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If you believe you have been discriminated against because of race, color, national origin, age, sex, or disability immediately contact USDA, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, S.W., Stop 9410, Washington, D.C. 20250-9410. Call Toll-Free: (866) 632-9992, Federal relay: (800) 877-8339, Spanish relay: (800) 845-6136, Fax: (202) 690-7442, or Email: Program.intake@usda.gov", "links": [ { "uri": "mailto:Program.intake@usda.gov", "dest": null, "action_type": "/URI", "bbox": [ 204.32, 127.2, 303.66, 136.4 ] } ], "reading_order": 55 } ] }, { "page": 2, "items": [ { "page": 2, "type": "TITLE", "location": { "l": 104.4, "t": 735.36, "r": 519.6, "b": 700.08 }, "text": "MONTANA DEPARTMENT OF LIVESTOCK USE ONLY\nCooperative Interstate Shipment Program Application checklist – completed by MPI staff", "reading_order": 0, "level": 1 }, { "page": 2, "type": "TEXT", "location": { "l": 55.68, "t": 679.92, "r": 558.96, "b": 629.94 }, "text": "Regulatory Compliance", "reading_order": 1 }, { "page": 2, "type": "FORM_FIELD", "location": { "l": 183.272, "t": 654.109, "r": 328.472, "b": 636.473 }, "text": "Last FSA Completed Date:", "field_kind": "text", "label": "Last FSA Completed Date:", "pdf_field_name": "Text18", 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If No, date the establishment will reach 90 days of under state inspection:", "reading_order": 26 }, { "page": 2, "type": "FORM_FIELD", "location": { "l": 389.814, "t": 268.365, "r": 408.585, "b": 250.365 }, "text": "Yes", "field_kind": "checkbox", "label": "Yes", "pdf_field_name": "Check Box33", "pdf_field_type": "CheckBox", "reading_order": 27 }, { "page": 2, "type": "FORM_FIELD", "location": { "l": 445.848, "t": 268.365, "r": 463.848, "b": 250.365 }, "text": "No", "field_kind": "checkbox", "label": "No", "pdf_field_name": "Check Box34", "pdf_field_type": "CheckBox", "reading_order": 28 }, { "page": 2, "type": "FORM_FIELD", "location": { "l": 376.093, "t": 250.775, "r": 495.675, "b": 236.564 }, "text": "Date to meet 90 days under Inspection", "field_kind": "text", "label": "Date to meet 90 days under Inspection", "pdf_field_name": "Date to meet 90 days under Inspection", "pdf_field_type": "Text", "reading_order": 29 }, { "page": 2, "type": "TEXT", "location": { "l": 55.68, "t": 230.1, "r": 558.96, "b": 130.14 }, "text": "Authorization I acknowledge establishment is in good standing with Montana MPI and is recommended for selection. Bureau Chief Signature Print Name of Signer:", "reading_order": 30 }, { "page": 2, "type": "FORM_FIELD", "location": { "l": 484.254, "t": 174.983, "r": 555.053, "b": 149.492 }, "text": "Date:", "field_kind": "text", "label": "Date:", "pdf_field_name": "Text36", "pdf_field_type": "Text", "reading_order": 31 }, { "page": 2, "type": "FORM_FIELD", "location": { "l": 271.854, "t": 174.111, "r": 443.236, "b": 146.474 }, "text": "Bureau Chief Signature", "field_kind": "signature", "label": "Bureau Chief Signature", "pdf_field_name": "Signature35", "pdf_field_type": "Signature", "reading_order": 32 }, { "page": 2, "type": "FORM_FIELD", "location": { "l": 271.854, "t": 141.82, "r": 442.799, "b": 119.82 }, "text": "Print Name of Signer:", "field_kind": "text", "label": "Print Name of Signer:", "pdf_field_name": "Text37", "pdf_field_type": "Text", "reading_order": 33 }, { "page": 2, "type": "TEXT", "location": { "l": 55.68, "t": 180.12, "r": 307.32, "b": 130.14 }, "text": "Bureau Chief’s Recommendation for Selection", "reading_order": 34 }, { "page": 2, "type": "TEXT", "location": { "l": 55.68, "t": 130.14, "r": 558.96, "b": 80.16 }, "text": "CIS Assigned Establishment Number:", "reading_order": 35 }, { "page": 2, "type": "FORM_FIELD", "location": { "l": 335.967, "t": 110.64, "r": 446.477, "b": 87.0764 }, "text": "CIS Assigned Establishment Number:", "field_kind": "text", "label": "CIS Assigned Establishment Number:", "pdf_field_name": "CIS Assigned Establishment Number", "pdf_field_type": "Text", "reading_order": 36 }, { "page": 2, "type": "TEXT", "location": { "l": 46.8, "t": 71.76, "r": 100.08, "b": 61.44 }, "text": "MI-1CIS 4-2022", "reading_order": 37 } ] } ]