QLA Program

Instructions CCC-942
CERTIFICATION OF INCOME FROM FARMING, RANCHING, AND
FORESTRY OPERATIONS
This certification is used to determine if individuals or legal entities whom exceed the
$900,000 AGI Limitation are eligible for program benefits. When the program authorizes
that the individuals and legal entities qualify based on if at least 75 percent of the AGI for
the taxable years preceding the most immediately complete taxable year was derived from
farming, ranching or forestry operations.
Submit the original of the completed form in hard copy or facsimile to the appropriate
USDA 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 8. Certified Public
Accountant/Attorney complete items 9 through 12.
Items 1-8
Fld Name /
Item No.

Instruction

1
Program Year

Enter the year for which program benefits are being requested. The
program year entered determines the 3-year period used for the
calculation of the average adjusted gross income (AGI) for payment
eligibility.

2
Return
Completed
Form To
3
Individual or
Legal Entity’s
Name and
Address

Enter the name and address of the FSA county office or USDA
service center where the completed CCC- 942 will be submitted.

Page 1 of 3

Enter the individual’s or legal entity’s name and address.

(08-12-20)

Fld Name /
Item No.

Instruction

4
Taxpayer
Identification
Number

Enter the Last 4 Digits of the taxpayer identification number for the
individual or legal entity identified in Item 3.

5
Signature

Read the acknowledgments, responsibilities and authorizations,
before signing. (INDIVIDUAL OR ENTITY)

6
Title/
Relationship
7
Date

Enter title or relationship to the legal entity identified in Item3.

8
Signature

Read the acknowledgments, responsibilities and authorizations,
before signing. (CPA or Attorney Only).

9
Title

Identify Certified Public Accountant (CPA) or Attorney as
applicable.

Page 2 of 3

Enter the signature date in month, day and year.

(08-12-20)

Page 3 of 3

(08-12-20)