CCC-36 Revised Assignment of Payment

Form Approved - OMB No. 0560-0183

Expiration date (08-31-2021)

This form is available electronically. See Page 2 for Privacy Act and Public Burden Statements.

CCC-36

(proposal 1)

U.S. DEPARTMENT OF AGRICULTURE

Commodity Credit Corporation

ASSIGNMENT OF PAYMENT

1. Check Applicable Agency

(only one)

FSA NRCS

PART A - GENERAL INFORMATION

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

     

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

     

4. Assignor's Tax Identification Number (9 Digit Number):      

5. Assignee's Tax Identification Number (9 Digit Number):      

PART B - APPLICABLE PROGRAM(S)

6.

Program

7.

Assigned Amount for Each Applicable Year

8.

State, County, and Reference Number, If Applicable

Agricultural Risk Coverage (ARC)

YEAR

    

YEAR

    

YEAR

    

YEAR

    

YEAR

    

     

AMOUNT

     

AMOUNT

     

AMOUNT

     

AMOUNT

     

AMOUNT

     

Price Loss Coverage (PLC)

YEAR

    

YEAR

    

YEAR

    

YEAR

    

YEAR

    

     

AMOUNT

     

AMOUNT

     

AMOUNT

     

AMOUNT

     

AMOUNT

     

Conservation Reserve Program

Annual Rental (CRP)

YEAR

    

YEAR

    

YEAR

    

YEAR

    

YEAR

    

     

AMOUNT

     

AMOUNT

     

AMOUNT

     

AMOUNT

     

AMOUNT

     

YEAR

    

YEAR

    

YEAR

    

YEAR

    

YEAR

    

AMOUNT

     

AMOUNT

     

AMOUNT

     

AMOUNT

     

AMOUNT

     

Emergency Assistance Livestock Honey Bee and Farm Raised Fish Program (ELAP)

YEAR

    

YEAR

    

YEAR

    

YEAR

    

YEAR

    

     

AMOUNT

     

AMOUNT

     

AMOUNT

     

AMOUNT

     

AMOUNT

     

Livestock Forage Program (LFP)

YEAR

    

YEAR

    

YEAR

    

YEAR

    

YEAR

    

     

AMOUNT

     

AMOUNT

     

AMOUNT

     

AMOUNT

     

AMOUNT

     

Livestock Indemnity Program (LIP)

YEAR

    

YEAR

    

YEAR

    

YEAR

    

YEAR

    

     

AMOUNT

     

AMOUNT

     

AMOUNT

     

AMOUNT

     

AMOUNT

     

eLoan Deficiency Web Payment (eLDP)

YEAR

    

YEAR

    

YEAR

    

YEAR

    

YEAR

    

AMOUNT

     

AMOUNT

     

AMOUNT

     

AMOUNT

     

AMOUNT

     

Noninsured Crop Disaster Assistance (NAP)

YEAR

    

YEAR

    

YEAR

    

YEAR

    

YEAR

    

     

AMOUNT

     

AMOUNT

     

AMOUNT

     

AMOUNT

     

AMOUNT

     

Agricultural Conservation Easement Program (ACEP) (NRCS USE ONLY)

YEAR

    

YEAR

    

YEAR

    

YEAR

    

YEAR

    

     

AMOUNT

     

AMOUNT

     

AMOUNT

     

AMOUNT

     

AMOUNT

     

Conservation Stewardship Program (CSP) (NRCS USE ONLY)

YEAR

    

YEAR

    

YEAR

    

YEAR

    

YEAR

    

     

AMOUNT

     

AMOUNT

     

AMOUNT

     

AMOUNT

     

AMOUNT

     

Environmental Quality Incentives Program (EQIP) (NRCS USE ONLY)

YEAR

    

YEAR

    

YEAR

    

YEAR

    

YEAR

    

     

AMOUNT

     

AMOUNT

     

AMOUNT

     

AMOUNT

     

AMOUNT

     

Grassland Reserve Program (GRP) (NRCS USE ONLY)

YEAR

    

YEAR

    

YEAR

    

YEAR

    

YEAR

    

     

AMOUNT

     

AMOUNT

     

AMOUNT

     

AMOUNT

     

AMOUNT

     

9.

Other Program Name

(For FSA/NRCS)

10.

Contract Year, Program Year, or Payment Year

11.

Assigned Amount

12.

State, County, and Reference Number,

If Applicable

     

    

$

     

     

     

    

$

     

     

     

    

$

     

     

     

    

$

     

     

CCC-36 (proposal 1) Page 2 of 3

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 6 and 9, this form must be completed by both the assignor and the assignee. Assignment is effective for all counties unless specify on Item 8 or Item 12. 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 or NRCS office of any change affecting this assignment. This assignment may be revoked at any time by written request signed by the assignee.

13A. Assignor's Signature (By)

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

     

13C. Date

(MM-DD-YYYY)

     

14A. Assignee's Signature (By)

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.

15A. Assignee's Signature (By)

15B. Title/Relationship of the Individual if Signing in a Representative Capacity

     

15C. Date

(MM-DD-YYYY)

     

FOR COUNTY OFFICE USE ONLY

16. Receiving State and County

17. Date Filed (MM-DD-YYYY)

18. Time Filed

     

     

     

SPECIAL PROVISIONS RELATING TO ASSIGNMENTS

A.	Assignment is effective for all counties unless a specific county is entered in Item 8 or Item 12.
B.	If the assignor assigns a specified value of payments to more than one assignee:
	1.	CCC, FSA and NRCS 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 or NRCS office.
C.	The payment due the assignor may be applied first against indebtedness owing by the assignor 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 CCC, FSA, NRCS, 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.

19A. COUNTY FSA or NRCS OFFICE NAME AND ADDRESS (Including Zip Code)

     

19B. TELEPHONE NO. (Including area code):      

NRCS COUNTY FSA COMMITTEE ASSIGNEE PARTICIPANT

CCC-36 (proposal 1) Page 3 of 3

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 the Soil Conservation and Domestic Allotment Act (16 U.S.C. 590h(g)), the Commodity Credit Corporation Charter Act (15 U.S.C. 714 et seq.), the Agricultural Act of 2014 (7 U.S.C. 9094) and 7 CFR Part 1404. The information will be used to assign payments made under applicable CCC, FSA, and/or NRCS programs to a designated 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) and for USDA/NRCS-1, Landowner, Operator, Producer, Cooperator, or Participant Files.  Providing the requested information is voluntary.  However, failure to furnish the requested information will result in a determination that the Assignor is unable to assign applicable CCC, FSA, and/or NRCS program payments to a designated assignee. 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. For certain programs such as ARC, PLC, CRP, ELAP, LIP, and eLDP, this information collection is exempted from the Paperwork Reduction Act as specified in the Agricultural Act of 2014 (See Pub. L. 113-79, Title I, Subtitle F, Administration and Title II, Subtitle G, Funding and Administration). For NRCS programs, this information collection is exempted from the Paperwork Reduction Act as specified in the Agricultural Act of 2014 (Pub. L. 113-79, Title II, Subtitle G, Funding and Administration).  RETURN THIS COMPLETED FORM TO YOUR COUNTY FSA OR NRCS 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.