The USDA Minority Farm Register is a voluntary tool that allows minority farmers and ranchers to provide their contact information to USDA in order to receive information about USDA programs and services. By completing and submitting a simple registration form with their name, address, signature and date, participants can opt-in to USDA's outreach efforts. The form collects optional additional information like phone number, email, ethnicity and location of farm or ranch. The purpose is to promote equal access to programs for minorities in agriculture.

1. IJSDA
ffi united states Department oi Agricutiure
Minority
Herm
Kmgflmter

2. WHAT IS THE USDA
Minority Farm
Register?
The USDA Minority Farm Register is a tool to promote equal access to
USDA farm p!"CIgrams and services for minority farmland owners, farmer$,
ranchers, tenants, and other individuals with an agricultural lnterest.
Participants rnay receive infarmatinn or be persanally eontaetecl through
U$DA outreach efforts. USDA prCIgrarns include direct and guaranteed farm
ownership and operating loans, marketing loans, as well as conservation,
hcusing & rural business, and risk nnanagement.
Participation in the Flegister is voluntary, Al[ minority persons involved in
farming or ranching are enesuraged to participate. The infsrmation you
provide may be shared through the USDA Sffice of Outreaeh with other
USDA-approved outreach partners such as commu n ity-based organizations,
educational instltuticns, and ather gsvernrnent agencies.
It you are involved with farming or ranching and wish to be lncluded in the
trVlinority Farm Reglster, you ar€ invit*d to eomplete this fonm and mail it to the
address on the baek of this brochure. You may also cornplete this form on
the Farm Service Agency (FSA) eFonms Web site at
,k$a:J.6p:c**,gge%-mda,es-glsM and su brn it it
electronically if you have an eAuthentication account with USDA, or print it
and mail it to the address on the back of this brochure.

3. MINORITY EARM REGISTER QT]ESTIONS AhJD AI{SWERS
If USDA does not have a record of mY
farm or ranch location, can or should I
pror-ide that additional information to
USDI?
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My name and farm records are alreadl' at
my local USDA Service Center. Ih]-
should I participate in the Register? l
...
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l-.
Does signing up for the Minority Farm
Register make me eligitrle for USDA
pf Ogf ams? ''l f .r,'1;.' ;:j;i:;:J: t'!1'j:1i1ll-: U.:iiji ll3-I ;i$
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: : : -. .-- '',t,,-tr*:]; ij iii; ,..,.;3r:'i ia: 31,:ii r]L1 f*l l':
Does signing up for the Minority Farm
Reqister make me eligible to vote in FSA
count- committee elections? ii i'1,: a.re
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4. AD-2035
07-29-04)
U.S. DEPARTMENT OF AGRICULTURE
Farm Sen,ice Agency
USDA MINORITY FARM REGISTER
Ihe Register is a tool to promote equal access to USDA farm programs and services for rninority fannland owners, fanners, ranchers,
cnants, and other individuals with an agricultural interest. Participants may receive infonnation or personal contact through USDA
rutreach efforts. USDA programs may include farm or ranch ownership and operating loans and loan guarantees, price and income
;upport. conservation, and others.
'IOTE: ThefollowingstatementismadeinaccotdancewiththePrivacyActofl9T4(5t-,SC552a)andthePapeworkReductionActafl99S,asamended. Theauthorityfor
requesting the following infotmation is section 10707 of Public Law 107-171 (7 t S.C. 2279). The infornation will be used fo assisa ln special minority fatm outrcach and
asslstarce efforls- Fumi$hing the requested infotnation is voluntary. This infaretian may be pravided to other agencies, lRS, Depaftment of Justice, ot othet State and
Federal Law enforcement agencies, ta a @ui magistrate or administrative tribL- ai. cammunity-based and other non USDA outreach organizatians. The prcvisions af
criminal and civil frcud statutes, including 1 I USC 286, 287, 371 , 641 , 651 , 1 0A' : 1 5 USC 71 4m; and 31 USC 3729. may be applicable to the information provided.
Accotding to the Papework Reduction Act af 1995, an agency may nat conduci :r sponsor, and a person is not required ta respand ta, a collection af information unless it
displays a valid OMB control number. The valid OMB contral number far this ir;:mation collection is 0560-0231 . The time required to complete this infomation collection
is estimated to average 7 minutes per response, including the time for reviewing lsttuctions, searching existing data sources, gathering and maintaining the data needed,
and campleting and rcviewing the collection of infarmatian. RETURN THIS COTIPLETED FORM TO MINORITY FARM REGISTER, USDA STOP CODE 0503, 1400
INDEPENDENCE AVE., SW, WASHINGTON, DC 20250.0503,
t certify that I am voluntarily granting pennission to be listed on the USDA Minority Fann Register. I fully understand and agree that my
rame and the other infonnation provided on this fonn may be released to organizations other than USDA.
*lnstructions: ltems 1 through 4, 5C, 5D, 7A and 78 are optional. You must Oflplete ltems 5A, 58, 6A and 68.
1. Ethnicity: Are you Hispanic or Latino? E vrs tr NO
Race: Check the race or races that describe you best.
! American lndian or Alaska Native
E nsi"n
! Black or African American
I wnit"
E Native Hawaiian or other Pacific lslander
Z Other race (specify): (Dc 1ot enter Hispanic or Latino here)
Gender: ! uate tr Female
Check one of the following: I tttt n Mrs. E u.
iA. Name (Last. First. Middle lnitial)
iB. Address (lnclude City/State/Zip Code) 5C. Telephone Numbet (lnclude Area Code) (For Government Use only)
5D. E-mail Address:
iA. Signature of lndividual 68. Date (MM-DD-YY/Y)
:arm or Ranch Location (lf applicable):
7A Strra 7R Count!
lndependenceAvenue,SW,Washington,D.C.2A2S094lAor6I(202)720-5964(vaiceorTDD)- US::lsanequaloppodunityptoviderandemplayer.

