Form Ccc 902 – Fill Out and Use This PDF

This form is available electronically.

CCC-902 Continuation U.S. DEPARTMENT OF AGRICULTURE		1.	COUNTY
(03-28-14)	Commodity Credit Corporation
CONTINUATION SHEET FOR LEASED OR OWNED LAND		2.	STATE
	ATTACH TO FORM CCC-902I or CCC902E	3.	PROGRAM YEAR
		4.	PARTICIPANT’S NAME
	Agricultural Act of 2014
NOTE:	The following statement is made in accordance with the Privacy Act of 1974 (5 USC 552a – as amended). The authority for requesting this information identified

on this form is 7 CFR Part 1400, the Commodity Credit Charter Act (15 USC 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 person’s or 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 Systems of Records for USDA/FSA-2, Farms 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 2006 (Pub. L. 113-79, Title I, Subtitle F – Administration). The provisions of criminal and civil fraud statutes may be applicable to the information provided. RETURN THIS COMPLETED

FORM TO YOUR COUNTY FSA OFFICE.

PART A - LAND

Enter the following information for ALL land you own and/or lease. If ALL land in this farming operation is owned and operated by you, enter the farm number. County and State, check "Owned," and enter the cropland acres. If this CCC-902 Continuation is attached to CCC-902E, for a joint operation, indicate whether the land is leased or contributed by the joint operation or a member.

The U.S. Department of Agriculture (USDA) prohibits discrimination against its customers, employees, and applicants for emp loyment on the basis of race, color, national origin, age, disability, sex, gender identity, religion, reprisal, and where applicable, political beliefs, marital status, familial or parental status, sexual orientation, or all or part of an individual’s income is derived from any public assistance program, or protected genetic information in employment or in any program or activity conducted or funded by the Department. (Not all prohibited basis will apply to all programs and/or employment activities.) Persons with disabilities, who wish to file a program complaint, write to the address below or if you require alternative means of communication for program information (e.g., Braille, large print, audiotape, etc.) please contact USDA’s TARGET Center at (202) 720-2600 (voice and TDD). Individuals who are deaf, hard of hearing, or have speech disabilities and wish to file either an EEO or program complaint, please contact USDA through the Federal Relay Service at (800) 877-8339 or (800) 845-6136 (in Spanish).

If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found online at http://www.ascr.usda.gov/complaint_filing_cust.html, or at any USDA office, or call (866) 632-9992 to request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint form or letter by mail to U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, by fax (202) 690-7442 or email at program.intake@usda.gov. USDA is an equal opportunity provider and employer.