U.S. Department of Agriculture

Natural Resources Conservation Service

NRCS-CPA-41 

02/2020 

Page 1 of 5

ENTITY APPLICATION for an AGRICULTURAL LAND EASEMENT (ALE) AGREEMENT

8. Do you have entity records established with the appropriate USDA service center

agency?

If no, you must establish them with the appropriate USDA service center agency prior to

submitting this application

Yes No

9. Do you have the authority and capability to acquire, manage,and enforce

agricultural land easements? Yes No

10. Are you an NRCS-Certified Eligible Entityiv? Yes No

11. How many eligible entity staff are dedicated to monitoring and easement

stewardship?

Section A: Agreement Information

1. This is an Entity Application for an ALE-Agreement through the: (Select Only One)

Agricultural Conservation Easement Program – Agricultural Land Easementi (ACEP-ALE)

2014 Farm Bill Regional Conservation Partnership Program (RCPP) Agreement – ACEP-ALE

2. Agreement Type:

(Select Only One)

Cooperative Agreement

(all eligible entity types)

Grant Agreement 

(certified entities only)

Program Agreement

(all eligible entity types)

COMPLETE 2a and 2b FOR 

COOPERATIVE OR GRANT AGREEMENTS ONLY

2a. Enrollment Type: (Select Only One)

General ALE 

Grassland of Special Environmental Significance (GSS)

2b. Transaction Type: (Select Only One)

Standard ALE Transaction 

Buy-Protect-Sell Transactionii* 

*Entity application for buy-protect-sell transactions may only have 1 associated

parcel sheet and must include all information required by the buy-protect-sell

supplement to the application.

3. Application Date: 4. State: 5. ACEP-ALE Application Number: AGENCY USE

Section B: Primary Applicant Information – Applying as an Eligible Entityiii to Participate in ACEP-ALE

1. Name - Applicant Eligible Entity: 2. Telephone - Applicant Eligible Entity

3. Address - Applicant Eligible Entity: 4. Email - Applicant Eligible Entity

5. Tax Identification Number (TIN) - Applicant Eligible Entity: 6. Applicant Eligible Entity Type:

State Government 

Local Government

Indian Tribe

Nongovernmental 

Organizationi

7. Dun and Bradstreet Data Universal Numbering System (DUNS) Number -

Applicant Eligible Entity

If you do not have a DUNS number information is available at 

http://fedgov.dnb.com/webform. To register with SAM, go to https://www.sam.gov/
U.S. Department of Agriculture

Natural Resources Conservation Service

NRCS-CPA-41 

02/2020 

Page 2 of 5

5. Do you have entity records established with the appropriate USDA service center

agency?

If no, you must establish them with the appropriate USDA service center agency prior to

submitting this application

Yes No

6. Do you have the authority and capability to acquire, manage,and enforce agricultural

land easements?

Yes No

7. Are you an NRCS-Certified Eligible Entityiv? Yes No

8. How many eligible entity staff are dedicated to monitoring and easement stewardship?

Signature of Authorized Eligible Entity Representative

(Optional) Signature of Co-holder Legal Entity Authorized Representative

(Optional) Signature of Co-holder Legal Entity Authorized Representative

(Optional) Signature of Co-holder Legal Entity Authorized Representative

Section C: ADDITIONAL ELIGIBLE ENTITIES:

Complete for each additional Eligible Entity that will be party to the ALE Agreement

(attach additional pages as needed)

1. Name - Additional Eligible Entity:

2. TIN - Additional Eligible Entity: 3. Additional Eligible Entity Type:

State Government

Local Government 

Indian Tribe

Nongovernmental Organization

4. DUNS Number - Additional Eligible Entity:

If you do not have a DUNS number information is available at 

http://fedgov.dnb.com/webform. To register with SAM, go to https://www.sam.gov/

Section D: CO-HOLDERSv

Complete for each legal entity that may be identified as a co-holder (grantee) on the agricultural land easement 

deed for any parcelsvi associated with this application and is not listed in Section B or C as an eligible entity 

(attach additional pages as needed)

