Instructions for CCC-21

SUPPLEMENT TO COMMODITY CREDIT CORPORATION (CCC) STORAGE AGREEMENTS

Highly Erodible Land and Wetland Conservation

Declaration of Eligibility to Receive Storage Payments Under a CCC Storage Agreement

Warehouse operators use this form to declare compliance with highly erodible land and wetland conservation provisions of the 1985 Food Security Act as amended.

Submit the original of the completed form in hard copy to the Kansas City Commodity Office, P.O. Box 419205, Kansas City, MO 64141-6205.

 

Warehouse Operators must complete Items 1 through 9.

Fld Name /
Item No.

Instruction

1

Crop Year

Enter the current crop year.

2-3

Type of Storage Agreement and Number

Check the type of CCC storage agreement and enter the applicable storage agreement number. If "Other" is checked, enter the agreement type and the storage agreement number.

4

Company Name

Enter the company name of the warehouse operator as shown on form AD-1026 and the main business location for the applicable storage agreement.

5

Social Security No.

Enter the social security number or the taxpayer identification number for the person or business shown in Item 3.

6

Warehouse Code(s)

Enter all the CCC warehouse codes for which this CCC-21 applies. If additional space is required, list codes on a separate sheet identified with the agreement number from Item 2.

7 A � C

Farm Owner

Item 7A. Enter State where the farm is located.

Item 7B. Enter the county where the farm is located.

Item 7C. Enter the Farm Service Agency assigned farm number(s), if applicable.

8 A - C

Affiliated Person with Farming Interests

Item 8A. Enter the name of the affiliated person with farming interests.

Item 8B. Enter the social security or taxpayer identification number for the affiliated person listed in Item 7A.

Item 8C. Check "Yes" or "No" to indicate a farming interest by the affiliated person

9 A � C

Signature of Person with Farming Interest

Item 9A. Enter the signature and title of person declaring that AD-1026 and 1026A have been filed with the appropriated FSA county office(s) for the company and all affiliated persons, and that the company and affiliates have not been declared ineligible to receive USDA benefits.

Item 9B. Enter title.

Item 9C. Enter date signed.

10A � C

Signature of Person without Farming Interest

Item 10A. Enter the signature and title of person declaring that the company or affiliated person(s) has no interest in a farm as owner, operator, tenant, or sharecropper and are not required to certify on AD-1026 to receive USDA loans or other program benefits as a producer of agricultural commodities on highly erodible lands or converted wetlands.

Item 10B. Enter title.

Item 10C. Enter date signed.