Form Fsa 211 PDF Details

Are you looking for a new way to manage your finances? If so, you may want to consider using a form FSA 211. This form can be used to help track your expenses and manage your budget. With this form, you can keep track of your income and expenses, making it easier to stay on top of your finances. In addition, the form FSA 211 can be helpful if you are planning to file taxes. By tracking your expenses, you can ensure that you are taking advantage of all the deductions available to you. If you are interested in learning more about the form FSA 211, continue reading. You will find information about how to use the form and what benefits it offers.

QuestionAnswer
Form NameForm Fsa 211
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesfsa 211 power of attorney, usda of attorney, fsa 211 11 25 14, fsa 211 instructions

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This form is available electronically.

FSA-211

U. S. DEPARTMENT OF AGRICULTURE

(11-25-14)

Farm Service Agency – Natural Resources Conservation Service -

Commodity Credit Corporation - Federal Crop Insurance Corporation – Risk Management Agency

POWER OF ATTORNEY

THE UNDERSIGNED does hereby appoint the following grantee:

(1)

 

 

of the following address: (2)

 

 

 

 

in the county of: (3)

 

 

in the State of:

(4)

 

 

the attorney -in-fact for

(5)

 

(insert grantor’s name) in connection with the Farm Service Agency, Natural Resources Conservation Service Agency, or Commodity Credit Corporation programs checked below. NOTE: This power of attorney form is not valid for FSA Farm Loan Program purposes.

A.FSA, NRCS and CCC PROGRAMS (Check applicable programs)

1.

All current programs.

10.

Marketing Assistance Loans

 

 

 

andLoan Deficiency Payments.

2.

All current and all future programs.

11.

Margin Protection Program for

 

 

 

Dairy Producers (MPP/Dairy).

3.

Agricultural Risk Coverage/Price Loss

12.

Farm Storage Facility Loan

 

Coverage (ARC/PLC).

 

Program.

4.

Biomass Crop Assistance Program (BCAP).

13.

Conservation Reserve Program

 

 

 

(CRP).

5.

Tree Assistance Program (TAP).

14.

NRCS Conservation Programs.

6.

Livestock Indemnity Program (LIP).

15.

Emergency Conservation

 

 

 

Program (ECP).

7.

Livestock Forage Disaster Program (LFP).

16.

Emergency Forest Restoration

 

 

 

Program (EFRP).

8.

Emergency Assistance for Livestock

17.

Other (Specify):

 

Honey Bees, and Farm-Raised Fish (ELAP).

 

 

9.Noninsured Crop Disaster Assistance Program (NAP).

B.TRANSACTIONS for FSA, NRCS, and CCCPROGRAMS

(Check applicable actions)

1. All actions.

2. Signing applications, agreements, and contracts.

3. Making reports.

4. Conducting all marketing assistance loan and LDP transactions.

5. AGI Certification.

6. Routing Banking Accounts.

7. Other (Specify):

This form may also be used to grant authority to an attorney-in-fact to act on the grantor’s behalf with respect to FCIC crop insurance policies. Checking any of the

FCIC transactions does not have any impact as to the FSA, NRCS or CCC transactionschecked above:

 

 

 

 

C. INSURED CROPS/STATE/COUNTY

 

D. CROP INSURANCE TRANSACTIONS

 

(Enter “All” or specify each crop, state, county and year(s))

 

(Check applicable actions)

1.

 

1.

All actions.

5.

Making transfers and cancellations.

2.

 

 

2.

Making applications for insurance.

6.

Making contract changes.

 

3.

 

3.

Reporting crop acreage and

7.

Other (Specify):

 

 

 

 

 

production reports.

 

 

 

 

 

 

4.

 

4.

Reporting a notice of damage or

 

 

 

 

 

loss and making claim for indemnity.

 

 

 

 

 

 

 

 

This Power of Attorney is valid in all counties in the United States unless otherwise noted. This power of attorney shall remain in full force and effect until(1) written notice of its revocation has been duly served upon FSA, NRCS or CCC as appropriate;(2) death of the undersigned grantor; or (3) incompetence or incapacitation of the undersigned grantor. The undersigned grantor shall provide separate written notice of revocation to the applicable crop insurance agent. This power of attorney shall not be effective until properly executed and served to a USDA Service Center.