1. Name - Co-holder Legal Entity:

2. TIN - Co-holder Legal Entity: 3. DUNS Number - Co-holder Legal Entity:

4. Name - Co-holder Legal Entity:

5. TIN - Co-holder Legal Entity: 6. DUNS Number - Co-holder Legal Entity:

7. Name - Co-holder Legal Entity:

8. TIN - Co-holder Legal Entity: 9. DUNS Number - Co-holder Legal Entity:
U.S. Department of Agriculture

Natural Resources Conservation Service

NRCS-CPA-41 

02/2020 

Page 3 of 5

(Optional) Signature of Third-Party Holder Legal Entity Authorized Representative

(Optional) Signature of Third-Party Holder Legal Entity Authorized Representative

Section E: THIRD-PARTY RIGHT HOLDERSvii

Complete for each legal entity that will hold a third-party right, contingent right, or any other real 

property interest in an agricultural land easement on any parcels that may be associated with this 

application and is not listed in section B, C, or D.

(attach additional pages as needed)

1. Name – Third-Party Holder Legal Entity:

2. TIN - Third-Party Holder Legal Entity: 3. (Optional) DUNS Number - Third-Party Holder Legal

Entity:

4. Name - Third-Party Holder Legal Entity:

5. TIN - Third-Party Holder Legal Entity: 6. (Optional) DUNS Number - Third-Party Holder Legal

Entity:

COMPLETE SECTIONS F and G ONLY FOR an ACEP-ALE Cooperative or Grant Agreement as identified 

Section A, Box 2.

Section F: Easement Value and Compensation Costs

Complete the table below with the sum totals for all parcels associated with this application.

These values may be estimates, subject to the final values being determined by an NRCS-approved appraisal 

report or easement valuationmethodology.

1. Total Estimated Fair Market Value of all ALEs

(Sum of Item (A) in Section D on all Parcel Sheets associated with this Entity Application) $ 

2. Total Estimated Entity Cash Contribution for all Parcels

(Sum of Item (B) in Section D on all Parcel Sheets associated with this Entity Application) $ 

3. Total Estimated Total Non-Federal Share for all Parcels

(Sum of Item (I) in Section D on all Parcel Sheets associated with this Entity Application) $ 

4. Total Requested Federal Share for ALEs

(Sum of Item (C) in Section D on all Parcel Sheets associated with this Entity Application) $ 

Section G: Roles, Contributions, and Distributions* 

(As applicable to any legal entities identified in Sections B, C, D, and E)

5. Name of Entity

6. Contribution:

Estimated Entity Cash

Contribution to all ALEs

• May be provided by any legal

entity identified in Section B, C,

D, or E above

• Total must equal item 2 above

7. Distribution: Estimated

Federal Share for all ALEs

• Federal share may only be paid

to an Eligible Entity identified in

Section B or C above

• Total must equal item 4 above

$ $ 

$ $ 

$ $ 

$ $ 
U.S. Department of Agriculture

Natural Resources Conservation Service

NRCS-CPA-41 

02/2020 

Page 4 of 5

The Terms and Certifications below are applicable to applications for 

all ACEP-ALE Agreement Types:

Each identified Eligible Entity has reviewed the template Agricultural Land Easement (ALE) 

Agreement that stipulates the terms and conditions under which the Eligible Entity would be 

permitted to use the cost-share assistance applied for herein. Each Eligible Entity agrees to 

participate in the ACEP-ALE if NRCS and the Eligible Entity enter into an ALE-Agreement. 

However, nothing in this application obligates the United States or an Eligible Entity to purchase all 

or any of the agricultural land easements listed on the Parcel Sheets attached to or associated with 

this application. To identify future roles should this application be funded, an Eligible Entity may 

hereafter be also be referred to as "Participant." Participants understand that acquiring an 

agricultural land easement without satisfying the requirements set forth in the terms of the applicable 

ALE-agreement causes the agricultural land easement to be ineligible for ACEP cost-share 

assistance.

It is the responsibility of the Participants to provide accurate data to support all items addressed in 

this application at the request of NRCS. Participants acknowledge that NRCS is relying upon the 

veracity of the information submitted for purposes of awarding Federal funds and that the submittal 

of false information may be subject to criminal or civil fraud statutes.

