" * " Required Field
- Use your mouse to click inside each data entry box.
- Type the requested information into the box.
- Click the "Submit Request" button when finished.
- Use the tab key on your keyboard to jump to each data entry box on the form.
- Type in the reqested information.
- Tab to the "Submit Request" button and press the enter key when done.
Privacy and Paperwork Reduction Act Statements
Privacy Act Information: This information is provided pursuant to Public Law 93-579 (Privacy Act of 1974) for individuals completing Federal records and forms that solicit personal information. The authority is Title 5 of the U.S. Code, sections 1302, 3301, 3304, and 7201.
Purpose and Routine Uses: The information from this form is used solely to respond to you regarding the service you have requested. No other uses will be made of this information.
Effects of Non-Disclosure: Providing this information is voluntary, however, without it we may not be able to respond to you regarding the service you have requested.
Paperwork Reduction Act Statement: A Federal agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a current valid OMB control number.
Public Burden Statement: Public reporting burden for this collection of information is estimated to vary from two to four minutes with an average to three minutes per response, including time for reviewing instructions, 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, Clearance Officer, OIRM, Room 404-W, Washington, D.C. 20250, and to the Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, D.C. 20503