Ccc 526 C Form – Fill Out and Use This PDF

This form is available electronically.

The authority to collect the following information is Pub. L. 107-171. This authority allows for the collection of information without prior OMB approval mandated by the Paperwork Reduction Act of 1995.

NOTE: The following statements are made in accordance with the Privacy Act of 1974 (5 USC 552a), as amended. The Farm Security and Rural Investment Act of 2002 (Pub. L. 107-171), and the regulations at 7 CFR Part 1400, as amended, authorize the collection of the information required by this certification. The information will be used to establish payment eligibility in accordance with the requirements of the law for applicants who are requesting program benefits subject to these provisions. Providing this information is voluntary; however, failure to furnish the requested information will result in a determination of ineligibility for program benefits. This information may be used by and provided to other agencies, IRS, Department of Justice, other State or Federal law enforcement agencies, and in response to orders of a court magistrate, or administrative tribunal. All information provided herein is subject to verification by the Commodity Credit Corporation. As provided in various statutes, failure to provide true and correct information may result in civil suit or criminal prosecution and the assessment of penalties or pursuit of other remedies. PLEASE

RETURN THIS COMPLETED FORM TO YOUR COUNTY FSA OR SERVICE CENTER OFFICE.

5. Identification Number (SSN or Tax ID No. last 4 digits)

CERTIFICATION OF AVERAGE ADJUSTED GROSS INCOME: Each individual or entity that requests program benefits directly or indirectly must complete a certification of average adjusted gross income.

By signing this form, I acknowledge that:

all requirements and definitions on Page 3 of this form were reviewed;

the average adjusted gross income is the average of the three years immediately preceding the year specified in Item 4 above;

this certification of average adjusted gross income is true and correct unless changes or revisions are submitted;

it is my responsibility to timely notify Farm Service Agency (FSA) in writing of any changes in the farming, ranching or forestry operation, or financial status that may affect this certification;

evidence such as tax records, certified public accountant's certification, or other documentation may be required to validate this certification; that the CRP contract(s) in Item 2 above was approved between May 13, 2002 and September 30, 2008, inclusive;

that the provisions of the regulations at 7 CFR Part 1400 governing Average Adjusted Gross Income in effect on September 30, 2008 apply.

7.Individual For individuals that file the IRS Form 1040, specific lines on the form represent the adjusted gross income and the income from farming, ranching or forestry operations. The income from farming, ranching or forestry is derived from the Schedule F, IRS Form 4835 or comparable form.

If "NO", proceed to Item 7B.

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual's income is derived from any public assistance program. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA's TARGET Center at (202) 720-2600 (voice and TDD). To file a complaint of discrimination, write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.

CERTIFICATION OF AVERAGE ADJUSTED GROSS INCOME (CONTINUATION)

8.Trust or Estate For a trust or estate, the adjusted gross income is the total income and charitable contributions reported to IRS on the IRS Form 1041, or comparable forms. The income for farming, ranching and forestry is derived from the Schedule F, IRS Form 4835 or comparable form.

9.Corporation For a corporation, the adjusted gross income is the total of the final taxable income and any charitable contributions reported to the IRS on Form 1120, or comparable forms. The income from farming, ranching and forestry is derived from the Schedule F, IRS Form 4835 or comparable form.

10.Limited Partnership (LP), Limited Liability Company (LLC), Limited Liability Partnership (LLP) or Similar Entity For an LP, LLC or LLP, the adjusted gross income is the total income from trade or business activities plus guaranteed payments to the members as reported to the IRS. The income from farming, ranching and forestry is derived from the Schedule F, IRS Form 4835 or comparable form.

11.Tax-exempt Organization For a tax-exempt organization, the adjusted gross income is the unrelated business taxable income excluding any income from non-commercial activities as reported to the IRS. The income from farming, ranching and forestry would be derived from the Schedule F, or IRS Form 4835 or comparable form.