Ccc 679 Form PDF Details

The SSA has released a new form, called the Ccc 679 Form. This form is used to request a change in your Social Security number (SSN). The Ccc 679 Form can be used to request any changes to your SSN, including a new number, name change, or correction. If you need to update your SSN for any reason, be sure to use this form. Note that there is a fee associated with requesting a change to your SSN. For more information on the Ccc 679 Form, visit the SSA website.

QuestionAnswer
Form NameCcc 679 Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesWashington, ccc 679, CCC, navmc 11667

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This form is available electronically.

CCC-679 U.S. DEPARTMENT OF AGRICULTURE

(04-07-10)

Commodity Credit Corporation

 

LIEN WAIVER

1A. County Name and Address (Including Zip Code)

1B. County Office Telephone Number (Including Area Code)

1C. County Fax Number (Including Area Code)

2. Name and Address of Producer (Including Zip Code)

3. Crop Year

4. Commodity

NOTE: The following statement is made in accordance with the Privacy Act of 1974 (5 USC 552a - as amended). The authority for requesting the information identified on this form is 7 CFR Part 1421, 7 CFR Part 1427, 7 CFR Part 1435, the Commodity Credit Corporation Charter Act (15 U.S.C. 714 et seq.), and the Food, Conservation, and Energy Act of 2008 (Pub. L. 110-246). The information will be used to determine eligibility for program benefits. The information collected on this form may be disclosed to other Federal, State, Local government agencies, Tribal agencies, and nongovernmental entities that have been authorized access to the information by statute or regulation and/or as described in applicable Routine Uses identified in the System of Records Notice for USDA/FSA-2, Farm Records File (Automated) and USDA/FSA-14, Applicant/Borrower. Providing the requested information is voluntary. However, failure to furnish the requested information will result in a determination of ineligibility for program benefits.

The authority for collecting 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. The time required to complete this information collection is estimated to average 6 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The provisions of appropriate criminal and civil fraud, privacy, and other statutes may be applicable to the information provided. RETURN THIS COMPLETED FORM TO YOUR COUNTY FSA OFFICE.

5.The undersigned is the holder of a lien on the commodity identified above. In order for the producer identified above to pledge such commodity as collateral for a Commodity Credit Corporation (''CCC'') loan, with respect to CCC only, the undersigned waives all interest in, and title to, such commodity. The undersigned agrees that the proceeds of the loan shall be disbursed (lienholder must check one of the following):

(a)

(b)

(c)

To the producer.

Jointly to the producer and the undersigned lienholder.

Jointly to the producer and the undersigned lienholder, less (1) $

administrative offset as of (2)

(Date)

and charges due (3)

 

.

6. Name and Address of Lienholder or Authorized Agent

7A.

Lienholder Signature (By)

7B.

Title/Relationship (of the Individual Signing in the

7C.

Date

 

 

 

Representative Capacity)

 

 

 

 

 

 

 

 

7A.

Lienholder Signature (By)

7B.

Title/Relationship (of the Individual Signing in the

7C.

Date

 

 

 

Representative Capacity)

 

 

 

 

 

 

 

 

The U.S. Department of Agriculture (USDA) prohibits discrimination in all of 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, political beliefs, genetic information, 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, Assistant Secretary for Civil Rights, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, S.W., Stop 9410, Washington, DC 20250-9410, or call toll-free at (866) 632-9992 (English) or (800) 877-8339 (TDD) or (866) 377-8642 (English Federal-relay) or (800) 845-6136 (Spanish Federal-relay). USDA is an equal opportunity provider and employer.

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Filling out section 1 in ccc 679 lien waiver

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The undersigned is the holder of, administrative offset as of, and To the producer of ccc 679 lien waiver

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ccc 679 lien waiver writing process clarified (part 3)

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