Emergency Conservation Program

Instructions for CCC-526

Payment Eligibility – Average Adjusted Gross Income Certification

Producers use this form to certify compliance with the adjusted gross income provision for the receipt of commodity, conservation and price support program benefits. See page 3 of the form for definitions, eligibility requirements and examples.

Submit the original of the completed form in hard copy or facsimile to the appropriate USDA servicing office.

Customers who have established electronic access credentials with USDA may electronically transmit this form to the USDA servicing office, provided that (1) the customer submitting the form is the only person required to sign the transaction, or (2) the customer has an approved Power of Attorney (Form FSA-211) on file with USDA to sign for other customers for the program and type of transaction represented by this form.

Features for transmitting the form electronically are available to those customers with access credentials only. If you would like to establish online access credentials with USDA, follow the instructions provided at the USDA eForms web site.

Submit this completed form to the address specified in Item 1.

Producers must complete Items 1 through 10.

Items 1-10

Fld Name / Item No.	Instruction
1 County FSA Office or Service Center Address	Enter the name, address and telephone number of the county Farm Service Agency or Service Center office that this form will be submitted.
2 Individual or Entity=s Name and Address	Enter the individual or entity=s name, address and telephone number for commodity, conservation and price support program benefits.
3 Program Year	Enter the applicable year for which program benefits are requested.
4 Identifica-tion Number	Enter the applicant's social security or tax identification number.
5 Type of Operation	Individual or entity should check the type of operation. Check only one.
6 - 10 Individual	Complete the appropriate section for your type of operation. Sign and date.