FSA-848A Cost-Share Agreement

This form is available electronically.

FSA-848A

Form Approved - OMB No. 0560-0082
U.S. DEPARTMENT OF AGRICULTURE
Farm Service Agency

(09-27-10)

1. ST. & CO. Code :
2. County Office Name, Address and Telephone Number

COST-SHARE AGREEMENT
(See Page 2 for Privacy Act and Burden Statements)
THIS AGREEMENT is entered into between the Farm Service Agency (referred to as “FSA”) and the undersigned owners, operators, tenants,
and/or producers (who individually will herein be referred to as "the Participant"). By signing this form, the Participant agrees to the following:
1) the Participant requested cost-share assistance to perform a practice(s) designed to meet the objectives of the program referenced on FSA-848;
2) the Participant agrees that this practice(s) would not be performed without Federal cost-sharing; and, 3) for the practice(s) approved, the
Participant agrees to refund all or part of the funds paid to him/her, as determined by the Approving Official, if, before expiration of the lifespan of
the specified practice(s), the Participant (a) destroys the approved practice(s), or (b) voluntarily relinquishes control of or title to, the land on
which the approved practice(s) has been established, and the new owner and/or operator of the land does not agree in writing to properly maintain
the practice(s) for the remainder of its life span. The Participant further agrees that if he or she began the practice(s) before receiving written
approval, he or she may be denied cost-share funding. Further, the Participant hereby authorizes a representative of USDA to have access to the
practice site area(s). Further, the participant understands that form FSA-848A-1 is by reference incorporated herein. BY SIGNING THIS
AGREEMENT, THE PARTICIPANT ACKNOWLEDGES RECEIPT OF THE FOLLOWING FORMS: FSA-848A AND ANY ADDENDUM
THERETO.

3. Application Number

4. Agreement Number

5. Program Year

6. Disaster ID Number

7. Program Code

8. Contract ID (If applicable)

9. PRACTICES APPROVED
A.
Farm No.

B.
Tract No.

C.
Field
No.

D.
Practice Control No.

E.
Program
Accounting
Code

F.
Fund
Code

G.
Practice Units

H.
Practice Extent
Approved

I.
Practice
Expiration
Date

J.
Practice Life
Span

K.
Approved Cost-Share
Rate and Type

L.
Approved
Cost-Share

M. TOTALS:

10. COMPONENTS APPROVED
A.
Farm No.

B.
Tract No.

C.
Field
No.

11. USDA USE ONLY –
Application Approval

D.
Practice Control No.

E.
Component
No.

A. Signature of FSA Representative

F.
Component Title

G.
Component Units

B. Date (MM-DD-YYYY)

H.
Component
Extent
Approved

C. Cost-Share Willing to Approve

I.
Approved Cost-Share
Rate and Type

J.
Approved
Cost-Share

D. Cost-Share Approved

12. PARTICIPANT APPROVAL ACKNOWLEDGEMENT
Your request for program cost-sharing to perform the practice(s) shown above is approved for the farm(s) identified above. By signing below, you agree to complete the specified practice(s) and components on or before the
practice expiration date(s). To receive payment or credit for any cost-shares earned on these practice(s), report performance on the FSA-848B and file with the issuing office by the practice expiration date(s) listed above. If you
decide not to perform this practice, or if you cannot complete it by the practice expiration date, please notify the Approving Official’
s office in writing at once.
A. Participant’
s Name, Address and Telephone Number

B. Signature (By)

C. Title/Relationship of the Individual If Signing in a Representative Capacity

D. Date (MM-DD-YYYY)

FSA-848A (09-27-10)

Page 2
EMERGENCY PROGRAMS ONLY

13. AGREEMENT INFORMATION
A. Program Code

B. Program Year

C. ST. & CO. Code

D. Agreement Number

E. Contract ID

F. Disaster ID

14. REMARKS

NOTE:

The follow ing statement is made in accordanc e w ith the Priv acy Act of 1974 ( 5 USC 552a - as amended). The author ity for requesting the infor mation identified on this form is 7 C FR Part 701, 7
CFR Part 1410, and the Food, Conservation, and Energy Act of 2008 (Pub. L. 110-246). The infor mation w ill be used to determine eligibility for pr ogr am benefits. The information collected on this
form may be disclosed to other Feder al, State, Local gover nment agenc ies, Tr ibal agenc ies, and nongov ernmental entities that have been author ized access to the infor mation by statute or
regulation and/or as descr ibed in applicable R outine Us es identified in the System of Rec ords N otic e for USD A/FSA-2, Far m R ecords File (Automated). Prov iding the r equested information is
voluntary. However, failur e to fur nish the r equested infor mation w ill r esult in a determination of ineligibility for progr am benefits.
According to the Paperw ork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not requir ed to r espond to, a c ollection of information unless it displays a valid OMB
control number . The valid OMB control number for this infor mation collection is 0560- 0082. The time r equir ed to complete this infor mation collection is estimated to aver age 3 minutes per
response, inc luding the time for rev iew ing instructions, searc hing ex is ting data sources, gather ing and maintaining the data needed, and c ompleting and rev iew ing the collec tion of infor mation.
RETUR N THIS COM PLETED FORM TO YOUR COU NTY FSA OFFICE.
By signing this form, the P artic ipant acknow ledges and understands that any fals e r epresentation or c laims are subject to c iv il and cr iminal penalties inc luding, but not limited to those under 18
U.S.C. 1001.

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 w here 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 w ith disabilities
who require alternative means for communication of program informa tion (Braille, large print, audiotape, etc.) should contact USD A’
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., St op 94 10, Washington, DC 2025 0-9410, or call toll-free at (866) 632-9992 (En glish) or (800) 877-8339 (TDD) or (866)
377-8642 ( English Federal-relay) or (800) 845-6136 (Sp anish Federal-relay). USDA is an equal opportunity provider and employer.