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Instructions For AD-1161 (Former NRCS-141, CCC-1202)

APPLICATION FOR PAYMENT

Program participants (landowners) submit this form to receive payment based on signed contracts or agreements under the following programs: Colorado River Salinity Control Program (CRSCP), Emergency Watershed Program (EWP), Forestry Incentives Program (FIP), Great Plains Conservation Program (GPCP), Interim Environmental Quality Incentives Program (IEQIP), Resource Conservation and Development Program (RC&D), Rural Abandoned Mine Program (RAMP), Watershed Protection and Flood Prevention Program (WPFPP; P.L. 566 & P. L. 534), WRP (direct appropriated funds), and Wildlife Habitat Incentives Program (WHIP). Information is needed from form AD- 1155, Conservation Plan Schedule of Operations, to complete this form.

Submit the original of the completed form in hard copy or facsimile to the appropriate USDA servicing office. Customers who have established electronic access credentials with USDA may electronically transmit this form to the USDA servicing office. Features for transmitting the form electronically are available to those customers with access credentials only. If you would like to establish online access credentials with USDA, complete form AD-2016 or visit your local servicing office. AD-2016 is available from USDA’s eForms service and must be notarized before mailing or faxing the form to USDA. It will not be accepted electronically.

Producers must complete Items 2, 3, 4, 7, 8, 9, 11.A, 11.B, 11.C, 11.H, 11.I, 11.J, 12.A, 12.C–12.G, and 12.I–12.L.

Items 1, 5, 6, 11D–11G, 11K–11N, 12B, 12H, and 13–15 are for NRCS use only.

Item 1 is completed by NRCS.

Items 2–4

Fld Name / Item No. Instruction
2

State		 Enter the state in which the land unit for which you are requesting payment is located.
3

Signature		 Enter the program name under which you are requesting payment. You may use the program’s acronym (e.g., WRP).
4

Agreement or
Contract No.		 Enter the number assigned to the contract or agreement for which you are requesting payment. See item 6 on the “Conservation Plan Schedule of Operations” form AD- 1155.
7

County		 Enter the county where the land unit for which you are requesting payment is located.
8

Specified Conservation Practices Performed		 Use this section to enter the details for payments requested for specific conservations practices performed. Each line requests information under ten columns (labeled A through J), and represents one item number from the “Conservation Plan Schedule of Operations” form AD-1155. You may enter up to 5 lines of data.
Column A

Agreement or Contract Item Number		 Enter the contract or agreement item number as it appears in the contract or agreement for the practice or component for which you are requesting payment. See column 8 on the “Conservation Plan Schedule of Operations” form AD-1155.
Column B Field Enter the field number from column 9, Field, on the “Conservation Plan Schedule of Operations” form AD-1155.
Column C

Practice and Identifiable Unit		 Enter the practice or component name from column 10, Planned Conservation Treatment, on the “Conservation Plan Schedule of Operations” form AD-1155.
Column D

Date Started		 Enter the date that the application of the practice or component began. Enter the date using the format of two digits for the month and day, and four digits for the year, separated by dashes. Example: mm-dd-yyyy.
Column E

Date COmpleted		 Enter the date that the practice or component was completed. Enter the date using the format of two digits for the month and day, and four digits for the year, separated by dashes. Example: mm-dd-yyyy.
Column F

Practice Units Completed		 Enter the number or amount of practice units, such as number, feet, acres, etc., certified as completed according to specifications. If you are unsure, leave this field blank for the NRCS designated conservationist to complete.
Column G

Extent		 Enter the extent of practice units cost-shared by NRCS. For example, enter the number or amount of practice units, such as number, feet, acres, etc. This may be the same number or amount as in column F. If you are unsure, leave this field blank for the NRCS designated conservationist to complete.
Column H

Average Cost $		 Enter the average cost shown in the contract or the average cost current at the time the practice or component was begun. When payment is to be made on the basis of actual cost not to exceed the average cost, or a specified maximum cost according to the contract, you must submit invoices and receipts along with this form.
Column I

Cost Share %		 Enter the cost-share percentage rate specified in the column 13, Cost Share or Payment Rate %, on the “Conservation Plan Schedule of Operations” form AD-1155.
Column J

Amount Earned $		 This item is automatically calculated by multiplying the amounts you entered in columns H and I.
9

Specified Conservation Practices Performed		 Use this section to enter the details for payments requested for other types of payments, such as appraisals, surveys, easements, title insurance, recording fees, and other items used in filing an easement. Each line requests information under ten columns (labeled A through J), and represents one item number from the “Conservation Plan Schedule of Operations” form AD-1155. You may enter up to 5 lines of data.
Column A

Agreement or Contract Item Number		 Enter the contract or agreement item number as it appears in the contract or agreement for the practice or component for which you are requesting payment. See column 8 on the “Conservation Plan Schedule of Operations” form AD-1155.
Column B

Field		 Enter the field number from column 9, Field, on the “Conservation Plan Schedule of Operations” form AD-1155.
Column C

