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Produce Safety Rule Exemption Application

If you have completed the initial Exemption Application in previous years, please fill out either the Basic Exemption Renewal or the Qualified Exemption Renewal, whichever is applicable.

Farm Information

Contact Information

Other Information

Number of water sources per source type:

Does your Farm use Soil Amendments of Animal Origin (ex. Chicken Litter)?

Please fill in your growing season:


Amount of Acreage Farmed:

Please check all that applies to your farm:

List of crops grown, harvested, packed and held:

Covered Produce (Check all boxes for Covered Produce that you grow)

Non-Covered Produce (Check all boxes for Non-Covered Produce that you grow)

Has your company taken the PSA grower training class?

Would your company like an On-Farm Readiness Review?