AUTHORIZED SIGNATURES

 

 

 

 

6A.

Signature of Grantor (Individual)

6B.

Signature Date (MM-DD-YYYY)

6C.

For Grantor’s Signature

 

 

 

 

 

Continuation, check here if

 

 

 

 

 

FSA-211A is attached.

7A.

Signature of Grantor (Partnership, Corporation,

7B.

Title/Relationship of Individual Signing in

7C.

Signature Date (MM-DD-YYYY)

 

Trust, etc.) (By)

 

the Representative Capacity

 

 

 

 

 

 

 

 

8.Notary Public (this form SHALL be acknowledged by a notary Public unless witnessed by a FSA employee or a corporate seal of grantor is affixed).

Signature (a)

 

 

 

the state of (b)

 

 

the County of

(c)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FOR FSA USE ONLY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9A. Witness Signature (FSA Employee Only)

 

9B. Signature Date (MM-DD-YYYY)

 

 

9C.

Official Position

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10. This power of attorney was served to (a)

 

 

 

 

 

 

 

 

USDA Service Center,

 

 

 

 

 

 

 

 

 

 

 

 

.

State of (b)

 

and became effective this (c)

 

day of (d)

 

 

,

(e)

 

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 718, the Commodity Credit Corporation Charter Act (15 U.S.C. 714 et seq.), the Federal Crop Insurance Act (7 U.S.C. 1501 et seq.), the Food, Conservation, and Energy Act of 2008 (Pub. L. 110-246), and the Agricultural Act of 2014 (Pub. L. 113-79). The information will be used to enable a

producer (grantor) to appoint an individual/organization to serve as an attorney-in-fact (grantee) that is authorized to on behalf of the producer, conduct business with USDA concerning Farm Service Agency, Natural Resources Conservation

Service, Commodity Credit Corporation, Federal Crop Insurance Corporation, and Risk Management Agency programs. 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), USDA/NRCS-1, Landowner, Operator,Producer, Cooperator, or Participant Files, and USDA/FCIC-10, Policyholder. Providing the requested information is voluntary. However, failure to furnish the requested information

will result in a determination of producer ineligibility to participate in and receive benefits under Farm Service Agency, Natural Resources Conservation Service, Commodity Credit Corporation, FederalCrop Insurance Corporation, and Risk Management Agency programs.

This information collection for FSA commodity and conservation programs in Titles I and II of the Agricultural Act of 2014 (Pub. L. 113-79) are exempt from the Paperwork Reduction Act (PRA) as specified in the Agricultural Act of 2014, Title I, Subtitle F, Administration, and Title II, Subtitle G, Funding Administration. For the EFRP, this information collection is exempted from the PRA, as specified in the Fiscal Year 2010 Supplemental Appropriations Act (Public L. 111-212). For

the FSFL, this information collection is exempted from the PRA as it is required for the administration of the Food, Conservation, and Energy Act of 2008 (see Pub. L.110-246, Title I, Subtitle F-Administration).

For those FSA, CCC, and NRCS programs that are not exempt from PRA, FSA may not conduct or sponsor, and a person is not required to respond to a collection of information unless this collection of information has a valid OMB control number, which is 0560-0190 for this information collection, and the average time required to complete this information collection is 15 minutes per response. RETURN THIS COMPLETED FORM TO THE APPLICABLE USDA SERVICE

CENTER.

The U.S. Department of Agriculture (USDA) prohibits discrimination against its customers, employees, and applicants for employment on the basis of race, color, national origin, age, disability, sex, gender identity, religion, reprisal, and where appl icable, 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 bases 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) 7 20-2600 (voice and TDD). Individuals who are deaf, hard of hearing, or have speech disabilities and wish to file either an EEO orprogram 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, fo und 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 infomation reuested in the form. Send your completed complaint form o r letter by mail to U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washing ton, D.C. 20250-9410, by fax (202) 690-7442 or email at program.intake@usda.gov . USDA is an equal opportunity provider and employer.

This form is available electronically.

