Form Ccc 901 – Fill Out and Use This PDF

The CCC-901 form, developed by the U.S. Department of Agriculture's Commodity Credit Corporation, plays a crucial role in identifying members of a legal entity for agricultural programs under the Agricultural Act of 2014. It encompasses details about individual or entity members, such as names, identification numbers, addresses, and their ownership shares. Designed to streamline the application process for program benefits, providing accurate information on this form is voluntary but essential for eligibility determination. Ensure your eligibility for benefits by filling out the CCC-901 form correctly; click the button below to get started.

Get Form Now Download PDF

Form Ccc 901 PDF Details

The CCC-901 form, formally titled under the United States Department of Agriculture and connected with the Commodity Credit Corporation, plays a pivotal role in identifying members of legal entities engaging with agricultural programs facilitated by the government. The essence of the form spans the need for precise member information under the Agricultural Act of 2014—highlighting the dual aims of adherence to federal regulations and ensuring equitable distribution of program benefits. This form is tailored to capture comprehensive details, including but not restricted to names, social security or employer identification numbers, addresses, and the ownership shares for individuals or entities within the agricultural sector. Additionally, subsets of the form address the specifics for embedded entities, minor members or shareholders, and the status of foreign persons with respect to U.S. citizenship, painting a detailed picture of the agricultural entity's structure. The CCC-901 requisition underscores transparency and accountability, with an emphasis on the voluntary nature of information provision albeit with implications for eligibility on program benefits upon non-compliance. Crafted under the legacies of the Privacy Act of 1974 and exempt from the Paperwork Reduction Act as specified in the Agricultural Act of 2014, this form reflects a designed balance between regulatory compliance and facilitation of agricultural program benefits, directly linking to the USDA's mission to uphold civil rights laws and ensure an equitable opportunity for all participants in its programming.

Question	Answer
Form Name	Form Ccc 901
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	ccc 901 fsa, fsa form ccc 901, form ccc 901 instructions, form ccc 901

Form Preview Example

This form is available electronically.

CCC-901	U.S. DEPARTMENT OF AGRICULTURE	1. County
(02-10-16)	Commodity Credit Corporation

MEMBER’S INFORMATION	2.	State
Agricultural Act of 2014

	3.	Program Year

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 members of a legal entity. 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.

PART A - For each individual or entity who is a member of this entity, list the member’s name, social security/employer identification number, address

and percentage share of ownership. If a member has both types of identification numbers, list both.

Name of Legal Entity

Complete Tax ID Number

Member’s Name

SSN or Tax

Address

Percent Share

Does this member

ID Number

have signature

(Last 4 digits if

authority for the legal

already on file)

entity?

(Yes or No)

YES

PART B - Embedded Entities: For any member listed in Part A, who is an entity, list such embedded entity's name and list the requested, information for

each member of such entity. If a member has both types of identification numbers, list both. If more than one member, listed in Part A is an

entity, provide the requested information for each entity on supplemental sheets.

Name of Embedded

Legal Entity

Complete Tax ID Number

Member’s Name

SSN or Tax

Address

Percent

Does this member

ID Number

have signature

(Last 4 digits if

authority for the legal

already on file)

entity?

(Yes or No)

YES

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.

CCC-901 (02-10-16)	Name of Entity (AS IDENTIFIED IN PART A):		Page 2 of 2
			Page 2 of 2

PART C - Embedded Entities: For any member listed in Part B, who is an entity, list such embedded entity's name and list the requested, information for each member of such entity. If a member has both types of identification numbers, list both. If more than one member, listed in Part B is an entity, provide the requested information for each entity on supplemental sheets.

Name of Embedded Legal Entity

Complete Tax ID Number

Member’s Name

SSN or Tax

Address

Percent

Does this member

ID Number.

have signature

(Last 4 digits if

authority for

already on file)

the legal entity?

(Yes or No)

YES

PART D – Minor Members or Shareholders - For any member or Shareholder who is a minor, provide the following:

Minor’s Name

Date of Birth

(MM-DD-YYYY)

Parent’s or Guardian’s Name

Parent’s or Guardian’s Address

Parent’s or

Guardian’s SSN

or Tax ID No.

