Submit the original of the completed form in hard copy to the FSA county office. Retain copies for the producer and joint payee. DO NOT FAX.
Field Name /
|
Instruction |
Part A |
General Information |
1 Producer's Name and Address |
Enter the producer's name and address (including Zip Code). |
2 Joint Payee's Name and Address |
Enter the name and address of the person, business, institution, etc. to be included in the payment (joint payee). |
3 Producer's Tax Identification Number (9 Digit Number) |
Enter the producer's social security number or tax identification number. |
Part B |
Applicable Program(s) |
4 Program |
Select the applicable program as displayed or enter an applicable multi-year program name:
Note:? All CRP, other than annual rental must be indicated in the ?????????? ?other? block.
|
5 Program Year or Payment Year |
Enter the year of the applicable program year or payment year of the program name entered for joint payment. |
6 State, County, and Reference Number, If Applicable |
If Joint Payment is applicable to only one FSA county office, or a particular farm or contract, enter State, county and reference number, if applicable. |
Part C |
Joint Payment Authorization The producer and joint payee shall read the certification statement carefully.
NOTE:? By signing both parties acknowledge and agree to the terms and conditions set forth in Part C. |
7A-7C Producer?s Signature, Title/Relationship and Date |
The producer or authorized agent shall sign and date.
If other authorized agent or representative signs on behalf of the entity, please enter title or nature of authority. |
8A-8C Joint Payee?s Signature, Title Relationship and Date |
Person, business, institution, etc. shall sign and date as joint payee.?
If other authorized agent or representative signs on behalf of the entity, please enter title or nature of authority. |
Part D |
Revocation of Joint Payment Authorization The joint payee must sign this part to revoke an existing joint payment authorization. |
9A-9C Joint Payee?s Signature, Title/Relationship and Date |
The joint payee must sign and date this form to revoke the joint payment authorization.? If applicable, enter the title of the person representing the joint payee. |
Items 10-12 are for FSA use only.?????
Item 13
Field Name /
|
Instruction |
Special Provisions |
Producer and the joint payee must read the Special Provisions Relating to Joint Payment Authorization, and the Privacy Act and Public Burden Statements on Page 2 of Form CCC-37. |
13A-13B County Office Name, Address, and Telephone Number |
When CCC-37 is to be mailed or to be delivered by a carrier to the? FSA county office, the producer shall enter the FSA servicing office name and address with zip code and the telephone number with area code. |
Field Name /
|
Instruction |
Joint Payee |
A joint payee is a person or entity to whom a payment is made jointly with the producer. |
Joint Payment Authorization |
A joint payment authorization is a written request to make payment to joint payees.
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File Type | application/msword |
Author | maryann.ball |
Last Modified By | maryann.ball |
File Modified | 2009-12-07 |
File Created | 2009-12-07 |