Spreadsheet: 20ea4aa3-2ee0-4326-acf3-e0cb8428cfe9
Sheet: CRPSignature Page

1. To be completed by NRCS; check appropriate box: |  |  | This transaction is for CCC. |  |  |  | This transaction is for NRCS. |  |  |  |  |  |  | OMB No. 0578-0013
U.S. DEPARTMENT OF AGRICULTURE |  |  |  |  | CONSERVATION PLAN |  |  |  |  |  |  |  | 2. | Page |  | of
 |  |  |  |  | SCHEDULE OF OPERATIONS
The above statements are made in accordance with the Privacy Act of 1974 (5 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.
3. NAME |  |  | 4. COUNTY |  |  | 5. STATE | 6. CONTRACT OR |  |  |  |  |  | 7. TOTAL ACRES UNDER
 |  |  |  |  |  | WI | AGREEMENT NO. |  |  |  |  |  | CONTRACT
 |  |  |  |  |  |  | COMPLETION SCHEDULE AND ESTIMATED
ITEM | FIELD | PLANNED  CONSERVATION |  | ESTIMATED | COST | COST SHARE | COST-SHARE OR PAYMENT BY YEAR
NO. |  | TREATMENT |  | AMOUNT | BASIS | OR PAYMENT | (For Non-Cost Share Items Show Units)
 |  | (Record of Decisions) |  | (UNITS) | $ | RATE
 |  |  |  |  |  | % | 14 | 15 | 16 | 17 | 18 | 19 | 20 | 21 | 22 | 23 | REF. NO.
 |  |  |  |  |  |  | Year | Year | Year | Year | Year | Year | Year | Year | Year | Year
 |  |  |  |  |  |  | 2014 | 2015 | 2016 | 2019 | 2020 | 2022 | 2024 | 2026
8 | 9 | 10 |  | 11 | 12 | 13 | 24 | 25 | 26 | 27 | 28 | 29 | 30 | 31 | 32 | 33 | 34
 |  | A. Total Cost-Share or Payment by Year:
 |  | B. Total Contract Payment:
NOTES: | A. All Items numbered in column 8 on form AD-1155 must be carried out as a part of this contract to prevent violation.
 | B. When established, the conservation practices listed in Column 8 must be maintained by the participant at no cost to the government
 | C. Enter total cost per unit in column 12 unless the method of cost-share is flat rate.  When flat rate, enter the amount per unit to be paid to the participant
 | D. All cost share rates in column 13 are based on average cost with the following exceptions:
 | AA = Actual costs not to exceed average cost
 | FR = Flat Rate
 | NC = Non cost-shared.
 | AM = Actual cost not to exceed a specified maximum
 | AP = Annual Payment
 | [NAME] will be referenced by number in column number 34 on form AD-1155.
 | F. By signing, the participant acknowledges receipt of this conservation plan including form AD-1155 and agrees to comply with
 | the terms and conditions hereof.
35. CERTIFICATION OF PARTICIPANTS
A. SIGNATURE |  |  | B. Date | C. SIGNATURE |  |  |  |  | D. Date | E. SIGNATURE |  |  |  |  | F. Date
36. REVIEWING OFFICIALS SIGNATURE
A. District Conservationist - Technical Adequacy Certification |  |  |  |  |  |  | B. Date | [NAME] BY (Conservation District Representative) |  |  |  |  |  | D. Date
SIGNATURE |  |  |  |  |  |  |  | SIGNATURE
OMB DISCLOSURE STATEMENT
Federal Agencies may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number.  Public reporting burden for this collection is estimated to average 37.5 mins. 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.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to Department of Agriculture, OIRM, [NAME], Wash. DC
NONDISCRIMINATION STATEMENT
The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, gender, religion, 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 individuals 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 USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW., Washington D.C. 20250-9410, or call (800) 795-3272 (voice) or (202)720-6382 (TDD).