AD 2106.pdf
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- Meat and Poultry Processing Expansion Program Federal grant opportunity
- Opportunity number
- RD-RBS-22-01-MPPEP
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AD 2106
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Other files for this federal grant opportunity
| File | Type | Posted |
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| MPPEP Summary Updates to the RFA 4-7-22.docx | DOCX document | |
| RFA_Meat and Poultry Processing Expansion Program 4-7-22.docx | DOCX document | |
| RFA_Meat and Poultry Processing Expansion Program 2-24-22.pdf | ||
| MPPEP Application Template.pdf | ||
| RFA_Meat and Poultry Processing Expansion Program 2-24-22.pdf | ||
| MPPEP Self-Screening Guide.pdf | ||
| MPPEP Application Checklist.pdf | ||
| Environmental Checklist.pdf | ||
| Feasibility Study Guide.pdf |
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Text version
AD-2106 Approved –OMB No. 0503-0019 (01-19-12)
U.S. Department of Agriculture
Form to Assist in Assessment of USDA Compliance With Civil Rights Laws
QUESTIONNAIRE
The purpose of this questionnaire is to gather race, ethnicity, and gender information about persons who apply and participate in this USDA program. The information you provide will not be used when reviewing your application or when determining whether you are eligible to participate in this program.
This is a voluntary questionnaire. You are not required to give this information, but we hope you will because the information you give will be used to improve the operation of this program, to help USDA design additional opportunities for program participation, and to monitor enforcement of laws that require equal access to this program for eligible persons. If you have previously provided this information to USDA please DO NOT fill out this form. Your information will be kept private to the extent permitted by law. Thank you for your response.
1. What is your name?
2. Legal Residence:
3. What is your gender? Male Female
Please answer BOTH question 4 and question 5 below about ethnicity and race. For this questionnaire, Hispanic or Latino origins are not races.
4. Ethnicity: Hispanic or Latino
Not Hispanic or Latino
5. What is your race? Mark all that apply.
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
According to the Paperwork Reduction Act of 1995, an agency may not conduct, 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 0503-0019. The time required to complete this information collection is estimated to average 2 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.
Instructions for AD-2106
Form to Assist in Assessment of USDA Compliance with Civil Rights Laws
This form is used by USDA agencies, including FSA, NRCS, RBS, RHS, and RUS to gather race, ethnicity, and gender information from program participants. For participants that are entities, complete a separate form for each member.
Participants should complete all items.
Fld Name / Item No.
Instruction
1. What is Your Name Enter your full legal name.
2. Legal Residence Enter your current address.
3. Gender Check your appropriate gender.
4. Ethnicity Check your appropriate ethnicity.
5. Race Check your appropriate race(s). Multiple races may be checked.
PRIVACY ACT STATEMENT
The following statement is made in accordance with the Privacy Act of 1974 (5 USC 552a - as amended).
The authority for requesting the information identified on this form is the Food, Conservation, and Energy Act of 2008 (Pub. L. 110-246). The information will be used to compile program application and participation rate data regarding socially disadvantaged farmers or ranchers and to conduct oversight and evaluation of civil rights compliance. The information collected on the form may be disclosed to other Federal, State, Local government agencies, Tribal agencies, and nongovernmental entities that have been authorized access to the information by statute or regulation and/or as described in applicable Routine Uses identified in the System of Records Notice for USDA/FSA-2, Farm Records File (Automated).
Providing the requested information is voluntary. However, failure to furnish the requested information will result in customer declared data not being entered into the database.
The provisions of appropriate criminal and civil fraud, privacy, and other statutes may be applicable to the information provided. RETURN THIS COMPLETED FORM TO THE
APPROPRIATE USDA SERVICING OFFICE.
NONDISCRIMINATION STATEMENT
The U.S. Department of Agriculture (USDA) prohibits discrimination in all of its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, political beliefs, genetic information, reprisal, or because all or part of an individual’s 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 to USDA, Assistant Secretary for Civil Rights, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, S.W., Stop 9410, Washington, DC 20250-9410, or call toll-free at (866) 632-9992 (English) or (800) 877-8339 (TDD) or (866) 377-8642 (English Federal-relay) or (800) 845-6136 (Spanish Federal-relay). USDA is an equal opportunity provider and employer.
