□ □

□ □

□

 

 

 

 

 

 

OMB No. 0581-0125

United States Exp. 10/31/2026

Department of

Agriculture

AGRICULTURAL MARKETING SERVICE, SPECIALTY CROPS PROGRAM 

LOGO USE REQUEST FOR AUDIT PROGRAMS 

FEDERAL AUTHORIZATION: This form is to be completed by authorized personnel in accordance with the specified Specialty Crops

Program audit program(s). All materials which make reference to the audit program(s) design or language are accountable items. Their use is 

authorized by a contract between the USDA and the participant company. No materials shall bear reference to the audit program(s) design or 

language without prior written consent of the Specialty Crops Program. 

A. Logo Description

(GAP&GHP) Audit Program

Identity Preservation (IP) Program

Partners in Quality (PIQ) Audit Program

Type of Logo: Black Color** 

**(GAP&GHP and IP color logos must use Pantone Matching System 

(PMS) color Green 348. PIQ color logos must use the colors red, white 

and blue in specified areas. Any other colors used will not be considered 

an approved audit program logo and will be in violation of the agreement.) 

B. Company Information

___________________________________________ _______________________________________________________________ 

Name of Company Mailing Address of Company 

___________________________________________ _________________________ ____________________________________ 

Name and Title of Person Requesting Logo Use Phone Number Email Address 

C. Logo Use

Commodities:_______________________________________________________________________________________________ 

Select type(s) of use and specify the number of materials that will contain the audit programs logo (Attach Additional Documentation): 

Containers : ____________ Publication(s) ________ type(s):_______________________________________ 

Labels/Stickers ___________ Website(s) _________ web address(es):________________________________ 

Other : ____________________________________________________________________________________________________ 

D. Manufacturer’s Information

___________________________________________ ___________________________________________ 

Manufacturer’s Name Manufacturer’s Phone Number 

_________________________________________________________________________________________ 

Manufacturer’s Mailing Address 

E. Applicant’s Request

As an authorized participant in the Specialty Crops Program audit program(s), I hereby request that the above materials be approved 

and produced with the audit program(s) logo. I agree to be responsible for all charges assessed by the manufacturer of the materials 

for this order. I also acknowledge that all materials containing the audit program(s) logo are in compliance with the audit program(s) 

logo use requirements and are for the exclusive use as a participant in good standing in the audit program(s) as authorized by the 

USDA. A copy of the manufacturers’ invoice bearing the exact number of preprinted materials produced with the audit program(s) logo 

and a signed copy of Section F will be forwarded to the Specialty Crops Program immediately after the time of receipt. 

_______________________________ _____________ ________________________________ ____________ 

Applicant’s Signature Date Federal Authority Signature Date 

F. Applicant’s Receipt

I have received the above listed materials and they are now my responsibility. I certify that only the materials in the above list have been 

produced and will only be used in accordance with an audit program(s) in good standing. 

_______________________________ _____________ ________________________________ ____________ 

Applicant’s Signature Date Federal Authority Signature Date 

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 0581-0125. The time required to complete this information collection is estimated average 20 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.

Non-Discrimination Policy: 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 How to File a Program Discrimination Complaint 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.

SC-652 (1-2024) (Previous editions are to be destroyed)