Form Ccc 901 PDF Details

Have you ever had to file a Form 901 with the IRS? If not, you're probably not alone. But what is this form, and why do you need to file it? A Form 901 is essentially an affidavit or declaration of tax due. When you owe taxes to the IRS, you must complete and submit a Form 901 to certify that the amount listed is correct. If you're unsure whether or not you need to file a Form 901, your best bet is to speak with a tax professional. They can help guide you through the process and let you know if there are any other forms or documentation that may be required. Filing a Form 901 may seem like an intimidating task, but it's important to remember that the IRS is here to help taxpayers comply with their obligations. With the assistance of a qualified professional, filing a Form 901 can be quick and easy.

QuestionAnswer
Form NameForm Ccc 901
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesccc 901 fsa, fsa form ccc 901, form ccc 901 instructions, form ccc 901

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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

 

 

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.

 

2.

3.

 

4.

 

5.

 

 

 

 

 

 

 

 

 

 

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

 

 

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YES

 

 

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YES

 

 

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YES

 

 

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

%

 

 

 

 

 

YES

 

 

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

 

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.

 

2.

3.

 

4.

 

5.

 

 

 

 

 

 

 

 

 

 

Member’s Name

SSN or Tax

Address

 

Percent

 

 

Does this member

 

 

ID Number

 

 

Share

 

 

 

have signature

 

 

(Last 4 digits if

 

 

 

 

 

authority for the legal

 

 

already on file)

 

 

 

 

 

 

 

 

 

 

 

entity?

 

 

 

 

 

 

 

 

 

 

 

 

 

(Yes or No)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

%

 

 

 

 

 

YES

 

 

 

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

%

 

 

 

 

 

YES

 

 

 

 

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YES

 

 

 

 

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

%

 

 

 

 

 

YES

 

 

 

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

%

 

 

 

 

 

YES

 

 

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

 

 

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

 

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.

2.

3.

 

4.

5.

 

 

 

 

Member’s Name

SSN or Tax

Address

 

Percent

 

Does this member

 

ID Number.

 

 

Share

 

have signature

 

(Last 4 digits if

 

 

 

 

 

authority for

 

 

 

already on file)

 

 

 

 

the legal entity?

 

 

 

 

 

 

 

(Yes or No)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

%

 

 

YES

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

%

 

 

YES

 

 

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

%

 

 

YES

 

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

%

 

 

YES

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

1.

Minor’s Name

2.

Date of Birth

(MM-DD-YYYY)

3.

Parent’s or Guardian’s Name

4.

Parent’s or Guardian’s Address

5.

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

 

 

(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:

 

 

 

 

 

 

 

 

 

 

 

 

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)

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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

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