Estimate And Certification Of Actual Cost
RD 1924-13
AD-2106
Approved –OMB No. 0503-0019 (01-19-12) U.S. Department of Agriculture Form to Assist in Assessment of USDA Compliance With Civil Rights Laws
QUESTIONNAIRE
The purpose of this questionnaire is to gather race, ethnicity, and gender information about persons who apply and participate in this USDA program. The information you provide will not be used when reviewing your application or when determining whether you are eligible to participate in this program. This is a voluntary questionnaire. You are not required to give this information, but we hope you will because the information you give will be used to improve the operation of this program, to help USDA design additional opportunities for program participation, and to monitor enforcement of laws that require equal access to this program for eligible persons. If you have previously provided this information to USDA please DO NOT fill out this form. Your information will be kept private to the extent permitted by law. Thank you for your response.
1. What is your name?
2. Legal Residence:
3. What is your gender?
Male Female Please answer BOTH question 4 and question 5 below about ethnicity and race. For this questionnaire, Hispanic or Latino origins are not races.
4. Ethnicity:
Hispanic or Latino Not Hispanic or Latino
5. What is your race? Mark all that apply.
American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White According to the Paperwork Reduction Act of 1995, an agency may not conduct, 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 0503-0019. The time required to complete this information collection is estimated to average 2 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.
Instructions for AD-2106 Form to Assist in Assessment of USDA Compliance with Civil Rights Laws This form is used by USDA agencies, including FSA, NRCS, RBS, RHS, and RUS to gather race, ethnicity, and gender information from program participants. For participants that are entities, complete a separate form for each member.
Participants should complete all items.
Fld Name / Item No.
Instruction
1. What is Your Name Enter your full legal name.
2. Legal Residence Enter your current address.
3. Gender Check your appropriate gender.
4. Ethnicity Check your appropriate ethnicity.
5. Race Check your appropriate race(s). Multiple races may be checked.
PRIVACY ACT STATEMENT
The following statement is made in accordance with the Privacy Act of 1974 (5 USC 552a - as amended). The authority for requesting the information identified on this form is the Food, Conservation, and Energy Act of 2008 (Pub. L. 110-246). The information will be used to compile program application and participation rate data regarding socially disadvantaged farmers or ranchers and to conduct oversight and evaluation of civil rights compliance. The information collected on the form may be disclosed to other Federal, State, Local government agencies, Tribal agencies, and nongovernmental entities that have been authorized access to the information by statute or regulation and/or as described in applicable Routine Uses identified in the System of Records Notice for USDA/FSA-2, Farm Records File (Automated). Providing the requested information is voluntary. However, failure to furnish the requested information will result in customer declared data not being entered into the database.
The provisions of appropriate criminal and civil fraud, privacy, and other statutes may be applicable to the information provided. RETURN THIS COMPLETED FORM TO THE APPROPRIATE USDA SERVICING OFFICE.
NONDISCRIMINATION STATEMENT
The U.S. Department of Agriculture (USDA) prohibits discrimination in all of its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, political beliefs, genetic information, reprisal, or because all or part of an individual’s 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 to USDA, Assistant Secretary for Civil Rights, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, S.W., Stop 9410, Washington, DC 20250-9410, or call toll-free at (866) 632-9992 (English) or (800) 877-8339 (TDD) or (866) 377-8642 (English Federal-relay) or (800) 845-6136 (Spanish Federal-relay). USDA is an equal opportunity provider and employer.
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| Item 1. Enter your full legal name. : |
| Item 2. Enter your current address.: |
| Item 2 Legal Residence Second line. Enter your second line current address. : |
| Item 3 What is your gender. Check this box if you are a male.: |
| Item 3 What is your gender. Check this box if you are a female.: |
| Item 4 Ethnicity. Check this box if you are a Hispanic or Latino.: |
| Item 4 Ethnicity Not Hispanic or Latino. Check this box if you are not Hispanic or Latino.: |
| Item 5. What is your race. Check this box if you are an American Indian or Alaska Native.: |
| Item 5. What is your race. Check this box if you are Asian.: |
| Item 5 What is your race. Check if you are Black or African American.: |
| Item 5 What is your race. Check if you are a Native Hawaiian or Other Pacific Islander.: |
| Item 5 What is your race. Check if you are White.: |
File details come from the government source that posted it. Updated .