   |           |
|                                     | e |        |   |   |           |
|                                     | a |        |   |   |           |
|                                     | r |        |   |   |           |
|                                     | o |        |   |   |           |
|                                     | n |        |   |   |           |
|                                     | l |        |   |   |           |
|                                     | y |        |   |   |           |
|                                     | ) |        |   |   |           |
|                                     | * |        |   |   |           |
+-------------------------------------+---+--------+---+---+-----------+
|                                     |   |        |   |   |           |
|                                     |   |        |   |   |           |
|                                     |   |        |   |   |           |
|                                     |   |        |   |   |           |
|                                     |   |        |   |   |           |
+-------------------------------------+---+--------+---+---+-----------+

**5. AWARD CATEGORIES** *(Check only "one" box)*

The contributions must have occurred or results realized within the last
year. For explanations on the award categories, please see applicable PM
Notice.

Civil Rights Leadership Award

Excellence in Program Support Award

Excellence in Leadership and Management Award

Outstanding Team Accomplishment Award

Excellence in Achieving Goals and Objectives Award

Heroism and Emergency Response Award

Newcomer Award

  ---------------------------- -------------- ------------- --------------------
  6\. Suggested Citation *(25                               
  words or less)*                                           

  **PART B -- COMPLETE FOR                                  
  INDIVIDUAL SUBMISSIONS                                    
  ONLY**                                                    

  1\. Name *(Last, First,      2\. Phonetic                 
  Middle)*                     Name Spelling                
                               *(If                         
                               Applicable)*                 

  3\. Position Title           4\. Telephone                5\. Fax Number
                               Number *(Area                *(Area Code)*
                               Code)*                       

  6\. Organization and Deputy                 7\. Work      
  Administrator                               Mailing       
                                              Address       
                                              *(Include     
                                              Physical      
                                              Address If    
                                              WDC)*         
  ---------------------------- -------------- ------------- --------------------

*The U.S. Department of Agriculture (USDA) prohibits discrimination in
all its programs and activities on the basis of race, color, national
origin, age, disability, and where applicable, sex, marital status,
familial status, parental status, religion, sexual orientation, genetic
information, political beliefs, reprisal, or because all or part of an
individual\'s income is derived from any public assistance program. (Not
all prohibited bases apply to all programs.) Persons with disabilities
who require alternative means for communication of program information
(Braille, large print, audiotape, etc.) should contact USDA\'s TARGET
Center at (202) 720-2600 (voice and TDD). To file a complaint of
discrimination, write to USDA, Director, Office of Civil Rights, 1400
Independence Avenue, S.W., Washington, D.C. 20250-9410, or call (800)
795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity
provider and employer.*

  --------------------- ------------ --------------- ---------------------
  FSA-187 (Proposal 1)                               
  Page 2 of 4                                        

  **PART C -- COMPLETE                               
  FOR GROUP SUBMISSION                               
  ONLY**                                             

  1\. Name of Group                  2\. Name of     
  *(As indicated in                  Group Leader    
  Part A)*                           *(Last, First,  
                                     Middle)*        

                                                     

  3\. Phonetic Name     4\. Work                     5\. Organization and
  Spelling *(if         Mailing                      Deputy Administrator
  applicable)*          Address                      
                        *(Include                    
                        physical                     
                        address if                   
                        WDC)*                        

                                                     
  --------------------- ------------ --------------- ---------------------

**6. Team Members:** Team recognition should be limited to the top 10
significant contributors. Exceptions may be

granted with justification.

+------------------+---------------+--------+---------------+---------+
| PROVIDE THE      |               |        |               |         |
| FOLLOWING        |               |        |               |         |
| INFORMATION FOR  |               |        |               |         |
| EACH GROUP       |               |        |               |         |
| MEMBER:          |               |        |               |         |
+------------------+---------------+--------+---------------+---------+
| A.               | B.            | C.     | D.            | E.      |
+------------------+---------------+--------+---------------+---------+
| **Name** *(Last, | **Work        | *      | *             | **Super |
| First, Middle)*  | Mailing       | *Phone | *Organization | visor** |
|                  | Address**     | Nu     | and Deputy    |         |
| *(Alphabetical   |               | mber** | Ad            | *       |
| Order and E-Mail | *(Include     |        | ministrator** | *Name** |
| Address)*        | physical      | *(Area |               |         |
|                  | address if    | Code)* |               |         |
|                  | WDC.*         |        |               |         |
|                  |               |        |               |         |
|                  | *Room number  |        |               |         |
|                  | if South      |        |               |         |
|                  | Building)*    |        |               |         |
+------------------+---------------+--------+---------------+---------+
|                  |               |        |               |         |
+------------------+---------------+--------+---------------+---------+
|                  |               |        |               |         |
+------------------+---------------+--------+---------------+---------+
|                  |               |        |               |         |
+------------------+---------------+--------+---------------+---------+
|                  |               |        |               |         |
+------------------+---------------+--------+---------------+---------+
|                  |               |        |               |         |
+------------------+---------------+--------+---------------+---------+
|                  |               |        |               |         |
+------------------+---------------+--------+---------------+---------+
|                  |               |        |               |         |
+------------------+---------------+--------+---------------+---------+
|                  |               |        |               |         |
+------------------+---------------+--------+---------------+---------+
|                  |               |        |               |         |
+------------------+---------------+--------+---------------+---------+
|                  |               |        |               |         |
+------------------+---------------+--------+---------------+---------+

  -----------------------------------------------------------------------
  FSA-187 (Proposal 1) Page 3 of 4

  **Part D -- JUSTIFICATION FOR NOMINATION**
  -----------------------------------------------------------------------

All nominations must clearly describe the significance of the
contribution/accomplishment being recognized relative to the category
selected, the impact on the FSA and or the Department successfully
meeting its mission or strategic goals, the degree to and the results by
which the contribution substantially exceeds normal job expectations,
and any measurable or non-measurable or non-measurable benefits.

NOTE: Avoid the use of general or vague statements; emphasizing job
responsibilities rather than accomplishments; in-house terminology and
technical language; statistics without using a comparison; retirement
testimonials, lengthy statements and excessive superlatives; and
descriptions of outside personal activities.

*Attach additional Microsoft Word sheets if needed*.

  -----------------------------------------------------------------------

  -----------------------------------------------------------------------

  ----------------------- ------- --------- ----------------- --------------------
  FSA-187 (Proposal 1)                                        
  Page 4 of 4                                                 

  **PART E -- CONTACT                                         
  INFORMATION**                                               

  **Nominator *(Person                                        
  recommending this                                           
  nomination)*:**                                             

  1\. Name                                  2\. Organization  
                                            and Deputy        
                                            Administrator     

                                                              

  3\. Work Mailing                                            
  Address *(Include                                           
  physical address if                                         
  WDC)*                                                       

                                                              

  4\. E-Mail Address              5\.                         6\. Fax Number
                                  Daytime                     *(Area Code)*
                                  Number                      
                                  *(Area                      
                                  Code)*                      

                                                              

  **PART F -- APPROVAL                                        
  (REVIEW/CLEARANCES)**                                       

  **For all nominations,                                      
  complete Items 1A                                           
  through 3C below:**                                         

  1A. Signature of        1B.                                 1C. Date
  Recommending Official   Title                               

                                                              

  2A. Signature of        2B.                                 2C. Date
  Reviewing Official      Title                               

                                                              

  3A. Signature of        3B.                                 3C. Date
  Recommending Official   Title                               

                                                              
  ----------------------- ------- --------- ----------------- --------------------