AES-28-15 Quarterly Planting and Distribution Report

Industrial Hemp Program - Quarterly Planting and Distribution Report
- This Quarterly Planting and Distribution Report (Report) is due for each location where the hemp crop is intended to produce vegetative clones/transplants. This Report should NOT be used for crops whose intended purpose is for commercial hemp (oil, flower, fiber, etc.) or “true seed” production. Plantings of commercial hemp or “true seed” production should be reported on the “First Report of Planting” form.
- This form is due on or before the end of each quarter. Complete and submit a separate form for each quarter and for each location address. Do not report multiple quarters or addresses on one form.
- IMPORTANT: A new FSA Lot ID (Farm-Tract-Field-Subfield) is required each time you plant. The FSA Lot ID is unique to the planting. All plants designated by an FSA Lot ID must remain together while in licensee’s possession. Licensees must maintain trace-ability of each FSA Lot ID throughout its life cycle or while in the licensee’s possession. Failing to maintain FSA Lot ID traceability is a violation of the Industrial Hemp Law and regulations.
Licensee or DRP Name
Seed Producer License No.
Location Address (MUST match address listed on your License Application or Site Modification Request Form)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Check the quarter which you are reporting. Check only one (quarter ending date):

March 31June 30September 30December 30
Reporting Calendar Year
Email
example@example.com
SECTION II - PLANTING INFORMATION
Complete this table for each planting that occurred during the quarter being reported.

Information being requested below:
- Site ID - as provided to LDAF on the license application/approved site modification (Ex. Greenhouse 1)
- Date of Planting (Ex. January 1, 2022)
- FSA Lot ID - format as Farm-Tract-Field-Subfield from FSA-578 form (Ex. 1234-461-12A)
- Variety or Strain (Ex. CBD 101)
- Number Planted - number of plants contained in this planting (Ex. 1500 plants)
- Area of Planting - area in square feet required for this planting (1,500sqft)

Planting Information

	Site ID	Date of Planting	FSA Lot ID	Variety or Strain	Number Planted	Area of Planting
1
2
3

SECTION III - DISTRIBUTION INFORMATION
Complete this table for all sales and transfers of vegetative clones/transplants during the quarter being reported.

Distribution Information

	Date Sold or Transferred	FSA Lot ID of the Plants Sold or Transferred	Variety or Strain	Number of Plants Sold or Transferred	Name of Recipient of Plants	License Number of Recipient of Plants
1
2
3

I hereby verify and affirm that all information contained in this Quarterly Planting and Distribution Report is true and accurate. I also understand that if LDAF later determines any of this information to be false or inaccurate, my license may be suspended or revoked.
Name

First NameLast Name
Signature of Licensee or Designated Responsible Party

Clear
Date

MonthDayYear
Should be Empty:

Industrial Hemp Program - Quarterly Planting and Distribution Report

SECTION II - PLANTING INFORMATION

SECTION III - DISTRIBUTION INFORMATION