Fsa 426 A Form PDF Details

The FSA 426 Form is a form that is used to report the sale or other disposition of farm assets. This form must be completed by the taxpayer and filed with their tax return. The form is used to report the gains or losses from the sale or other disposition of certain farm assets, including livestock, crops, and land. There are specific instructions for completing this form, so it is important to review them carefully before filing. Failure to properly complete this form may result in penalties from the IRS. So make sure you understand how to fill out this form correctly before submitting it.

QuestionAnswer
Form NameFsa 426 A Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesusda 426 form, fsa 426, usda 426 a form, fsa 426 a blank form

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This form is available electronically.

FSA-426-A

U.S. DEPARTMENT OF AGRICULTURE

(02-11-08)

Farm Service Agency

MPCI/FCIC INFORMATION REQUEST

1A. COUNTY FSA OFFICE NAME AND ADDRESS (Zip Code)

1B. TELEPHONE NO. (Area Code)

2. CROP YEAR

3. DATE (MM-DD-YYYY)

 

 

ITEMS 4 THROUGH 14 TO BE COMPLETED BY REQUESTER

4. APPROVED INSURANCE PROVIDER (AIP) NAME

5. TELEPHONE NO. (Area Code)

6. REQUESTER

 

 

 

 

 

 

 

 

 

Company’s Request

RMA Request

 

 

 

 

 

 

 

 

 

 

 

7.

8.

9.

10.

11. INFORMATION REQUESTED

 

 

 

PRODUCER’S NAME

 

 

 

(/) Check appropriate box(es) that are applicable to producer.)

 

ID NUMBER

CROP NAME

POLICY

A.

B.

C.

D.

E.

F.

G.

 

(Last 4 Digits of

 

NUMBER

CCC-

AD-

FSA-578

FSA-578

PRODUC-

MAP

OTHER

 

 

 

 

SSN or Tax ID No.)

 

 

502

1026A

PRIOR YEAR

CURRENT YEAR

TION

PHOTO

 

 

 

 

 

 

 

 

 

 

 

 

PRODUCER

PRODUCER

EVIDENCE

COPIES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PRINT

PRINT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

12A. INFORMATION WILL BE:

12B. ADDRESS, IF MAILED

MAILED

FAXED

AVAILABLE FOR PICK UP

13.REMARKS (Include purpose of request, i.e., quality control review)

14.CERTIFICATION

I certify that the producer(s) listed above has a current policy subject to review. This information will be used solely by the insurance company I represent for the express purpose of fulfilling claim audits, inspections, and quality control reviews.

A. REQUESTER’S PRINTED NAME

B. REQUESTER’S SIGNATURE

C. TITLE

D.DATE (MM/DD/YYYY)

15. TO BE COMPLETED BY FSA ONLY

A.DATE RECEIVED (MM-DD-YYYY)

B. DATE FURNISHED (MM-DD-YYYY)

C. WORKLOAD DATA

D. INITIALS

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its program and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual’s income is derived from any public assistance program. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information ( Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at (202) 720-

2600 (voice and TDD). To file a complaint of Discrimination, write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW., Washington, DC 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.