Form AG04004 "Safe on the Farm Direct Marketing Cost Share Program" - Minnesota

What Is Form AG04004?

This is a legal form that was released by the Minnesota Department of Agriculture - a government authority operating within Minnesota. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 27, 2020;
  • The latest edition provided by the Minnesota Department of Agriculture;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form AG04004 by clicking the link below or browse more documents and templates provided by the Minnesota Department of Agriculture.

ADVERTISEMENT
ADVERTISEMENT

Download Form AG04004 "Safe on the Farm Direct Marketing Cost Share Program" - Minnesota

Download PDF

Fill PDF online

Rate (4.3 / 5) 12 votes
625 Robert Street North, Saint Paul, MN 55155-2538
www.mda.state.mn.us
Agricultural Marketing and Development
Phone: 651-201-6500
Safe on the Farm Direct Marketing Cost Share Program
The Safe on the Farm Direct Marketing Cost Share program provides Minnesota U-Pick Operations, On-Farm Markets, and Community
Supported Agriculture (CSA) farms with financial support to purchase supplies and equipment to prepare for safe sales on their farms and
pick-up sites during the COVID-19 pandemic. Eligible farmers and producers may receive up to $250 for actual expenses incurred.
Applications will be accepted until October 31, 2020 or until all funds are depleted. Funds will be awarded on a first-come, first-served basis.
Completed applications must be emailed to Emily Mehr (emily.mehr@state.mn.us); applications will not be considered complete until all
components are received.
Contact First Name:
Contact Last Name:
Email Address:
Phone Number:
Farm Name:
Minnesota Grown License Number:
Mailing Address:
City:
State:
Zip:
Purchases
Store
Item(s) Purchased
Total Cost
$
$
$
$
$
$
The following items need to be submitted to the MDA for your application to be considered complete:
Completed application form with your signature.
Copy of receipts/paid invoices/proof of purchase for the items you are submitting for reimbursement. We recommend only including
eligible items on the receipt.
Copy of your Minnesota Grown license/membership number.
https://www.irs.gov/pub/irs-pdf/fw9.pdf
IRS Form W-9, signed and dated (available at
).
By signing here, I acknowledge that I have read and agreed to the Privacy Notice on page 2, I hereby attest that the information I
am submitting is true, complete, and accurate, and I am attesting that I have the authority to apply on behalf of the farm.
Applicants Signature:
Date:
In accordance with the Americans with Disabilities Act, this information is available in alternative forms of communication upon request
AG04004
by calling 651-201-6000. TTY users can call the Minnesota Relay Service at 711. The MDA is an equal opportunity employer and provider.
8.27.20
Page 1 of 2
625 Robert Street North, Saint Paul, MN 55155-2538
www.mda.state.mn.us
Agricultural Marketing and Development
Phone: 651-201-6500
Safe on the Farm Direct Marketing Cost Share Program
The Safe on the Farm Direct Marketing Cost Share program provides Minnesota U-Pick Operations, On-Farm Markets, and Community
Supported Agriculture (CSA) farms with financial support to purchase supplies and equipment to prepare for safe sales on their farms and
pick-up sites during the COVID-19 pandemic. Eligible farmers and producers may receive up to $250 for actual expenses incurred.
Applications will be accepted until October 31, 2020 or until all funds are depleted. Funds will be awarded on a first-come, first-served basis.
Completed applications must be emailed to Emily Mehr (emily.mehr@state.mn.us); applications will not be considered complete until all
components are received.
Contact First Name:
Contact Last Name:
Email Address:
Phone Number:
Farm Name:
Minnesota Grown License Number:
Mailing Address:
City:
State:
Zip:
Purchases
Store
Item(s) Purchased
Total Cost
$
$
$
$
$
$
The following items need to be submitted to the MDA for your application to be considered complete:
Completed application form with your signature.
Copy of receipts/paid invoices/proof of purchase for the items you are submitting for reimbursement. We recommend only including
eligible items on the receipt.
Copy of your Minnesota Grown license/membership number.
https://www.irs.gov/pub/irs-pdf/fw9.pdf
IRS Form W-9, signed and dated (available at
).
By signing here, I acknowledge that I have read and agreed to the Privacy Notice on page 2, I hereby attest that the information I
am submitting is true, complete, and accurate, and I am attesting that I have the authority to apply on behalf of the farm.
Applicants Signature:
Date:
In accordance with the Americans with Disabilities Act, this information is available in alternative forms of communication upon request
AG04004
by calling 651-201-6000. TTY users can call the Minnesota Relay Service at 711. The MDA is an equal opportunity employer and provider.
8.27.20
Page 1 of 2
What is the Safe on the Farm Direct Marketing Cost Share Program?
The Safe on the Farm Direct Marketing Cost Share program provides Minnesota U-Pick Operations, On-Farm Markets, and CSA farms with
