Form Ccc 902E – Fill Out and Use This PDF

Agricultural Act of 2014

For “actively engaged in farming” and other payment eligibility/limitation determinations.

This form is to be completed for an entity, including a joint operation, that is seeking benefits from the Farm Service Agency (FSA) under one or more programs that are subject to the regulations at 7 CFR Part 1400. This form collects farming and other information about the entity that receives program benefits directly using the tax identification number listed in Part A. This form also collects information about the members of such entity. An individual who receives program benefits directly as an individual must complete a CCC- 902I with respect to that individual’s operation. Payment eligibility is based upon the contribution of certain inputs to a farming operation such as land, capital, equipment, labor, and management by the entity listed in Part A. The information on this form will be used by FSA to determine payment eligibility and limitation of payments by direct attribution.

PART A - ENTITY INFORMATION

3. Date of Formation (MM-DD-YYYY)

PART B - TYPE OF OPERATION (Select only one)

1. Select appropriate type of operation that defines the entity identified in Part A:

2.Supporting documentation (such as articles of incorporation, trust papers, partnership agreement, evidence of heirship, and operational authorities of all shareholders, members and owners) is required, except for public schools, States, State entities, cities, and counties, to verify the legal status of the entity and the authority of its shareholders, members or owners to the satisfaction of CCC.

PART C - MEMBER INFORMATION (Use CCC-902E Continuation if additional space is needed for any information in Part C)

1. Members - List all members/shareholders of the entity identified in Part A of this form:

*Family member means great grandparent, grandparent, parent, child (including legally adopted children and stepchildren), grandchild, great grandchild, sibling of family member in the farming operation, spouse of family member in the farming operation.

2. If the entity in Part A is an Estate or Trust, or if any member/shareholder is listed above is an Estate or Trust, list the Executor, Administrator, or Grantor:

3.Embedded Entities – If any member/shareholder of the entity identified in Part A is an entity, a CCC-901, Member’s Information, must also be completed and submitted concurrent with this CCC-902E. Additionally, a CCC-902E must be completed and submitted for each embedded entity.

4. Other farming interests: Complete this item for any member/shareholder identified in Part C that has an interest in other farming operations.

6A. Citizenship Status - Is each Member and Shareholder of the entity or joint operation identified in Part A, and any embedded entity identified in Part C a U.S. Citizen?

YES, all members/shareholders are US Citizens - Go to Part D

NO, one or more members/shareholders is not a US Citizen - Complete Item 6B

6B. For each member or shareholder (direct or embedded) who is not a US Citizen, provide the following:

PART D - SUMMARY OF CONTRIBUTIONS TO THE FARMING OPERATION

1. For the farming operation of the entity identified in Part A, what percentages of the overall inputs will be contributed directly by the Entity? Enter the following information for contributions to be made by the entity identified in Part A. These percentages should reflect the capital provided directly by the legal entity; land and equipment owned and/or cash leased by the legal entity and used in the farming operation; labor hired by the legal entity; and management hired by the legal entity. (Provide detailed information about these contributions in Items A through E.)

2. For the farming operation of the entity identified in Part A, what percentages of the following farm inputs will be contributed by the Members listed in PART C? Enter the following information for the contributions to be made by the members. These percentages should reflect any capital originating from members’ funds rather than from the entity; land and equipment owned or obtained by the member(s) and contributed to this farming operation without compensation to the member(s); labor and management hired by the members for the entity; and labor and management performed personally by the member(s) for the benefit of the farming operation identified in Part A. (Provide information about these contributions in Items B through H).

For additional space, use and attach CCC-902E Continuation

PART E - LAND

1.Land: Enter the following information for ALL land in the farming operation of the entity identified in Part A. If land is cash leased from an individual or entity that has an interest in the crop or crop proceeds, include the rental rate in $/acre in Column F; otherwise enter “cash.” (For additional space, complete CCC-902 Continuation and attach to this form)

Farm No.:

Location:

Farm No.:

Location:

Farm No.:

Location:

Farm No.:

Location:

Farm No.:

Location:

PART F - CAPITAL SOURCES and USES

1.Indicate the source(s) of all farming capital for the entity identified in Part A? (Check ALL that apply.)

2. Will contributions of capital, farming equipment or land be acquired as a result of a loan or credit arrangement?

3.Will such loan or credit be acquired from, guaranteed by, co-signed by, or secured by an individual, joint operation or entity that has an interest in the farming operation identified in Part A (Such interest may be as a landowner or other tenant)?

