FSA-894 Continuati WHIP Application (Continuation Sheet)

Form Approved – OMB No. 0560-0291 This form is available electronically. See Page 3 for Privacy Act and Public Burden Statements.

FSA-894 Continuation U.S. DEPARTMENT OF AGRICULTURE (proposal 2) Commodity Credit Corporation WILDFIRES AND HURRICANES INDEMNITY PROGRAM + APPLICATION (Continuation Sheet)

Crop Year     

Public Burden Statement (Paperwork Reduction Act):  Public reporting burden for this collection is estimated to average 30 minutes per response, including reviewing instructions, gathering and maintaining the data needed, completing (providing the information), and reviewing the collection of information. You are not required to respond to the collection or FSA may not conduct or sponsor a collection of information unless it displays a valid OMB control number.  RETURN THIS COMPLETED FORM TO YOUR COUNTY FSA OFFICE.

2. Producer’s Name      

3. Producer’s Address (City, State and Zip Code)      

4A. Administrative State Name/Code      

4B. Administrative County Name/Code      

Each producer must apply by administrative county.

PART A – NOTICE OF LOSS

The following crop(s), crop type(s), and intended use(s) suffered a loss due to the disaster event cause of loss that occurred January 1, 2018 – December 31, 2019.

5. What disaster event caused the loss?

6. Disaster Event Dates (Beginning and Ending)

     

     

7A. Crop

7B. Crop Type

7C. Intended Use

7D. Practice

7E. Planting Period

8. Insured/NAP Coverage/Uninsured

9. Crop Loss, Prevented Planted, or Trees, Bushes, and Vines Loss (If prevented planted Part B must be completed)

10. COC Approved or Disapproved

    

     

     

     

     

Insured

Crop Loss

Approved Disapproved

NAP Coverage

Prevented Planting

Uninsured

Trees, Bushes and Vines Loss

    

     

     

     

     

Insured

Crop Loss

Approved Disapproved

NAP Coverage

Prevented Planting

Uninsured

Trees, Bushes and Vines Loss

    

     

     

     

     

Insured

Crop Loss

Approved Disapproved

NAP Coverage

Prevented Planting

Uninsured

Trees, Bushes and Vines Loss

PART B – RECORD OF MANAGEMENT FOR PREVENTED PLANTING CROPS

11A. Crop      

11B. Crop Type      

11C. Intended Use      

11D. Practice      

11E. Planting Period      

12. Purchased/delivered/arranged for. If “YES”, explain (Attach copies of receipts).

YES NO. A. Seed, Chemical, and Fertilizer

     

YES NO. B. Land Preparation Measures

     

13. What cultivation practices were performed on prevented planted acreage?      

14A. What did you do with the acreage you claim was prevented planted?      

14B. Final Planting Date      

FSA-894 Continuation (proposal 2) Page 2 of

PART C – PAY GROUPING INFORMATION

15. Producer Name      

16. Insured/NAP Coverage/Uninsured Insured NAP Coverage Uninsured

17. Administrative State Name/Code      

18. Administrative County Name/Code      

19. Physical State Name/Code

20. Physical County Name/Code

     

Same as Administrative

     

Same as Administrative

21. Crop Year     

22. Unit      

23. Pay Crop Code      

24. Pay Type Code      

25. Planting Period      

PART D – PRODUCTION INFORMATION

COC USE ONLY

26. Crop

27. Crop Type

28. Crushing District

29. Int. Use

30. Practice

31. Organic Status

32. Native Sod

33. Acres

34. Share

35. Stage

36. Unit of Measure

37. Production To Count

38. Yield (Select Crops Only)

39. Assigned or Adjusted Production

40. Secondary Use or Salvage Value

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

PART E – VALUE LOSS CROPS

COC USE ONLY

41. Crop

42. Crop Type

43. Share

44. Dollar Value Before Disaster

45. Dollar Value After Disaster

46. Ineligible Dollar Value

47. Salvage Value

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

PART F – TREES, BUSHES, & VINES

COC USE ONLY

48. Crop

49. Crop Type

50. Acres

51. Share

52. Tree Stage

53. Number in Tree Stage

54. Number Destroyed

55. Number Damaged

56. Adjusted Number in Tree Stage

57. Adjusted Number Destroyed

58. Adjusted Number Damaged

59. Salvage Value

     

     

     

     

