Form CCC-910 2018 MARKET FACILITATION PROGRAM (MFP) APPLICATION

This form is available electronically.							OMB Control No. 0560-XXXX OMB Expiration Date: XX-XX-XXXX (See Page 2 for Privacy Act and Paperwork Reduction Act Statements)
CCC-910 (proposal 19)	U.S. DEPARTMENT OF AGRICULTURE Commodity Credit Corporation 2018 MARKET FACILITATION PROGRAM (MFP) APPLICATION
PART A – RECORDING COUNTY OFFICE (FOR COC USE ONLY)
1A. Recording State & County Office Name				1B. Recording County Office Address		1C. Recording County Office Telephone Number (Include Area Code)
						     
     				     		1D. Recording County Office Fax Number (Include Area Code)
						     
PART B - PRODUCER CONTACT INFORMATION
2A. Producer Name				2B. Producer Address		2C. Contact Producer’s Name
     				     		     
						2D. Contact Producer’s Telephone Number (Include Area Code)
						     
PART C – PRODUCTION INFORMATION											COC USE ONLY
3. Commodity		4. Unit of Measure	5. Actual Production (Producer’s Share)	6. Source of Production Evidence	7. Producer’s Signature (By)			8. Title/Relationship of Individual Signing in the Representative Capacity		9. Date (MM-DD-YYYY)	10. Adjusted Production
CORN		bushels	     	     				     		     	     
COTTON		pounds	     	     				     		     	     
SORGHUM		bushels	     	     				     		     	     
SOYBEANS		bushels	     	     				     		     	     
WHEAT		bushels	     	     				     		     	     
DAIRY (MPP historical production)		cwt	     	     				     		     	     
HOGS (August 1, 2018 inventory)		head	     	     				     		     	     
     		     	     	     				     		     	     
     		     	     	     				     		     	     
PART D – PRODUCER CERTIFICATION
The undersigned certifies that all the information entered on this form, whether personally entered by the undersigned or not, or by someone else, is true and correct. The undersigned certifies and acknowledges that the production on this form is accurately identified by the producer and represents only the producer’s share of total production for the year shown. The undersigned understands that the information entered on this form is subject to verification by spot-check. Failure to certify any of the information on this form and application accurately may result in a loss of program benefits. Additionally, by signing this form, the undersigned authorizes the purchaser, warehouse operator, ginner, or any person who otherwise, stores or purchases crop production listed on this form to disclose the production records of such crops to USDA representatives for the purpose of verification. The undersigned (1) agrees to comply with all terms and conditions associated with MFP as stated in 7 CFR Part 1409 and notice of funds availability; and (2) will maintain and provide verifiable and reliable production evidence upon request.
11A. Producer’s Signature (By)				11B. Title/Relationship of Individual Signing in the Representative Capacity      					11C. Date (MM-DD-YYYY)      

CCC-910 (proposal 19) Page 2 of 2

PART E – COC DETERMINATION (FOR COC USE ONLY)
12. Commodity		13A. Signature of COC Representative	13B. Title/Position of COC Representative	13C. Date (MM-DD-YYYY)	14. Action
CORN			     	     	APPROVED DISAPPROVED
COTTON			     	     	APPROVED DISAPPROVED
SORGHUM			     	     	APPROVED DISAPPROVED
SOYBEANS			     	     	APPROVED DISAPPROVED
WHEAT			     	     	APPROVED DISAPPROVED
DAIRY			     	     	APPROVED DISAPPROVED
HOGS			     	     	APPROVED DISAPPROVED
     			     	     	APPROVED DISAPPROVED
     			     	     	APPROVED DISAPPROVED
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 Sec. 5 of the Commodity Credit Corporation Act [15 U.S.C. 714 et seq.]. The information will be used to determine producer eligibility to participate in and receive benefits under the Market Facilitation Program. 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 statue 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) and USDA/FSA-14, Applicant/Borrower. Providing the requested information is voluntary. However, failure to furnish the requested information will result in a determination of ineligibility concerning the processing of the cotton ginning cost-share payment request. 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-XXXX. The time required to complete this information collection is estimated to average 30 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. The provisions of appropriate criminal and civil fraud, privacy, and other statutes may be applicable to the information provided. RETURN COMPLETED FORM TO YOUR COUNTY FSA OFFICE.

In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, gender identity (including gender expression), sexual orientation, disability, age, marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident.

Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the responsible Agency or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English. To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at http://www.ascr.usda.gov/complaint_filing_cust.html and at any USDA office or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: [email protected]. USDA is an equal opportunity provider, employer, and lender