Practice and Identifiable Unit		 Enter the practice or component name from column 10, Planned Conservation Treatment, on the “Conservation Plan Schedule of Operations” form AD-1155.
Column D

Date Started		 Enter the date that the application of the practice or component began. Enter the date using the format of two digits for the month and day, and four digits for the year, separated by dashes. Example: mm-dd-yyyy.
Column E

Date Completed		 Enter the date that the practice or component was completed. Enter the date using the format of two digits for the month and day, and four digits for the year, separated by dashes. Example: mm-dd-yyyy.
Column F

Practice Units Completed		 Enter the number or amount of practice units, such as number, feet, acres, etc., certified as completed according to specifications. If you are unsure, leave this field blank for the NRCS designated conservationist to complete.
Column G

Extent		 Enter the extent of practice units cost-shared by NRCS. For example, enter the number or amount of practice units, such as number, feet, acres, etc. This may be the same number or amount as in item column F. If you are unsure, leave this field blank for the NRCS designated conservationist to complete.
Column H

Average Cost $		 Enter the average cost shown in the contract or the average cost current at the time the practice or component was begun. When payment is to be made on the basis of actual cost not to exceed the average cost, or a specified maximum cost according to the contract, you must submit invoices and receipts along with this form.
Column I

Cost Share %		 Enter the cost-share percentage rate specified in the column 13, Cost Share or Payment Rate %, on the “Conservation Plan Schedule of Operations” form AD-1155.
Column J

Amount Earned $		 This item is automatically calculated by multiplying the amounts you entered in columns H and I.
10

Total Earned		 This item is automatically calculated by adding all the amounts shown in all the rows for column J, Amount Earned.
11

Division of Payment Between Participants		 This section is completed by both the program participant(s) and NRCS. It can be used to record information for one or two participants. If only one participant is requesting payment, fill out items 11.A through 11.G. If a second participant is involved, fill out items 11.H through 11.N. If more than two participants are requesting payments, make additional copies of this form and fill in the appropriate information in this section.
A

Did the State or Federal Government bear any part of this expense?		 (Participant 1) Check the box labeled “No” if the state or federal government did not bear any part of the expense for the practices for which you are requesting payment. Note that this amount does not include the requested payment from NRCS. If you check the “No” box, you may skip item 11.B. Check the box labeled “Yes” if the state or federal government did not bear any part of the expense for the practices for which you are requested. If you check the “Yes” box, you must fill in item 11.B.
B

How much?		 (Participant 1) If you checked the “Yes” box in item 11.A, enter the amount of payment you received for the practices for which you are requesting payment.
H

Did the State or Federal Government bear any part of this expense?		 (Participant 2) Check the box labeled “No” if the state or federal government did not bear any part of the expense for the practices for which you are requesting payment. Note that this amount does not include the requested payment from NRCS. If you check the “No” box, you may skip item 11.I. Check the box labeled “Yes” if the state or federal government did not bear any part of the expense for the practices for which you are requested. If you check the “Yes” box, you must fill in item 11.I.
I

How much?		 (Participant 2) If you checked the “Yes” box in item 11.H, enter the amount of payment you received for the practices for which you are requesting payment.
Enter Item No.

Enter Field Name		 Enter instruction.
12

Participants' Certification		 This section is completed by both the program participant(s) and NRCS. It can be used to record information for one or two participants. If only one participant is requesting payment, fill out items 12.A through 12.F. If a second participant is involved, fill out items 12.G through 12.L. If more than two participants are requesting payments, make additional copies of this form and fill in the appropriate information in this section.
12A

Tax Identification No.		 (Participant 1) Enter your tax identification number. If you are an individual, enter your social security number.
12.C

Name		 (Participant 1) Enter your full name.
12.D

Address		 (Participant 1) Enter your address, city, state, and zip code.
12.E (Participant 1) If you are mailing, faxing, or delivering this form in person, print the form and manually enter your signature. This form has been approved for electronic transmission. If you have established credentials with USDA to submit forms electronically, use the buttons provided for transmitting the form.
12.F

Date		 (Participant 1) Enter the date you sign the agreement. Enter the date using the format of two digits for the month and day, and four digits for the year, separated by dashes. Example: mm-dd-yyyy.
12.G

Tax Ident. No.		 (Participant 2) Enter your tax identification number. If you are an individual, enter your social security number.
12.I

Name		 (Participant 2) Enter your full name.
12.J

Address		 (Participant 2) Enter your address, city, state, and zip code.
12.K (Participant 2) If you are mailing, faxing, or delivering this form in person, print the form and manually enter your signature. This form has been approved for electronic transmission. If you have established credentials with USDA to submit forms electronically, use the buttons provided for transmitting the form.
12.L

Date		 (Participant 2) Enter the date you sign the agreement. Enter the date using the format of two digits for the month and day, and four digits for the year, separated by dashes. Example: mm-dd-yyyy.

Items 13-15 are completed by NRCS.