CCC-577 Transfer of NAP Coverage

This form is available electronically.

Form Approved - OMB No. 0560-0175

CCC-577

(06-08-05)

U.S. DEPARTMENT OF AGRICULTURE

Commodity Credit Corporation

See Page 2 for Privacy Act and

Public Burden Statements.

TRANSFER OF NAP COVERAGE

PART A - NOTICE OF TRANSFER

1. Transferor's Name and Address (Include Zip Code)

3. Crop

4. Pay Crop

5. Pay Type

6. Planting

Period

7. Crop Year

8. Unit

Number

2. Taxpayer ID No. or SSN (Last 4 Digits of SSN):

9. Farm Location

10.

Transferee Name and Address (Include Zip Code)

11.

Taxpayer ID No. or SSN

(Last 4 Digits of SSN)

12.

Farm Number

13.

Share Transferred

%

%

%

%

14. Effective Date of Transfer

(MM-DD-YYYY)

15. Nature of Transfer

PART B - TERMS AND CONDITIONS

16A. Transferor's Signature

16B. Date (MM-DD-YYYY)

A. Acceptance by CCC of the above-described transfer shall transfer the producer's NAP coverage to the above-named transferee subject to:

1. Receipt by CCC of satisfactory evidence that said transfer occurred before the end of the coverage period; i.e., the earlier (a) the date harvest

was completed on the unit, (b) the calendar date for the end of the coverage period, or (c) the date the entire crop on the unit was destroyed, as

determined by CCC.

2. The terms of the above-identified NAP application for coverage, including any outstanding assignment of payment made by the transferor

prior to the date of transfer.

3. All other terms and provisions set forth herein.

B. CCC shall not be liable for more risk than existed before the transfer occurred.

C. The NAP application for coverage of the transferor covers the share hereby transferred only to the end of the coverage period.

17A. Transferee's Signature

17B. Date (MM-DD-YYYY)

17A. Transferee's Signature

17B. Date (MM-DD-YYYY)

PART C - APPROVAL OF CCC

18A. Name and Address of County FSA Office (Include Zip Code)

19. State and County Code

20. Approval Status

21. Signature of CCC Representative

22. Date

(MM-DD-YYYY)

18B. Telephone Number (Include Area Code):

     

     

     

     

     

    

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

Approved

Disapproved

     

     

CCC-577 (06-08-05)

Page 2

COLLECTION OF INFORMATION AND DATA (PRIVACY ACT)

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 Pub. L. 93-86. The information will be used to document legal transfer of interest from one producer to another. Furnishing the requested information is voluntary. Failure to furnish the requested information will result in agency's inability to transfer crop interests. 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, 651, 1001; 15 USC 714m; and 31 USC 3729, may be applicable to the information provided.

PAPERWORK REDUCTION ACT

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 0560-0175. The time required to complete this information collection is estimated to average 5 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.

NONDISCRIMINATION STATEMENT

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, gender, religion, age, disability, political beliefs, sexual orientation, and marital or family status. (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 USDA, Director, Office of Civil Rights, Room 326-W, Whitten Building, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410 or call (202) 720-5964 (voice or TDD). USDA is an equal opportunity provider and employer.