Form CCC-752 2008 Supplemental Ag Disaster Asst Buy-In for Insurable

This form is available electronically. Form Approved – OMB No. 0560-XXXX

CCC-752 U.S. DEPARTMENT OF AGRICUTLURE (proposal 10) Commodity Credit Corporation				1. Crop Year	2. County FSA Office Name and Address (Including Zip Code):
2008 SUPPLEMENTAL AGRICULTURAL DISASTER ASSISTANCE BUY-IN FOR INSURABLE CROPS				2008	     
					Telephone No. (Including Area Code):
					     
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 the following information is The Food, Conservation, and Energy Act of 2008. The information will be used to determine program eligibility. Furnishing the requested information is voluntary. Failure to furnish the requested information will result in denial of program benefits. 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. The provisions of criminal and civil fraud statutes, including 18 USC 286, 287, 371, 641, 1001; 15 USC 714m; and 31 USC 3729, may be applicable to the information provided. Under the Paperwork Reduction Act of 1995, where applicable, an agency 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-XXXX. 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 FORM ALONG WITH YOUR APPLICABLE BUY-IN FEE TO YOUR COUNTY FSA OFFICE.
PART A - PRODUCER INFORMATION
3. Name and Address of Producer (Including Zip Code)			Administrative State and County Office
     			4A. State		4B. County
			     		     
			5. ID Number (Last 4 digits only)		6. Schedule of Deposit Number According to 3-FI
			    		     
PART B - WAIVER OF 2008 BUY-IN FEE
DEFINITIONS FOR THE PURPOSE OF THIS FORM: A "Socially Disadvantaged Farmer or Rancher" is a farmer or rancher who is a member of a socially disadvantaged group. (For entity applicants, all members of the entity must be socially disadvantaged.) A "Socially Disadvantaged Group" is a group whose members have been subject to racial or ethnic prejudice because of their identity as members of a group without regard to their individual qualities. A "Limited Resource" producer is a producer with both of the following: • Direct or indirect gross farm sales not more than $100,000 in both of the previous 2 years (**to be increased starting in FY 2004 to adjust for inflation using Price Paid by Farmer Index as compared by NASS); And • Total household income at or below the national poverty level for a family of 4, or less than 50 percent of county median household income in both of the previous 2 years (**to be determined annually using Commerce Department Data). **NOTE: For up-to-date data for this definition, a "limited resource farmer or rancher" status can be determined using the website for USDA Limited Resource Farmer and Rancher Online Self Determination Tool at http://www.lrftool.sc.egov.usda.gov/tool.asp. This tool will determine your status using your personal data at your state/county location. (7 C.F.R § 1469.3) A "Beginning Farmer or Rancher" means an individual or entity who: • Has not operated a farm or ranch for more than 10 years; • Substantially participates in the operation. If the applicant is an entity, all members must be eligible beginning farmers.
7. Are you, under FSA standards, a socially disadvantaged, limited resource, or beginning farmer or rancher?
Socially Disadvantaged		YES NO
Limited Resource		YES NO
C. Beginning Farmer or Rancher		YES NO
If ''YES'' to A, B, or C, then you are not required to pay the 2008 buy-in fee. If ''NO'' to A, B, and C, then you are required to pay the 2008 buy-in fee at this time.

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs 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, S.W., Washington, D.C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.

CCC-752 (Proposal 10) Page 2

PART C - CROP/TYPE IDENTIFICATION
Purpose of this notice and definitions. For purposes of this form "insurable crops" are those for which a policy or plan of catastrophic coverage (CAT) insurance was available through the Federal Crop Insurance Corporation (FCIC). "Noninsurable crops" are those crops for which a policy or plan of insurance is not available, however, coverage is offered by the Farm Service Agency (FSA) under the Noninsured Crop Disaster Assistance Program (NAP). In Title XII of the Food, Conservation, and Energy Act of 2008, Congress provided for new disaster programs, which together will be called the "Supplemental Agricultural Disaster Assistance Programs". Generally, producers are eligible only if they have, for all crops, obtained either FCIC crop insurance or NAP coverage. However, for the 2008 crop year only, producers who were eligible to obtain crop insurance but did not, can "buy-in" or be "waived in" to be eligible for these disaster programs by paying by the deadline a fee in an amount equal to the unpaid CAT or NAP fees. For this purpose, producers who want to buy-in to these disaster programs must complete this form if they had unpaid CAT crops and a separate form if they had unpaid NAP crops. This form is for the 2008 insurable CAT crops listed below. The CAT fee is $100 per crop, but not more than $300 per producer per county, or $900 total per producer for all counties. Accordingly, the buy-in cost with respect to 2008 insurable crops is based on those levels minus any previously paid fees for CAT (this does not include any premiums paid for buy-up insurance coverage). The producer must "buy-in" for all noninsurable and insurable crops. If a producer has 2008 noninsurable crops, there is a separate buy-in amount due. Separate forms are required for the 2008 noninsurable crops and separate dollar limitations apply to those crops. List all of the producer’s insurable crops below for which a crop insurance policy was not purchased. Remember, producers need to file a separate form for 2008 noninsurable crops if they did not obtain NAP for all of those crops for 2008. The buy-in fee is non-refundable and due at the time a producer files the CCC-752.
8. Crop/Type		9. Intended Use		10. Planting Period
     		     		     
     		     		     
     		     		     
     		     		     
     		     		     
     		     		     
     		     		     
     		     		     
11A. Fees required for buy-in, based on the crops listed in Item 8 above:					$	     
11B. CAT fees previously paid on other crops in this county:					$	     
11C. CAT fees previously paid on crops in other counties:					$	     
11D. Balance of required buy-in fees due and received:					$	     
12. Remarks (Including additional crops if necessary):
     
PART D - PRODUCER AND CCC REPRESENTATIVE'S CERTIFICATION
I have read this form and would like to buy-in or be waived in to the 2008 Supplemental Agricultural Disaster Assistance Programs. To be eligible for the program, payment is due at the time this form is filed. I have paid the above calculated buy-in fee, or my buy in fee is $0. (Note - Application will not be complete until payment is made - payment must be made by August 20, 2008, unless that date is extended by law). I certify all information entered on this form (CCC-752) is true and correct. I understand that the buy-in fee waives the risk management purchase requirement of the Food, Conservation, and Energy Act of 2008, but does not provide insurance for insurable crops. A separate application must be filed to be eligible for benefits under the 2008 Supplemental Agricultural Disaster Assistance Programs. All information provided herein is subject to verification by the Commodity Credit Corporation. As provided in various statutes, failure to provide true and correct information may result in civil suit or criminal prosecution and the assessment of penalties or pursuit of other remedies. I am aware of and understand the requirements of the Collection of Information and Data (Privacy Act). This application is not valid unless accompanied by the applicable buy-in fee.
13A. Producer's Signature	13B. Date (MM-DD-YYYY)		14A. CCC Representative's Signature				14B. Date (MM-DD-YYYY)