Request Mediation

Please take a few moments to complete the submission form below. We will contact you within a few days to follow-up. Please note, not all matters qualify for mediation or other services and some may require a fee. (See information below about appeal deadlines.)

Mediation Request Form

Name

First Name

Last Name

Organization (if any)

Address

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Best way to contact:

Phone (work, home or cell number), email address. other

Best days & times to contact:

Are you currently a borrower, grantee or client of a USDA agency?

If yes, which agency:

Farm Service Agency

Rural Housing/Rural Development

Risk Management Agency

Natural Resources Conservation Service

Other

Who have you been working with at the agency?

Issue/Claim

Please provide a brief description of the issue or claim in dispute.

Have you received an adverse decision letter from the agency?

If yes, when did you receive it?

YYYY

If no, how is this dispute connected to a USDA agency?

Other party?

Is there another party involved in this dispute? If so, please describe who and how they are involved.

Grievance or suit pending?

If there is currently a grievance or suit pending on this issue please give the date it was filed and the status.

Your goals in mediation.

If this matter goes to mediation, what are you hoping to achieve by participating?

Other Connecticut Agricultural Mediation Program services.

Are there other services we offer or can link you with that might benefit your situation? For example: farm viability counseling, credit counseling or business planning.

About Appeal Deadlines. If you are a borrower appealing a USDA decision or a USDA adverse determination, request mediation as soon as possible open receiving the notice of the decision or adverse determination, in order to stay the period of appeal. Address any questions regarding time limits for appeals to your local USDA office.