financial support to purchase supplies and equipment to help prepare for safe sales on their farms during the COVID-19 pandemic. Funding
for this program is made available through the Agricultural Growth, Research, and Innovation (AGRI) program. The MDA anticipates making
approximately $20,000 available for this program.
Who may apply?
Minnesota farmers and producers of specialty crops and livestock who sell directly to customers from their farm or through a CSA model.
You must be a new or current Minnesota Grown member at the time of submission. Pick-your-own berry farms, apple orchards, pumpkin
patches, Christmas tree farms, CSA farms, and on-site farm stands are encouraged to apply. Only one application per farm will be accepted.
Do I need to be a Minnesota Grown member to apply for this program?
Yes, you need to have a current Minnesota Grown license to participate. The annual license cost is $20 and allows you to use the Minnesota
Grown label. You can apply to become a Minnesota Grown member by visiting: https://minnesotagrown.com/members-retailers/about/.
What types of equipment can I purchase with this program?
Supplies and equipment that help farmers comply with the
Guidance for Minnesota U-Pick Operations and On-Farm Markets
are eligible.
Examples of eligible supplies and equipment include:
Customer handwashing stations (water catching buckets, water dispensers, paper towels, soap etc.)
Personal Protective Equipment (cloth face coverings, face shields, gloves, etc.).
Tables to create space between workers and customers at counters, registers, or display areas.
Rope, fencing, tape, chalk, or flags to create walkways and borders to identify designated picking areas or a specific flow of traffic
through your fields and gathering areas.
Signage to communicate proper handwashing, social distancing, and safety instructions.
Sanitation supplies to clean “high touch” surfaces.
Other ideas may be proposed for approval by the MDA.
How much am I eligible to receive?
Payments will be based on eligible purchases, up to $250 per farm. In no case, will your farm receive more money than you submitted in
eligible receipts.
When can I expect payment?
Applications are processed on a continual basis. You will receive your payment approximately 2-4 weeks after your application is approved.
How do I submit an application?
Application materials must be emailed to Emily Mehr (emily.mehr@state.mn.us). Applications will be accepted until October 31, 2020
or until all funds are depleted, whichever is first. Applications will not be added to the list for funding until all parts of the application are
received. The MDA is not responsible for any technical or logistical problems resulting in the MDA not receiving the application on time. It is
the responsibility of the applicant to ensure that submission is received by the MDA before the deadline.
Where do I get more information?
https://www.mda.
More information about the Safe of the Farm Direct Marketing Cost Share program is available on the program’s website
state.mn.us/business-dev-loans-grants/safe-farm-direct-marketing-cost-share-program
emily.mehr@
or by contacting Emily Mehr (
state.mn.us
).
Privacy Notice
The information provided as part of the Safe on the Farm Direct Marketing Cost Share program application will be used to assess the
applicant’s eligibility to receive payment under the AGRI program, and to fulfill applicable financial reporting requirements. Completing this
application is voluntary; applicants are not legally required to provide MDA with the information requested, but only completed applications
will be considered. While much of the information applicants provide is classified by Minnesota law as public, some of the information
may be classified by law as private or nonpublic at MDA. Data classified as private or nonpublic will be accessible only to MDA employees
and contractors that have a work assignment that requires access to the data, and to other entities authorized by law to receive the data.
MDA may be obligated to provide the data to law enforcement, the Minnesota Department of Administration, Minnesota Management
and Budget, the Office of the State Auditor, or the Office of the Legislative Auditor. Finally, private data about you may be released to third
parties through your informed consent, or pursuant to a valid court order. Internal Revenue Service code Section 6109 requires applicants to
provide their correct taxpayer identification number to payers who must file information returns with the IRS. MDA will use the information
provided on the applicant’s W-9 form in order to report payments received as part of the AGRI Program to the IRS. The IRS uses the numbers
for identification purposes and to help verify the accuracy of the applicant’s tax return. For more information on how the information
provided on a W-9 may be used, refer to the Privacy Act Notice on page 6 of the W-9 form.
In accordance with the Americans with Disabilities Act, this information is available in alternative forms of communication upon request
AG04004
by calling 651-201-6000. TTY users can call the Minnesota Relay Service at 711. The MDA is an equal opportunity employer and provider.
8.27.20
Page 2 of 2
Page of 2