U.S. USDA Form usda-kc-140
KC-140
1. DATE
U. S. DEPARTMENT OF AGRICULTURE
Farm Service Agency
(5-4-04)
WAREHOUSE OPERATOR'S REPORT OF SPACE AVAILABILITY
INSTRUCTIONS: Submit separate form for each warehouse location.
NOTE: The following statements are made in accordance with the Privacy Act of 1974 (5 U.S.C. 552a). The authority for requesting the information to be
supplied on this form is 7 CFR 1423.1. The information will be used to identify storage space available for CCC use. Furnishing the requested information is
voluntary. However, failure to furnish correct, complete information may result in a determination of ineligibility for program benefits. The provisions of criminal
and civil fraud statutes, including 18 U.S.C. 286, 287, 271, 641, 1001; 15 U.S.C. 714m; and 31 U.S.C. 3729, may be applicable to information provided by the
warehouse operator on this form. Information will be made available to the public upon request.
Please submit one copy monthly (by the fifth (5th) day of each month) to:
U. S. Department of Agriculture, FSA
Kansas City Commodity Office
Attn: Judith Williams FAX: 816-926-6595
Dairy and Domestic Operations Division (D&DOD), Mail Stop 8718
P. O. Box 419205
Kansas City, Missouri 64141-6205
If we do not receive a report from you, we will assume that you do not have space available which you desire to offer CCC over
and above commercial requirements and seasonal demands in the territory you service.
2a
2b
2c
2d
COMMODITY
QUANTITY
(NUMBER OF RAILCARS)
QUANTITY
(NUMBER OF TRUCKS)
QUANTITY
(POUNDS)
DRY
COOLER
FREEZER
3. REMARKS
a. WAREHOUSE CODE
b. CONTACT PERSON
c. PHONE NUMBER (Include Area Code)
d. FAX NUMBER
e. LOAD/UNLOAD CAPACITY
f. SPECIAL INSTRUCTION
PLEASE NOTE:
th
This is an offer valid through the fifth (5 ) day of the following month, unless subsequently revised by warehouse operator.
4a. NAME OF WAREHOUSE (COMPANY)
4b. LOCATION OF WAREHOUSE
In offering the above space, consideration has been given to the normal commercial requirements and seasonal
demands. It is understood that this offer does not obligate CCC to utilize space offered.
5a. SIGNATURE
5b. TITLE
PUBLIC BURDEN STATEMENT
The authority for collecting the following information is Public Law 107-171. This authority allows for the collection of information without prior OMB approval mandated by the
Paperwork Reduction Act of 1995. The time required to complete this information collection is estimated to average 15 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.
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,
political beliefs, sexual orientation, and marital or family status. (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). USDA is an equal
opportunity provider and employer.