FSA-211A

 

U. S. DEPARTMENT OF AGRICULTURE

Attachment Pages

(11-25-14)

 

Farm Service Agency – Natural Resources Conservation Service -

 

 

 

 

 

 

 

Commodity Credit Corporation - Federal Crop Insurance Corporation – Risk Management Agency

 

 

 

 

 

 

 

 

POWER OF ATTORNEY SIGNATURE CONTINUATION SHEET

 

 

of

Attach to Form FSA-211

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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 718, the

 

 

Commodity Credit Corporation Charter Act (15 U.S.C. 714 et seq.), the Federal Crop Insurance Act (7 U.S.C. 1501 et seq.), the Food, Conservation, and Energy Act of 2008 (Pub. L. 110-246), and the

 

 

Agricultural Act of 2014 (Pub. L. 113-79). The information will be used to enable a producer (grantor) to appoint an individual/organization to serve as an attorney-in-fact (grantee) that is authorized to

 

 

on behalf of the producer, conduct business with USDA concerning Farm Service Agency, Natural Resources Conservation Service, Commodity Credit Corporation, Federal Crop Insurance

 

 

Corporation, and Risk Management Agency programs. 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), USDA/NRCS-1, Landowner, Operator, Producer, Cooperator, or Participant Files, and USDA/FCIC-10, Policyholder. Providing the requested

 

 

information is voluntary. However, failure to furnish the requested information will result in a determination of producer ineligibility to participate in and receive benefits under Farm Service Agency,

 

 

Natural Resources Conservation Service, Commodity Credit Corporation, Federal Crop Insurance Corporation, and Risk Management Agency programs.

 

 

 

 

 

 

This information collection for FSA commodity and conservation programs in Titles I and II of the Agricultural Act of 2014 (Pub. L. 113-79) are exempt from the Paperwork Reduction Act (PRA) as

 

 

specified in the Agricultural Act of 2014, Title I, Subtitle F, Administration, andTitle II, Subtitle G, Funding Administration. For the EFRP, this information collection is exempted from the PRA, as

 

 

specified in the Fiscal Year 2010 Supplemental Appropriations Act (Public L. 111-212). For the FSFL, this information collection is exempted from the PRA as it is required for the administration of the

 

 

Food, Conservation, and Energy Act of 2008 (see Pub. L.. 110-246, Title I, Subtitle F-Administration).

 

 

 

 

 

 

For those FSA, CCC, and NRCS programs that are not exempt from PRA, FSA may not conduct or sponsor, and a person is not required to respond to a collection of information unless this collection

 

 

of information has a valid OMB control number, which is 0560-0190 for this information collection, and the average time required to complete this information collection is 15 minutes per response.

 

 

RETURN THIS COMPLETED FORM TO THE APPLICABLE USDA SERVICE CENTER.

 

 

 

 

1. Name of Attorney -In-Fact (Item (1) from FSA-211)

 

2. Name of Grantor (Item (5) from FSA-211)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AUTHORIZED SIGNATURES

 

 

 

 

 

 

 

 

 

 

 

 

 

3A.

Signature of Grantor (By)

 

 

3B.

Title/Relationship of Individual Signing in the

 

3C.

Signature Date

 

 

 

 

 

 

 

 

Representative Capacity

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3D.

Witness Signature (FSA Employee Only)

 

 

 

 

 

3E. Signature Date

 

3F.

Official Position

 

 

 

 

 

 

 

 

3G.

Notary Public (this form SHALL be acknowledged by a Notary Public unless witnessed by a FSA employee or a corporate seal of grantor is affixed).

Signature:

 

 

the State of

 

 

 

 

the County of

 

 

 

 

 

 

 

 

 

 

 

 

 

4A.

Signature of Grantor (By)

 

 

4B.

Title/Relationship of Individual Signing in the

 

4C.

Signature Date

 

 

 

 

 

 

 

 

Representative Capacity

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4D.

Witness Signature (FSA Employee Only)

 

 

 

 

 

4E. Signature Date

 

4F.

Official Position

 

 

 

 

 

4G.

 

Notary Public (this form SHALL be acknowledged by a Notary Public unless witnessed by a FSA employee or a corporate seal of grantor is affixed).

Signature:

 

 

the State of

 

 

 

 

the County of

 

 

 

 

 

 

 

 

 

 

 

 

 

5A.

Signature of Grantor (By)

 

 

5B.

Title/Relationship of Individual Signing in the

 

5C.

Signature Date

 

 

 

 

 

 

 

 

Representative Capacity

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5D.

Witness Signature (FSA Employee Only)

 

 

 

 

 

5E. Signature Date

 

5F.

