BCAP-2 BIOMASS Crop Assistance Program Worksheet

Form Approved –OMB No. 0560-XXXX

BCAP-2
(proposal 6)

U.S. DEPARTMENT OF AGRICULTURE
Farm Service Agency

BIOMASS CROP ASSISTANCE PROGRAM WORKSHEET

1. Farm Number

2. Tract Number

3A. Contract Period:
FROM: (MM-DD-YYYY)

TO: (MM-DD-YYYY)

3B. Contract Length (Yrs)

4. Project Area ID Number

5A. Admin. ST & CO Code

5B. Phys. Loc. ST & CO Code

(See Page 2 for Privacy Act Statement.)
NOTE: According to the Paperwork Reduction Act of 1995, 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 4 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 –ADMINISTRATIVE DATA TO BE COMPLETED BY FSA IN CONSULTATION WITH APPLICANTS
6. Name and Address of Producer (Include Zip Code)

7A. Acres Offered

8. Administrative County FSA Office Address (Include Zip Code)

9. Administrative County FSA Office Telephone Number (Include Area Code)

10A. Proposed Biomass Production (Woody Perennial Crops):
1.
2.
CLU/Field Number
Energy Crop

7B. Acres Eligible

3.
Acres
Offered

10B. Proposed Biomass Production (Non-woody Perennial Crops):
1.
2.
CLU/Field Number
Energy Crop

Eligible

4.
Est. Production
(Dry Tons/Ac/Yr)

5.
Est. First Harvest Date
(MM-DD-YYYY)

Eligible

4.
Est. Production
(Dry Tons/Ac/Yr)

5.
Est. First Harvest Date
(MM-DD-YYYY)

4.
Est. Production
(Dry Tons/Ac/Yr)

5.
Est. First Harvest Date
(MM-DD-YYYY)

3.
Acres
Offered

10C. Proposed Biomass Production (Annual Crops):
1.
CLU/Field Number

2.
Energy Crop

3.
Acres
Offered

11. Land Classification (Select One):

Cropland

NIPF

Eligible

Pastureland/Grassland/Hayland Etc

12. Soil Map Data:
A.
Physical Location
(ST & CO Code)

B.
Soil Survey
ID Number

C.
Map Unit Symbol

(1) Primary
(2) Secondary
(3) Tertiary
G. Totals:

D.
Acres

E.
Soil Rental
Rate

F.
Total Rent

BCAP-2 (propos al 6)

Page 2 of 2

13A. Weighted Average Soil Rental Rate (Per Acre)
(Item 12F total divided by Item 12D total)

13B. Incentive Rate (Per Acre) (if applicable)

13C. Annual Payment Rate (Per Acre)
(Item 13A x Item 13B)

$
14. Remarks

$

PART B –PRODUCER CERTIFICATION STATEMENT AND SIGNATURES

By signing below I certify to all of the following: (1) I have been informed that planting energy plants suitable for biomass does not ensure that the facility
will purchase the harvested product; (2) That CCC is not liable if the facility changes the terms and condition of the purchase of biomass product produced
on land under contract; (3) I will comply with the terms and conditions of the BCAP conservation plan; (4) I will notify CCC within 14 calendar days after
the sale of biomass material from land enrolled in the program; (5) I have been informed of the estimated cost of establishing the energy plants offered;
(6) I have been informed that I may be required to pay for a measurement service on the acreage offered before such acreage may be enrolled in the
BCAP; (7) To the best of my knowledge and belief the acreage of annual and /or perennial crops including woody perennial crops and land listed herein, if
applicable, are true and correct; (8) The signing of this form gives USDA representatives authorization to enter and inspect crops and land uses and for
other purposes on the above identified land and (9) I agree to make available to the Secretary, or to an institution of higher education or other entity as
designated by the Secretary such information the Secretary considers to be appropriate to promote the production of eligible crops and the development of
biomass conversion technology and (10) I agree to grow energy crops on the enrolled acreage and generally agree to harvest, collect and deliver biomass
from such crops to a biomass conversion facility.
I understand that an inaccurate certification could result in a payment reduction or loss of program benefits.
15. Producer’
s Name

16. Producer’
s Signature (By)

17. Title/Relationship of the Individual if Signing in a
Representative Capacity

18. Date (MM-DD-YYYY)

PART C –COUNTY COMMITTEE ELIGIBILITY DETERMINATION (See 1-BCAP Part 4 for eligibility policies) (Check “YES”or “NO”for each)
Eligible Producer Criteria
YES

NO

19. Is the producer an owner or operator of agricultural or NIPF Land?
20. Is the producer in compliance with the highly erodible land conservation requirements of subtitle B of title XII of the Food Security Act of 1985 (16 U.S.C. 3811
et seq.) and the wetland conservation requirements of subtitle C of title XII of that Act (16 U.S.C.3821 et seq.)?
21. Is the land owned by a producer who is not a Federal Agency or State Agency, including any department or any political subdivision of a State?
Eligible Land Criteria
22. Is the land offered physically located within an approved project area which has not already reached the project acreage limit?
23. Is the land offered one or more of the following? Cropland, Grassland, Pastureland, Hayland, other lands on which food, fiber, or other agricultural products are
produced or capable of being produced or NIPF?
24. The land is not native sod, including rangeland, as of (Publication of the final rule).
25. The land is not enrolled in CRP, WRP, or GRP at the time the offer is submitted by the producer.
26. The land is not subject to restrictions such as easements or conveyances that conflict with energy crop production as specified in the BCAP Contract and CPO
or FSP.
Eligible Crop(s) Criteria
27. Are the energy crop(s) listed in the project proposal?
28. Are the energy crop(s) ineligible to receive payments under Title I of the Food, Conservation, and Energy Act of 2008 or an amendment made by that title?
29. Are all energy crop(s) non-invasive and non-noxious, and without the potential to become invasive or noxious as recommended by NRCS, TSP or SFA?
30. Are the energy crop(s) listed above determined agronomically suitable for the land as recommended by NRCS, TSP or SFA?

COC Certification
31. Does this offer meet all eligibility criteria listed above? Note: All above must be “
YES”for the offer to be eligible. (Check “
YES”or “
NO”
)
32. Signature of CCC Representative

YES

NO

33. Date (MM-DD-YYYY)

33. Eligibility Remarks

NOTE:

The following statement is made in accordance with the Privacy Act of 1974 (5 USC 552a –as amended). The authority for requesting the
information identified on this form is 7 CFR Part 1404 and the Commodity Credit Corporation Charter Act (15 U.S.C. 714). The information will be
used to allow the producer to authorize CCC to make a program payment to an assignee. The information collected on this form may be disclosed
to other Federal, State, Local government agencies, Tribal agencies, and nongovernmental entities that have been authorized access to the
information by statute or regulation and/or as described in applicable Routine Uses identified in the System of Records Notice for USDA/FSA-2,
Farm Records File (Automated). Providing the requested information is voluntary. However, failure to furnish the requested information will result
in a deter mination that a payment to the ass ignee cannot be made. RETURN THIS COMPLETED FORM TO YOUR COUNTY FSA OFFICE.

The U.S. Department of Agriculture (USDA) prohibits discrimination in all of 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, political beliefs, genetic information, 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, Assistant Secretary for Civil Rights, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, S.W., Stop
9410, Washington, DC 20250-9410, or call toll-free at (866) 632-9992 (English) or (800) 877-8339 (TDD) or (866) 377-8642 (English Federal-relay) or (800) 845-6136 (Spanish Federal-relay). USDA is an equal
opportunity provider and employer.