U.S. USDA Form usda-ccc-24-1
This form is available electronically.
U.S. DEPARTMENT OF AGRICULTURE
CCC-24-1
Commodity Credit Corporation
(08-28-03)
LEAVE BLANK - CCC USE ONLY
SUPPLEMENT TO FORM CCC-24, APPLICATION
FOR APPROVAL OF WAREHOUSE
A. APPROVED (MM-DD-YYYY)
B. CONTRACT NUMBER
C. WAREHOUSE CODE NUMBER
D. MASTER CODE NUMBER
NOTE: The authority for collecting; the following information is Pub. L. 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 1 hour 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.
The following statements are made in accordance with the Privacy Act of 1974 (5 USC 552a). The authority for requesting this information is the Commodity Credit
Corporation (CCC) Charter Act (15 USC 714 et seq.) and the regulations promulgated thereunder (7 CFR Part 1421). The information will be used to complete the
terms of a contract between the warehouse operator and CCC. Furnishing this information is voluntary, however, without it, eligibility to enter into an agreement with
CCC cannot be determined and the agreement will be denied. In addition to the routine uses published in the Federal Register for this information, the information on
this form may be provided to the IRS, the Department of Justice, other governmental agencies, other State or Federal law enforcement agencies, or to a court
magistrate or administrative tribunal. All information provided herein is subject to verification by the CCC. The provisions of criminal and civil fraud statutes include,
but are not limited to, 18 USC 286, 287, 371, 641, 651, 1001, 1014; 15 USC 714m; and 31 USC 3729. RETURN THIS COMPLETED FORM TO THE KANSAS CITY
COMMODITY OFFICE, ATTENTION: BULK COMMODITIES DIVISION, STOP 8748, P.O. BOX 419205, KANSAS CITY, MO 64141-6205.
INSTRUCTIONS: A separate CCC-24-1 must be filed for each section of the facility.
1. Legal Name of Entity (Enter same name as in Item 1 of CCC-24.)
2. This Report
Applies To:
2B. Location (Give street address, town, county, and state Including Zip Code.
2A. Section
If not in town, give road, direction and approximate distance from named town.)
4A. Name of Lessor (Enter Lessor if Item 3B is Checked.)
3 Applicant:
4B. Expiration Date of the Lease 4C. Renewal Option on
Leased Section(s)?
(MM-DD-YYYY)
A. Owner
YES
B. Lessee of Section
NO
5A. Does Section have direct access to rail siding?
YES
5B. If "YES," give name of railroad(s) and initials on which rail shipments are received and loaded out. If "NO TRUCK
ONLY," show location and name of railroad(s) where shipments are made.
NO, TRUCK ONLY
6A. Does Warehouse Operator have complete control of warehouse space?
6B. If Item 6A "NO," Explain:
NO
YES
7B. If Item 7A "NO," Explain:
7A. Is Warehouse ready to operate?
YES
NO
8. TYPES OF CONSTRUCTION:
B. FLAT WAREHOUSE:
A. UPRIGHT CONSTRUCTION:
Concrete
Metal
Concrete
Wood
C. BINS OR TANKS:
Metal
Wood
Concrete
Metal
Wood
D. Additional Descriptive Comments Regarding Construction:
9. Operating Equipment at This Section:
YES
NO
YES
Type
A. Receiving Scales (Weighing)
D. Aeration
B. Shipping Scales (Weighing)
E. Turning
C. If No Scales, State Where Weighted:
NO
F. Permanent Operating Equipment
G. Portable Operating Equipment
H. Comments:
The making of a willfully false statement to, or theft or conversion of property owned by or pledged to CCC, is punishable by law (15 USC 714m
and 18 USC 1001).
10. CERTIFICATION
NOTE:
The applicant certifies that all statements made herein are true and correct and that the applicant will operate in accordance with the terms and provisions of the
Uniform Grain and Rice Storage Agreement. Form must be signed by an authorized individual, i.e., corporate officer, partner or proprietor. A manager cannot sign
unless authorized by a resolution of the Board of Directors or Power of Attorney furnished by a partner or proprietor.
10A. By
10B. TITLE
10C. DATE (MM-DD-YYYY)
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). To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, Room 326-W, Whitten Building, 1400 Independence
Avenue, SW, Washington, D.C. 20250-9410 or call (202) 720-5964 (voice or TDD). USDA is an equal opportunity provider and employer.