5. To participate in the Minority Farnn Register,
complete, sign and date the florm (anly name,
address, signature, and date are required for
participation) and mail it to:
Minority Farm Register
USDA Stop Code 0503
1400 Independence Ave., SW
Washington, DC 20250-0503
The {ollowing statement is made in accordance with the Privacy Act of '1974
(5 USC 552a) and ihe Paperwork Reducticn Act of 1 995, as amended. The
authority for requesting the following information is section 10707 of Public Law
107-171 (7 U.S.C. 2279). The information will be used to assist in special
minority farm outreach and assistance effcrts. Furnishing the requested
:nformatjon is voluntary. This information may be provided to other agencies,
lRS. Depa*ment of ..lustice, oI other State and Federal Law enforeement
agencies, to a court magistrate or administrative tribunal, commLjnity-based and
other non-USDA outreach organizations. The provisions of criminal and civil
fraud slatutes, including 18 USC 286, 287,371,641, 651, 1001 ; 15 USC 7'14m;
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 in{ormation collection is 0560-0231 , The time required to
complete this information colleclion is estimated to average 7 minutes per
response, including the time {or 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
MINORIry FARM REGISTER, USDA STOP CODE 0503, 14OO INDEPENDENCE
AVE., SW, WASHINGTON, D.C, 20250-0503.
NONpTSCRTMTNAnOjl
The U.S. Deparlment 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 alternaiive means for communication of program information
(Braille, large print, audiotape, etc.) should contact USDA'S TARGET Center at
(202) 72A-2600 (voice and TDD). To file a complaint of discrimination, write
USDA, Director, Office of Civil Rights, Room 326-W Whitten Building, '1400
lndependence Avenue, SW, Washington, D.C, 20250-9410 or call (202) 720'5964
(voice or TDD). USDA is an equal opportunity provider and employer.
PA.1785 August 2004