U.S. USDA Form usda-fsa-378
This form is available electronically.
U.S. DEPARTMENT OF AGRICULTURE
FSA-378
Farm Service Agency
(09-01-03)
APPLICATION FOR REALLOCATION OF
FORFEITED ALLOTMENT OR QUOTA
Form Approved - OMB No. 0560-0058
2. KIND OF TOBACCO
1. CROP YEAR
3. STATE
4. COUNTY
(See Page 2 for the Privacy Act and Pubic Burden Statements)
5A. NAME AND ADDRESS OF APPLICANT
5C. FARM NO.
6. CURRENT ALLOTMENT, QUOTAS, OR BASES
A. Kind of Tobacco
B. Acres
C. Quota
5D. FARMLAND
D. Commodity
5B. ID NO.
E. Base (Acres)
F. Commodity
G. Base (Acres)
5E. CROPLAND
Application is hereby made for reallocation and quota from the forfeiture pool for the above identified kind of tobacco for the crop year shown above. I request that any reallocation and quota be assigned to the farm identified in item 5.
7. In the current year, I will produce the kind of tobacco identified in item 2 above by sharing in the risk of producing the crop.
8. During the current year or during the 4 years preceding the current year, I have not:
A. Sold or forfeited allotment or quota from any farm; or
B. Used the designed method of division to retain less allotment and quota than the farm would have retained by another
method of division.
9. I own the farms listed in item 12 below with a current year allotment or quota for the kind of tobacco identified in item 2 above.
10. I understand that any reallocated allotment and quota shall be forfeited if I, the applicant to whom the allotment and quota is
reallocated, fail to share in the risk of production of tobacco produced under such allotment and quota during any of the 5 years
beginning with the crop year in which the allotment and quota is reallocated. The definition for "Shared in Risk of Production" for
the kind of tobacco identified above has (check item10A and 10B below):
10A. BEEN PROVIDED ME BY THE COUNTY FSA OFFICE
10B. BEEN EXPLAINED TO ME BY THE COUNTY FSA OFFICE
11. I REQUEST THAT THE POUNDS OF FORFEITED QUOTA IN ITEM 13 BELOW BE REALLOCATED TO THE FARM ABOVE FOR THE
FOLLOWING REASONS: (If additional space is needed use item 18, page 2).
12. COUNTY (IES) AND FARM SERIAL NUMBER(S)
13. POUNDS REQUESTED
14B. APPLICANT'S SIGNATURE
14A. APPLICANT'S CERTIFICATION: I hereby certify that the information furnished here in is true to the best of
my knowledge and belief.
15A. CONSENT STATEMENT FOR FARM OWNER TO HAVE REALLOCATED 15B. FARM OWNER'S SIGNATURE
ALLOTMENT AND QUOTA ASSIGNED TO FARM
(Complete if owner is not applicant). I hereby give my consent for any reallocation
allotment and quota approved for the applicant in this application to be assigned to
the farm identified above 14C. DATE
(MM-DD-YYYY)
15C. DATE
(MM-DD-YYYY)
16. COUNTY COMMITTEE ACTION
A. On the basis of information contained in this application, a review of County FSA Office records, and pursuant to eligibility requirements contained in
applicable regulations, this applicant is (Check one) : ELIGIBLE
INELIGIBLE
The quota approved or recommended for approval
from the forfeiture pool is in our judgment fair and reasonable.
B. Lbs. Quota Approved/Recommended for Reallocation
C. COC SIGNATURE
D. DATE (MM-DD-YYYY)
17. STATE COMMITTEE ACTION (Where Applicable)
A. Lbs. Quota Approved for Reallocation
B. STC SIGNATURE
C. DATE (MM-DD-YYYY)
FSA-378 (09-01-03) Page 2
18. REMARKS
NOTE: The following statements is made in accordance with the Privacy Act of 1974 (5 U.S.C. 552a) and the Paperwork Reduction Act of 1995, as amended. The authority for requesting the following information is Agricultural Adjustment Act of 1938, as amended, the Commodity Credit Corporation Character Act, as amended and Pub. L. 430. The information will be used to determine eligibility for reallocation of forfeited allotments or quotas. Furnishing the requested is voluntary. Failure to furnish the requested information will result in a loss of program benefits. This information may be provided to other agencies, IRS, Department of Justice or other State and Federal law enforcement agencies and in response to a court magistrate or administrative tribunal. The provisions of criminal and civil fraud statutes, including 18 USC 286, 287, 371, 641, 651, 1001; 15 USC 714m; and 31 USC 3729, may be applicable to the information provided. According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a
collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is
0560-0058. The time required to complete this information collection is estimated to average 10 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. RETURN THIS COMPLETED FORM TO YOUR COUNTY FSA OFFICE.
The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the 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.