The Fsa 426 form is a government document that is used to track employee benefits. This form can be used to report employer contributions and employee deductions for certain benefits plans. The Fsa 426 form must be filed annually with the IRS. If you are an employer who sponsors a benefits plan, it is important to understand how to complete this form correctly. Failure to file the Fsa 426 form may result in penalties from the IRS.
Question | Answer |
---|---|
Form Name | Fsa 426 Form |
Form Length | 1 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 15 sec |
Other names | fsa form 426, fsa 426 request form, id requester fsa create, fsa 426a |
THIS FORM IS AVAILABLE ELECTRONICALLY.
U.S. DEPARTMENT OF AGRICULTURE |
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Farm Service Agency |
MPCI/FCIC INFORMATION REQUEST WORKSHEET
1.COUNTY OFFICE NAME, ADDRESS, AND TELEPHONE NO. (Include area code)
()
2. PROGRAM YEAR
3. DATE
ITEMS 4 THROUGH 11 TO BE COMPLETED BY REQUESTER
4A. REQUESTER=S NAME
4B. TELEPHONE NUMBER 4C. ID NUMBER
()
4D. ID TYPE
5.
PRODUCER=S NAME
6.
ID NUMBER
7.
ID TYPE
8. INFORMATION REQUESTED
(/ ) Check appropriate box(es) that are applicable to producer.)
A. |
B. |
Map Photocopies |
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9A. INFORMATION WILL BE:
MAILED
PICKED UP
9B. ADDRESS, IF MAILED
10.REMARKS
11.CERTIFICATION
I certify that the producer(s) listed above has a current policy with the insurance company I represent. This information will be used by the insurance company I represent for the express purpose of fulfilling its loss adjustment and compliance obligations.
A. REQUESTER=S SIGNATURE
B. TITLE
C. DATE
12. TO BE COMPLETED BY FSA ONLY
A. DATE RECEIVED
B. DATE FURNISHED
C. WORKLOAD DATA
D. INITIALS
The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, gender, religion, age, disability, political beliefs, sexual orientation, and marital or family status. (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)