FSA-747 Dairy Disaster Assistance Payment Program (DDAP-III) App

This form is available electronically.
U.S. DEPARTMENT OF AGRICULTURE
FSA-747
Farm Service Agency
(Proposal 8)

1. State Code

DAIRY DISASTER ASSISTANCE PAYMENT
PROGRAM (DDAP-III) APPLICATION

3. Application Date
(MM-DD-YYYY)

Form Approved - OMB No. 0560-0252
2. County Code
4. Application Number

NOTE: The following statement is made in accordance with the Privacy Act of 1974 (5 USC 552a) and the Paperwork Reduction Act of 1995, as amended. The authority for requesting information is the U. S.
Troop Readiness, Veterans' care, Katrina, Recovery, and Iraq Accountability Appropriations Act, 2007, Pub. L. 110-28. The information will be used to establish eligibility of losses and determine payment
amounts for dairy operations located in an eligible county declared a natural disaster, and counties contiguous, when requesting benefits under the Dairy Disaster Assistance Payment Program III (DDAP-III).
Furnishing the requested information is voluntary; however, failure to furnish the requested information will result in a determination of ineligibility for DDAP-III Program benefits unless this report is completed
and filed as required by existing law and regulations provided at 7 CFR Part 786. This information may be provided to other agencies, IRS, Department of Justice, or other State and Federal law enforcement
agencies, and in response to a court magistrate or administrative tribunal or to other request for information. The provisions of criminal and civil fraud statues, including 18 USC 286, 287, 371, 641, 651, 1001,
1004 and 31 USC 3729, may be applicable to the information provided.
Under the Paperwork Reduction Act of 1995, where applicable, an agency generally may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid
OMB control number. The valid OMB control number for this information collection is 0560-0252. The time required to complete this information collection is estimated to average 15 minutes per response,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. RETURN THIS
COMPLETED FORM TO YOUR COUNTY FSA OFFICE.

PART A - PRODUCER INFORMATION
5A. Name of Dairy Operation (Prepare 1 application per dairy operation)

5B. Contact Producer's Name and Address (Including Zip Code)

5C. Email Address (Optional)

5D. Telephone Number (Including Area Code)

PART B - BASE PERIOD INFORMATION
6. Enter the average number of cows in the dairy herd (wet and dry) during the year and the total annual marketed production for each calendar year 2003
and 2004.
Year

2003

2004

A. Average Number of Cows in the Dairy Herd
During Year
B. Marketed Production (pounds)

PART C - PRODUCTION INFORMATION
7. Enter total commercially marketed production (pounds) and number of cows in the dairy herd (wet and dry) during the relevant year(s). Applicant must
check the appropriate box for each applicable disaster year(s) for which benefits are being requested.

2005

A. Disaster Year

2007

2006

B. Average Number of Cows in the Dairy Herd
During Year
C. Marketed Production (pounds)

PART D - DISASTER YEAR PRODUCTION LOSS ADJUSTMENTS - (For County Office Use Only)
8. County Office will record applicable production adjustments and corresponding justification to increase and/or decrease production
losses when applicable. Enter pounds of production that need to be adjusted by applicable year. Use Item 22 for additional space.
Year

2005

2006

2007

A.
Decrease (-) Production Loss
Downward

B.
Justification for Adjustment

C.
Increase (+) Production Loss
Upward

lbs.

lbs.

lbs.

lbs.

lbs.

lbs.

D.
Justification for Adjustment

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.

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FSA-747 (Proposal 8)
PART E - PRODUCER CERTIFICATION

I certify that all the information entered on this application is true and correct and all persons in this operation have submitted adequate production and herd evidence to verify the claim made by
this document for production, cow numbers, and production losses suffered by the dairy operation as a result of a natural disaster occurring in a disaster county covered by a natural disaster
declaration, or contiguous county, between January 1, 2005, and December 31, 2007. I hereby apply for payment to the extent that the County FSA Committee determines I am eligible to receive
benefits and I understand that if funding is insufficient to compensate eligible producers for eligible losses, then the FSA will pay losses at two levels according to 7 CFR Part 786, in an effort to
more equitably distribute the limited funds and maximize the effectiveness of the program. Further, I understand if a national factor is applied, the benefit payment to be otherwise calculated is
subject to reduction. In addition, I understand that proper documentation of commercially marketed milk, the number of cows in the herd, and natural disaster losses suffered by the dairy operation
are required to the satisfaction of the County FSA Committee. I further understand that this program is subject to the rules found in 7 CFR Part 786. I understand that I can be denied payments
based on any inaccuracy in this certification and application and that the payment issued to the dairy operation may be reduced by the percentage of the member's share of the production or share in
the quantity, whichever is higher. I understand that payments are subject to conditions and limits imposed by regulation and FSA and that this is an application only. Providing a false certification
to the Government is punishable by imprisonment, fines, or other penalties. All information provided herein is subject to verification by FSA. The criminal and civil fraud statutes that apply to this
certification, may include 15 USC 714m, 18 USC 286, 297, 371, 641, 651, and 1001; and 31 USC. Other authorities may apply.
Regulations at 7 CFR Part 786 require that the amount of any payment received from DDAP-III shall be reduced from any disaster payments previously received for the loss including any made
under a previous dairy disaster assistance payment program for 2005 (DDAP-II). Accordingly, I certify to the following concerning 2005 Dairy Disaster Assistance Payments (DDAP-II):

9. Was a Payment Received for 2005 DDAP-II Program?

COC Use Only (Payment Amount)

NO

YES

11.
Last 4-digits of
Producer's ID (TIN/SSN/EIN)

10.
Producer's Signature

$
12.
Date Signed

13.
Share Percentage of Production %
2005

2006

2007

14.
Refuse Payment?
YES

PART F - COC DETERMINATION (For County Office Use Only)
15. Name of COC Designee

16. Title of COC Designee

17. Signature of COC Designee

18. Date Signed

19. Application Status:

APPROVED

DISAPPROVED

20. County FSA Office Name and Address (Including Zip Code)

22. Remarks

21. County FSA Office Telephone Number (Including Area Code)

NO