REPRODUCE LOCALLY. Include form number and edition date on all reproductions. FORM APPROVED - OMB No. 0581-0191

U.S. DEPARTMENT OF AGRICULTURE 

AGRICULTURAL MARKETING SERVICE 

APPLICATION FOR ACCREDITATION 

Please send electronic version to: AIAInbox@ams.usda.gov and mail original to: 

Deputy Administrator, National Organic Program 

USDA, Agricultural Marketing Service 

1400 Independence Ave., SW, Room 2648 So., Ag Stop 0268 

Washington, DC 20250-0268

NOTE: The following statements are made in accordance with the Privacy Act of 1974 (U.S.C. 522a) and the Paperwork Reduction Act of 1995, as amended. The 

authority for requesting this information to be supplied on this form is the Agricultural Marketing Agreement Act of 1937, Secs. 1-19, 48 Stat. 31, as amended, (7 U.S.C. 

601-674). Furnishing the requested information is necessary for the administration of this program. Submission of the Tax identification Number (TIN) or Employer 

Identification Number (EIN) is mandatory, and will be used to determine affiliation or entity identity. Please note that background statements will not become invalid if a 

TIN or EIN is not disclosed. 

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 0581-0191. The time required to complete this information 

collection is estimated to average 93.75 hours per initial response and 1 hour per annual 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. 

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. 

The undersigned hereby applies for accreditation to the National Organic Program, U.S. Department of Agriculture. 

Business Name, Mailing Address, and Primary Office Location (if different) Name of person responsible for day-to-day operations: 

Title of person responsible for day-to-day operations: 

Tax ID# 

Telephone Number: EMail address: 

Fax Number: 

PLEASE ESTIMATE THE ANNUAL ANTICIPATED NUMBER OF CERTIFICATIONS FOR EACH TYPE OF ACCREDITATION 

CROPS LIVESTOCK WILD CROP HANDLING 

LEGAL STATUS (Check one)

GOVERNMENT FOR-PROFIT 

BUSINESS

NOT FOR PROFIT 

BUSINESS 

OTHER ( (Specify)

I, (We), affirm that, if granted accreditation, I (we) will carry out the provisions of 7 CFR Part 205 including: 

1. Accepting the certification decisions made by another certifying agent accredited or accepted by USDA; 

2. Refraining from making false or misleading claims about my (our) accreditation status, the USDA accreditation program for certifying agents, or the nature or 

qualities of products labeled as organically produced; 

3. Conducting an annual performance evaluation of all persons who review applications for certification, perform on-site inspections, review certification documents, 

evaluate qualifications for certification, make recommendations concerning certification, or make certification decisions and implement measures to correct any 

deficiencies in certification services; 

4. Having an annual internal program review conducted of certification activities by the certifying agent's staff, an outside auditor, or a consultant who has the 

expertise to conduct such reviews and implement measures to correct any noncompliance’s with the Organic Foods Production Act of 1990 (Act) and the 

provisions of 7 CFR Part 205; 

5. Paying and submitting fees to AMS; 

6. Complying with, implementing, and carrying out any other terms and conditions determined by the Administrator to be necessary; 

7. (Items 7, 8, and 9 apply only to private entities) 

Holding the Secretary harmless for any failure on my (our) part to carry out the provisions of the Act and 7 CFR Part 205; 

8. Furnishing reasonable security, in an amount and according to such terms as the Administrator may by regulation prescribe, for the purpose of protecting the rights 

of production and handling operations that I (we) certify under the Act and 7 CFR Part 205; 

9. Transferring to USDA and making available to the applicable State organic program’s governing State official all records or copies of records concerning my (our) 

certification activities in the event that I (we) dissolve or lose my (our) accreditation. Such transfer does not apply to a merger, sale, or other transfer of ownership 

of a certifying agent. 

SIGNATURE OF APPLICANT OR REPRESENTATIVE PRINT OR TYPE NAME OF SIGNEE 

TITLE OF APPLICANT OR REPRESENTATIVE DATE 

PLEASE ATTACH: 

1) A list of each organizational unit, such as chapters or a subsidiary office including the name, office location, mailing address, and contact numbers (telephone, 

facsimile, and Internet address), and the name of a contact person for each unit; 2) A copy of the fee schedule for all services to be provided under these regulations by the 

applicant; 3) For a government entity, a copy of the official’s authority to conduct certification services under 7 CFR Part 205; 4) For a private entity, documentation 

showing the entity’s status and organizational purpose, such as articles of incorporation and by-laws or ownership or membership provisions, and it’s date of 

establishment; 5) A list of each State or foreign country in which the applicant currently certifies production and handling operations and a list of each State or foreign 

country in which the applicant intends to certify production and handling operations; 6) The requirements of 7 CFR Part 205, § 205.504, Evidence of expertise and 

ability. 

FOR USE BY USDA 

DATE OF RECEIPT NAME OF RECIPIENT SIGNATURE OF RECIPIENT 

TM-10CG (10-13)