CCC-36 (0560-0183) Assignment of Payment

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This form is available electronically.

Form Approved - OMB No. 0560-0183

CCC-36

U.S. DEPARTMENT OF AGRICULTURE
Commodity Credit Corporation

(09-09-09)

ASSIGNMENT OF PAYMENT
See Page 2 for Privacy Act and Public Burden Statements.

PART A - GENERAL INFORMATION
1. Producer's (Assignor's) Name and Address (Including Zip Code)

2. Assignee's Name and Address (Including Zip Code)

3. Producer's (Assignor's) Tax Identification Number (9 Digit Number)

4. Assignee's Tax Identification Number (9 Digit Number)

PART B - APPLICABLE PROGRAM(S)
5.
Program

6.
Assigned Amount for Each Applicable Year

Conservation
Reserve Program
Annual Rental (CRP)

Milk Income Loss
Contract (MILC)

Direct and CounterCyclical Payment (DCP)

Loan Deficiency
Payment (LDP)

7.
State, County, and
Reference Number,
If Applicable

YEAR

YEAR

YEAR

YEAR

YEAR

AMOUNT

AMOUNT

AMOUNT

AMOUNT

AMOUNT

YEAR

YEAR

YEAR

YEAR

YEAR

AMOUNT

AMOUNT

AMOUNT

AMOUNT

AMOUNT

YEAR

YEAR

YEAR

YEAR

YEAR

AMOUNT

AMOUNT

AMOUNT

AMOUNT

AMOUNT

YEAR

YEAR

YEAR

YEAR

YEAR

AMOUNT

AMOUNT

AMOUNT

AMOUNT

AMOUNT

YEAR

YEAR

YEAR

YEAR

YEAR

AMOUNT

AMOUNT

AMOUNT

AMOUNT

AMOUNT

8.
Other Program Name
(All CRP, other than annual rental)

9.
Program Year or
Payment Year

10.
Assigned Amount

11.
State, County, and Reference Number, If Applicable

$
$
$
$

PART C - REPRESENTATION OF ASSIGNOR AND ASSIGNEE
In order to assign a cash payment in accordance with the programs specified by the assignor in Items 5 and 8, this form must be completed by both the
assignor and the assignee. Assignment is effective for all counties unless specify on Item 7 or Item 11. This assignment is applicable only to programs
publicly announced before this form is filed and is subject to the terms stated in this form and the provisions of 7 CFR Part 1404.
The assignee agrees to repay promptly to the Federal Government any amount by which the assigned payment exceeds the amount secured by the
assignment. The assignor and the assignee agree that they will promptly notify the county FSA office of any change affecting this assignment. This
assignment may be revoked at any time by written request signed by the assignee.
12A. Producer's (Assignor's) Signature (By)

12B. Title/Relationship of the Individual if Signing in a
Representative Capacity

12C. Date (MM-DD-YYYY)

13A. Assignee's Signature (By)

13B. Title/Relationship of the Individual if Signing in a
Representative Capacity

13C. Date (MM-DD-YYYY)

14B. Title/Relationship of the Individual if Signing in a
Representative Capacity

14C. Date (MM-DD-YYYY)

PART D - REVOCATION OF ASSIGNMENT
Assignment of payment authorization above is hereby revoked.
14A. Assignee's Signature (By)

FOR COUNTY OFFICE USE ONLY
15. Receiving State and County

16. Date Filed (MM-DD-YYYY)

COUNTY FSA COMMITTEE

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ASSIGNEE

17. Time Filed

PRODUCER

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CCC-36 (09-09-09)

Page 2

SPECIAL PROVISIONS RELATING TO ASSIGNMENTS

A.

Assignment is effective for all counties unless a specific county is entered in Item 7 or Item 11.

B.

If the assignor assigns a specified value of payments to more than one assignee:
1.

CCC and FSA will recognize assignments for each program per program year or group of years if multi-year is
selected.

2.

Assignments will be honored in chronological sequence based on the order of filing with the county FSA

office.
C.

The payment due the producer may be applied first against indebtedness owing by the producer to the United States,
including debts arising after the execution of a Form CCC-36, which may be offset in accordance with the regulations
governing, 7 CFR Parts 3, 1403, and 1951, and any balance will be subject to assignment.

D.

Neither the United States of America, the Commodity Credit Corporation, the Secretary of Agriculture, any disbursing
officer, nor any other Government employee or official shall be subject to any suit or liable for payment of any amount
if payment is inadvertently made to the assignor without regard to this assignment.

E.

This assignment does not extend to any successor of the assignee, nor may the assignee re-assign this assignment.

F.

The assignee’
s payment is subject to offset for any delinquent Federal debt owed by the assignee.

18A. COUNTY FSA OFFICE NAME AND ADDRESS (Including Zip Code)

18B. TELEPHONE NO. (Including area code):
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 determination that a payment to the assignee cannot be made.
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 0560-0183. The time
required to complete this information collection is estimated to average 10 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.

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

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