Participants are required to be registered in the System for Award Management (SAM) before 

submitting this application and must provide a valid Dun and Bradstreet Data Universal Numbering 

System (DUNS) number on this application. Each Participant must continue to maintain an active 

SAM registration with current information at all times during which it has an active application for 

funding under consideration and at all times for the duration of any ALE-Agreement entered into 

under the program. NRCS may not enter into an ALE-Agreement with an Eligible Entity until all 

applicable DUNS and SAM requirements have been met. If an Eligible Entity has not fully complied 

with these requirements by the time NRCS is ready to award the ALE-Agreement, NRCS may 

determine that the Eligible Entity is not qualified to receive an ALE-Agreement and use that 

determination as a basis for making an award to another applicant.

The Participant certifies that all highly erodible land conservation/wetland conservation, 

adjusted gross income certifications, and member information for each Landowner of record 

for each parcel associated with this entity application are on file with the appropriate USDA 

service center agency and are up to date.

PRIMARY APPLICANT ELIGIBLE ENTITY CERTIFICATION AND SIGNATURES:

Primary Applicant Eligible Entity identified in Section B must complete the following section

Check

Each Box

I certify that the Applicant Eligible Entity has the resources necessary to acquire, monitor, 

manage, and enforce the easements being applied for and acknowledge that additional 

documentation to substantiate this may be required to receive Federal cost-share assistance.

I have received and reviewed a copy of the required ALE-Agreement and associated 

attachments and understand that the terms of the agricultural land easement deed must 

address the provisions required as a condition of participation in ACEP-ALE as identified in 

the ALE-agreement.

Signature of Applicant Eligible Entity Authorized Representative Date
U.S. Department of Agriculture

Natural Resources Conservation Service

NRCS-CPA-41 

02/2020 

Page 5 of 5

NONDISCRIMINATION STATEMENT

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, AD3027, 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.

i Agricultural land easement means an easement or other interest in eligible land that is conveyed for the 

purposes of protecting natural resources and the agricultural nature of the land and of promoting agricultural 

viability for future generations and permits the Landowner the right to continue agricultural production and 

related uses subject to the terms of the easement.

ii Buy-Protect-Sell transaction means a legal arrangement between an eligible entity and NRCS relating 

to land owned or being purchased by an eligible entity on a transitional basis during which an agricultural 

land easement will be secured on eligible private or Tribal land, and ownership of the land transferred to a 

qualified farmer or rancher following conditions specified by NRCS. 

iii Eligible Entity means a State or local government, Indian Tribe, or nongovernmental organization that 

NRCS has determined to meet the requirements of 7 CFR Section 1468.20(b). An Eligible Entity must be 

identified as a holder (grantee) on an agricultural land easement deed acquired on any parcels that may be 

associated with this application. An Eligible Entity is considered a participant in ACEP-ALE, must be party 

to the ALE-agreement, may receive direct payment of ACEP-ALE cost-share funds, and must have current 

registration in DUNS and SAM.

iv Certified Entity means an eligible entity that NRCS has determined to meet the requirements 

of 7 CFR Section 1468.26. An Entity may only be certified by the Chief of NRCS.

v Co-Holder is any legal entity identified as a co-holder (grantee) in an agricultural land easement deed 

held by an Eligible Entity on a parcel associated with this application. A Co-holder is not considered a 

participant in ACEP-ALE and may not receive a direct payment of ACEP-ALE cost-share funds; however, a 

Co-holder is a beneficiary of such Federal funds and therefore must acknowledge their agreement to 

comply with the terms of an ALE-agreement and must have current registration in DUNS and SAM.

vi Parcel means a farm or ranch submitted for consideration for funding under ACEP-ALE.

vii Third-Party Right Holder is any legal entity that is not identified as a grantee but is instead identified as 

a holder of a third-party right, contingent right, or any other real property interest in an agricultural land 

easement deed held by an Eligible Entity on a parcel associated with this application. A Third-Party Right 

Holder is not considered a participant in ACEP-ALE, may not receive a direct payment of ACEP-ALE costshare funds, is not a beneficiary of the Federal funds, and is not required to be registered in DUNS and 

SAM.

PRIVACY ACT STATEMENT

The following statements are made in accordance with the Privacy Act of 1974 (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.

This information collection is exempted from the Paperwork Reduction Act under 16 U.S.C. 3801 note and 

16 U.S.C. 3846.