Common use of OMB DISCLOSURE STATEMENT Clause in Contracts

OMB DISCLOSURE STATEMENT. 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 collections is 0578-0013. The time required to complete this information collection is estimated to average 40 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 information. The signature by the NRCS representative signifies a CCC or NRCS transaction as indicated above. AD-1157A rev. OPTION AGREEMENT TO PURCHASE CONTRACT NO. NONDISCRIMINATION STATEMENT The U.S. Department of Agriculture (USDA) prohibits discrimination in all its program 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, genetic information, political beliefs, 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 (000) 000-0000 (voice and TDD). To file a complaint of Discrimination, write to USDA, Director, Office of Civil Rights, 0000 Xxxxxxxxxxxx Xxxxxx, XX., Xxxxxxxxxx, XX 00000-0000, or call (000) 000-0000 (voice) or (000) 000-0000 (TDD). USDA is an equal opportunity provider and employer. PRIVACY ACT STATEMENT The above statements are made in accordance with the Privacy Act of 1974 (5 U.S.C. 522a). Furnishing this information is voluntary; however, failure to furnish correct, complete information will result in the withholding or withdrawal of such technical or financial assistance. The information may be furnished to other USDA agencies, the Internal Revenue Service, the Department of Justice, or other State or Federal law enforcement agencies, or in response to orders of a court, magistrate, or administrative tribunal. OMB No. 0578-0013 The signature by the NRCS representative signifies a CCC or NRCS transaction as indicated above. AD-1157A

OMB DISCLOSURE STATEMENT. According to the Paperwork Reduction Act of 1995, an agency Federal Agencies may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. The valid OMB control number Public reporting burden for this collection of information collections is 0578-0013. The time required to complete this information collection is estimated to average 40 37.5 minutes per response, including the time for reviewing instructionsinstruction, searching existing data sources, gathering gatahering and maintaining the data needed, needed and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducting this burden, to USDA, Clearance Officer, OIRM (OMB No.0578-0013 The signature by the NRCS representative signifies a CCC or NRCS transaction as indicated above. AD-1157A revExp. 9/30/2009 OPTION AGREEMENT TO PURCHASE CONTRACT NO. NONDISCRIMINATION STATEMENT The U.S. Department of Agriculture (USDA) prohibits discrimination in all its program 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, genetic information, political beliefs, reprisal, or because all or part parat 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 (000) 000-0000 (voice and TDD). To file a complaint of Discriminationdiscrimination, write to USDA, Director, Office of Civil Rights, 0000 Xxxxxxxxxxxx XxxxxxXxx, XX., Xxxxxxxxxx, Xxxx. XX 00000-0000, 0000 or call (000) 000000)000-0000 (voice) or (000) 000000)000-0000 (TDD). USDA is an equal opportunity provider and employer. PRIVACY ACT STATEMENT The above statements are made in accordance with the Privacy Act of 1974 (5 U.S.C. 522a). Furnishing this information is voluntary; however, failure to furnish correct, complete information will result in the withholding or withdrawal of such technical or financial assistance. The information may be furnished to other USDA agencies, the Internal Revenue Service, the Department of Justice, or other State or Federal law enforcement agencies, or in response to orders of a court, magistrate, or administrative tribunal. OMB No. 0578-0013 The signature by the NRCS representative signifies a CCC or NRCS transaction as indicated above. AD-1157A