I

     

     

     

     

     

     

     

II

     

     

     

     

     

     

     

III

     

     

     

     

     

     

     

     

     

     

     

I

     

     

     

     

     

     

     

II

     

     

     

     

     

     

     

III

     

     

     

     

     

     

     

     

     

     

     

I

     

     

     

     

     

     

     

II

     

     

     

     

     

     

     

III

     

     

     

     

     

     

     

PART G - COC DETERMINATION OF PAY GROUPING

60. COC Action: Approved Disapproved

FSA-894 Continuation (proposal 2) Page 3 of 4

PART A – NOTICE OF LOSS

The following crop(s), crop type(s), and intended use(s) suffered a loss due to the disaster event cause of loss that occurred January 1, 2018 – December 31, 2019.

5. What disaster event caused the loss?

6. Disaster Event Dates (Beginning and Ending)

     

     

7A. Crop

7B. Crop Type

7C. Intended Use

7D. Practice

7E. Planting Period

8. Insured/NAP Coverage/Uninsured

9. Crop Loss, Prevented Planted, or Trees, Bushes, and Vines Loss (If prevented planted Part B must be completed)

10. COC Approved or Disapproved

    

     

     

     

     

Insured

Crop Loss

Approved Disapproved

NAP Coverage

Prevented Planting

Uninsured

Trees, Bushes and Vines Loss

    

     

     

     

     

Insured

Crop Loss

Approved Disapproved

NAP Coverage

Prevented Planting

Uninsured

Trees, Bushes and Vines Loss

    

     

     

     

     

Insured

Crop Loss

Approved Disapproved

NAP Coverage

Prevented Planting

Uninsured

Trees, Bushes and Vines Loss

PART B – RECORD OF MANAGEMENT FOR PREVENTED PLANTING CROPS

11A. Crop      

11B. Crop Type      

11C. Intended Use      

11D. Practice      

11E. Planting Period      

12. Purchased/delivered/arranged for. If “YES”, explain (Attach copies of receipts).

YES NO. A. Seed, Chemical, and Fertilizer

     

YES NO. B. Land Preparation Measures

     

13. What cultivation practices were performed on prevented planted acreage?      

14A. What did you do with the acreage you claim was prevented planted?      

14B. Final Planting Date      

FSA-894 Continuation (proposal 2) Page 4 of 4

PART C – PAY GROUPING INFORMATION

15. Producer Name      

16. Insured/NAP Coverage/Uninsured Insured NAP Coverage Uninsured

17. Administrative State Name/Code      

18. Administrative County Name/Code      

19. Physical State Name/Code

20. Physical County Name/Code

     

Same as Administrative

     

Same as Administrative

21. Crop Year     

22. Unit      

23. Pay Crop Code      

24. Pay Type Code      

25. Planting Period      

PART D – PRODUCTION INFORMATION

COC USE ONLY

26. Crop

27. Crop Type

28. Crushing District

29. Int. Use

30. Practice

31. Organic Status

32. Native Sod

33. Acres

34. Share

35. Stage

36. Unit of Measure

37. Production To Count

38. Yield (Select Crops Only)

39. Assigned or Adjusted Production

40. Secondary Use or Salvage Value

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

PART E – VALUE LOSS CROPS

COC USE ONLY

41. Crop

42. Crop Type

43. Share

44. Dollar Value Before Disaster

45. Dollar Value After Disaster

46. Ineligible Dollar Value

47. Salvage Value

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

PART F – TREES, BUSHES, & VINES

COC USE ONLY

48. Crop

49. Crop Type

50. Acres

51. Share

52. Tree Stage

53. Number in Tree Stage

54. Number Destroyed

55. Number Damaged

56. Adjusted Number in Tree Stage

57. Adjusted Number Destroyed

58. Adjusted Number Damaged

59. Salvage Value

     

     

     

     

I

     

     

     

     

     

     

     

II

     

     

     

     

     

     

     

III

     

     

     

     

     

     

     

     

     

     

     

I

     

     

     

     

     

     

     

II

     

     

     

     

     

     

     

III

     

     

     

     

     

     

     

     

     

     

     

I

     

     

     

     

     

     

     

II

     

     

     

     

     

     

     

III

     

     

     

     

     

     

     

PART G - COC DETERMINATION OF PAY GROUPING

60. COC Action: Approved Disapproved