(Last 4 digits if already on file)

6. Separate Status of Minors
(a)	Is any minor a producer on a farm in which the parent or guardian has no interest?	YES	NO
(a)		YES	NO
(b)	Does any minor maintain a separate household from the parent or guardian and personally carry out	YES	NO


	farming activities with respect to the minor’s farming operation, including maintaining separate accounting?
(c)	Does any minor who is represented by a court-appointed guardian or conservator responsible for the minor:	YES	NO


	1) live in a household other than the parents’ household(s), and 2) have a vested ownership in the farm?
(d)	If any minor with an interest in this farming operation can answer “YES” to Items 6(a)-6(c), list that minor’s name:
(d)

Part E. Foreign Persons – For any Member or Shareholder who is a foreign person, provide the following: minor, provide the following:

7A. Citizenship Status - Is each Member and Shareholder of the legal entity identified in Part A, and any embedded entity identified in Parts C, D and E a U.S. Citizen?

YES, all members/shareholders are US Citizens - Go to Part F NO, one or more members/shareholders is not a US Citizen - Complete Item 7B

7B. For each member or shareholder (direct or embedded) who is not a US Citizen, provide the following:

(1) Name of Individual

PART F- CERTIFICATION - By Signing:

(2) This individual	FOR FSA USE ONLY
has a valid Form I-551
	Form I-551 Presented to FSA	CCC Initials

YES	NO	YES	NO
YES	NO	YES	NO
YES	NO	YES	NO
YES	NO	YES	NO

-I certify that I have signature authority for the entity identified in Part A and all information entered on this document is true and correct

-I understand that furnishing incorrect information will result in forfeiture of payments and benefits.

-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 the information provided.

1. Representative’s Signature (By)

2. Title/Relationship of Individual Signing in the Representative

3.Date (MM-DD-YYYY)

How to Edit Form Ccc 901 Online for Free

When you want to fill out government form ccc 901, there's no need to install any sort of software - simply try our PDF tool. In order to make our editor better and less complicated to use, we constantly implement new features, with our users' feedback in mind. All it requires is a few easy steps:

Step 1: Simply press the "Get Form Button" in the top section of this webpage to launch our pdf file editing tool. This way, you will find all that is required to work with your file.

Step 2: After you start the online editor, you'll see the document prepared to be filled out. In addition to filling out various fields, you could also do some other things with the PDF, specifically adding any text, modifying the initial textual content, adding graphics, affixing your signature to the document, and more.

To be able to finalize this PDF form, be certain to provide the required details in each blank field:

1. Start completing the government form ccc 901 with a number of major blanks. Note all of the information you need and make certain there is nothing neglected!

Step number 1 in filling out usda form information

2. After this array of fields is finished, you need to insert the necessary details in YES, YES, YES, PART B Embedded Entities For any, Complete Tax ID Number, Members Name, SSN or Tax ID Number Last digits, Address, Percent Share, Does this member, have signature, authority for the legal, entity, Yes or No, and YES so that you can go to the third stage.

Part no. 2 in completing usda form information

3. This next segment is related to YES, YES, and In accordance with Federal civil - fill in all of these blanks.

Filling out section 3 in usda form information

4. This next section requires some additional information. Ensure you complete all the necessary fields - CCC Name of Entity as identified, Page of, Name of Embedded Legal Entity, Complete Tax ID Number, Members Name, SSN or Tax ID Number Last digits, Address, Percent Share, Does this member, have signature authority for, the legal entity, Yes or No, YES, YES, and YES - to proceed further in your process!

Yes or No, Address, and Complete Tax ID Number of usda form information

As to Yes or No and Address, be certain you take another look here. Both of these are viewed as the most significant ones in the page.

5. To wrap up your document, the last part features a couple of additional blanks. Completing Separate Status of Minors, a Is any minor a producer on a, b Does any minor maintain a, YES, YES, c Does any minor who is, YES, d If any minor with an interest in, Part E Foreign Persons For any, A Citizenship Status Is each, YES all membersshareholders are US, NO one or more membersshareholders, B For each member or shareholder, Name of Individual, and This individual is going to wrap up the process and you will be done before you know it!

Part # 5 in completing usda form information

Step 3: After you have glanced through the information you given, just click "Done" to conclude your form. Make a free trial account at FormsPal and get direct access to government form ccc 901 - available from your personal account. Here at FormsPal, we do everything we can to guarantee that your details are stored protected.

Form Ccc 901 – Fill Out and Use This PDF

Form Ccc 901 PDF Details

Form Preview Example

How to Edit Form Ccc 901 Online for Free

Form Ccc 901 isn’t the one you’re looking for?

Related Documents