Official Position

 

 

 

 

5G.

Notary Public (this form SHALL be acknowledged by a Notary Public unless witnessed by a FSA employee or a corporate seal of grantor is affixed).

Signature:

 

 

the State of

 

 

 

 

the County of

 

 

 

 

 

 

 

 

 

 

 

 

 

6A.

Signature of Grantor (By)

 

 

6B.

Title/Relationship of Individual Signing in the

 

6C.

Signature Date

 

 

 

 

 

 

 

 

Representative Capacity

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6D.

Witness Signature (FSA Employee Only)

 

 

 

 

 

6E. Signature Date

 

6F.

Official Position

 

 

 

 

6G.

Notary Public (this form SHALL be acknowledged by a Notary Public unless witnessed by a FSA employee or a corporate seal of grantor is affixed).

Signature:

 

 

the State of

 

 

 

 

the County of

 

 

 

 

 

 

 

 

 

 

 

 

 

7A.

Signature of Grantor (By)

 

 

7B.

Title/Relationship of Individual Signing in the

 

7C.

Signature Date

 

 

 

 

 

 

 

 

Representative Capacity

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7D.

Witness Signature (FSA Employee Only)

 

 

 

 

 

7E. Signature Date

 

7F.

Official Position

 

 

 

 

7G.

Notary Public (this form SHALL be acknowledged by a Notary Public unless witnessed by a FSA employee or a corporate seal of grantor is affixed).

Signature:

 

the State of

 

 

 

the County of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The U.S. Department of Agriculture (USDA) prohibits discrimination against its customers, employees, and applicants for employment on the basis of race, color, national origin, age, disability, sex, gender identity, religion, reprisal, and where appl icable, 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 bases 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) 7 20-2600 (voice and TDD). Individuals who are deaf, hard of hearing, or have speech disabilities and wish to file either an EEO orprogram 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, fo und 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 o r letter by mail to U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washing ton, D.C. 20250-9410, by fax (202) 690-7442 or email at program.intake@usda.gov . USDA is an equal opportunity provider and employer.

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Writing segment 1 in fsa 211 instructions

2. Soon after this section is done, proceed to type in the relevant details in all these - Reporting crop acreage and, production reports, Other Specify, Reporting a notice of damage or, loss and making claim for indemnity, This Power of Attorney is valid in, B Signature Date MMDDYYYY, A Signature of Grantor Partnership, B TitleRelationship of Individual, C For Grantors Signature, Notary Public this form shall be, Signature a FOR FSA USE ONLY A, the state of b, the County of c, and B Signature Date MMDDYYYY.

Find out how to complete fsa 211 instructions part 2

Be extremely careful when filling in loss and making claim for indemnity and B Signature Date MMDDYYYY, because this is the part where a lot of people make some mistakes.

3. This subsequent step is considered fairly simple, This form is available, Farm Service Agency Natural, Commodity Credit Corporation, POWER OF ATTORNEY SIGNATURE, Attachment Pages, Attach NOTE, to Form FSA The following, this form is CFR Part the, Name of Attorney InFact Item, Name of Grantor Item from FSA, AUTHORIZED SIGNATURES A Signature, D Witness Signature FSA Employee, B TitleRelationship of Individual, E Signature Date, and C Signature Date - all of these form fields will have to be filled out here.

fsa 211 instructions completion process shown (portion 3)

4. The following subsection requires your details in the subsequent places: Signature A Signature of Grantor By, D Witness Signature FSA Employee, B TitleRelationship of Individual, E Signature Date, C Signature Date, F Official Position, G Notary Public this form shall be, the State of, the County of, B TitleRelationship of Individual, D Witness Signature FSA Employee, E Signature Date, C Signature Date, F Official Position, and G Notary Public this form shall be. Ensure you fill in all of the needed information to go further.

F Official Position, the State of, and C Signature Date in fsa 211 instructions

5. To wrap up your document, this final section incorporates a couple of extra blank fields. Completing G Notary Public this form shall be, B TitleRelationship of Individual, D Witness Signature FSA Employee, E Signature Date, G Notary Public this form shall be, the State of, the County of, The US Department of Agriculture, C Signature Date, and F Official Position will finalize everything and you can be done in a short time!

Writing section 5 in fsa 211 instructions

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