%

%

%

PART G - EQUIPMENT (All percentages are based on annual rental values.)

1.Owned Equipment: Enter the percent of ALL equipment owned by the farming operation of the entity identified in Part A that will be used on the farms

2.Leased Equipment: Enter the following information for ALL leased equipment to be used in the farming operation of the entity identified in Part A. If leased equipment is not used in this farm operation, enter 0%.

3.Lease Agreements: If Item 2D is “YES,” copies of lease agreement and documentation may be required for compliance purposes. GO TO Part H.

PART H - CUSTOM SERVICES

1. Will custom services be utilized by the entity identified in Part A on the farms listed in Part E?

PART I - LABOR NOT PROVIDED BY MEMBERS/SHAREHOLDERS IDENTIFIED IN PART C

For the farms listed in Part E, enter the information for contributions of labor to the farming operation that will not be provided by the members or shareholders listed in Part C:

2.Hired labor:

A. Will any of the hired labor for the farming operation identified in Part A originate from the same source as the leased equipment in Part G?

B. Will any of the hired labor for the farming operation identified in Part A be included in the custom services shown in Part H?

PART J - MANAGEMENT

Enter all managerial duties and/or activities required for the farming operation indentified in Part A which will be provided personally by member(s) or shareholder(s) of the entity or joint operation; or by hired management.

1.Active personal management:

List each member or shareholder in column A; the specific managerial duties/activities that will be performed personally by each member or shareholder in column B. For nonfamily member operations only, complete items in column C to include the amount of time expended annually, either in hours or as a percentage of the total management hours required for the farming operation.

For additional space, use and attach CCC-902E Continuation

2.Hired management:

Describe any hired management duties/activities that will be provided by someone other than a member or shareholder (Include management by an administrator or trustee who receives compensation for this service or activity):

3.Other management:

Describe any non-compensated management that will be provided by someone other than a member or shareholder (include management by an administrator or trustee who does not receive compensation for this activity):

Check all of the following that apply:

CCC-902 Continuation attached for additional information for Part E - Land

CCC-902E Continuation attached for additional information for the following Parts:

Part C – Member information

Part D – Summary of Contributions

Part F – Capital

Part G – Equipment

Part H – Custom Services

PART L - CERTIFICATION - (FOR JOINT VENTURES AND GENERAL PARTNERSHIPS, A SIGNATURE IS REQUIRED FOR EACH MEMBER)

I certify that all the information entered on this document and any supporting documentation is true and correct. I understand that furnishing incorrect information will result in forfeiture of payments and may result in the assessment of a penalty. I will timely provide written notification to the Farm Service Agency committees for the county and State listed on this form of any changes in this farming operation. By signing this form I acknowledge that:

•all supporting documentation has been submitted as required

•I have reviewed and understand all definitions and requirements on Page 6 of this form.

•all information will be considered in effect continuously unless changes or revisions are submitted.

•it is my responsibility to timely notify FSA in writing of any changes that may affect these representations, including, but not limited to: the composition of the entity identified in Part A; the farming, ranching or forestry operation of the entity identified in Part A; financial status of the entity identified in Part A.

•evidence such as tax records, certified public accountant's certification, or other documentation may be required to validate these representations and I will take all necessary actions to provide such materials to the applicable State or county committee if requested by FSA..

•it is my responsibility to timely notify FSA in writing of any successors who acquire an interest in this farming operation as the result of the death of a member or shareholder.

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 1400, the Commodity Credit Corporation Charter Act (15 U.S.C. 714 et seq.), and the Agricultural Act of 2014 (Pub. L. 113-79). The information will be used to identify the farm operating plan data needed to determine a legal entity’s 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). Providing the requested information is voluntary. However, failure to furnish the requested information will result in a determination of ineligibility for program benefits.

This information collection is exempted from the Paperwork Reduction Act as specified in the Agricultural Act of 2014 (Pub. L. 113-79, Title I, Subtitle F, Administration). The provisions of criminal and civil fraud, privacy, and other statutes may be applicable to the information provided. RETURN THIS COMPLETED FORM TO YOUR

COUNTY FSA OFFICE.

In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, gender identity (including gender expression), sexual orientation, disability, age, marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident.

Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the responsible Agency or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.

To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at

http://www.ascr.usda.gov/complaint_filing_cust.html and at any USDA office or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: program.intake@usda.gov. USDA is an equal opportunity provider, employer, and lender.