Instructions For AD-1026B

HIGHLY ERODIBLE LAND CONSERVATION EXEMPTION REQUEST

Producers use this form to request an exemption for highly erodible land conservation provisions under USDA programs.

Submit the original of the completed form in hard copy or facsimile to the appropriate FSA servicing office.

Customers who have established electronic access credentials with USDA may electronically transmit this form to the USDA servicing office, provided that (1) the customer submitting the form is the only person required to sign the transaction, or (2) the customer has an approved Power of Attorney (Form FSA-211) on file with USDA to sign for other customers for the program and type of transaction represented by this form.

Features for transmitting the form electronically are available to those customers with access credentials only. If you would like to establish online access credentials with USDA, follow the instructions provided at the USDA eForms web site.

Producers must complete Items 1 through 9B.

Items 1 � 9B

Fld. Name/ Item No.	Instruction
1A State Name	Enter the State name where the farm is located.
1B County Name	Enter the County name where the farm is located.
2 Producer Information	Enter the producer�s name, address including Zip code, and telephone number including area code.
3 Identifica- tion Number	Enter the producer�s social security number or tax ID number.
4 Farm Number	Enter the Farm Number on which the exemption request is being made.
5 Crop Year	Enter the crop year for which the exemption request is being made.
6 Cropland	Enter the number of acres for which the exemption request is being made.
7 Reason for Request	Enter the reason for the request. Describe in detail the conservation measures that are required but will not be applied and the reasons they will not be applied.
8A Producer�s Signature	Enter the producer�s signature. If you are mailing or faxing this form, print the form and manually enter your signature. If this form is approved for electronic transmission and you have established credentials with USDA to submit forms electronically, use the buttons provided on the form for transmitting the form to the USDA servicing office.
8B Date	Enter the date of producer�s request.
9A Landlord�s Signature	Landlord�s signature, if applicable.
9B Date	Date of landlords� signature.

Fld. Name/ Item No.

Instruction

State Name

Enter the State name where the farm is located.

County Name

Enter the County name where the farm is located.

Producer Information

Enter the producer�s name, address including Zip code, and telephone number including area code.

Identifica-

tion Number

Enter the producer�s social security number or tax ID number.

Farm Number

Enter the Farm Number on which the exemption request is being made.

Crop Year

Enter the crop year for which the exemption request is being made.

Cropland

Enter the number of acres for which the exemption request is being made.

Reason for Request

Enter the reason for the request. Describe in detail the conservation measures that are required but will not be applied and the reasons they will not be applied.

Producer�s Signature

Enter the producer�s signature.

If you are mailing or faxing this form, print the form and manually enter your signature. If this form is approved for electronic transmission and you have established credentials with USDA to submit forms electronically, use the buttons provided on the form for transmitting the form to the USDA servicing office.

Date

Enter the date of producer�s request.

Landlord�s Signature

Landlord�s signature, if applicable.

Date

Date of landlords� signature.

Items 10 � 27 are for FSA's use only.