AD-3117 CORONAVIRUS FOOD ASSISTANCE Program 2.0

This form is available electronically.
AD-3117
U.S. DEPARTMENT OF AGRICULTURE
(proposal 3)

NOTE:

1. Recording State

Form Approved - OMB No. 0560-0297
OMB Expiration Date: 03/31/2021
2. Program Year

2020

CORONAVIRUS FOOD ASSISTANCE
PROGRAM 2 (CFAP 2)
APPLICATION

3. Recording County

4. Application Number

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 7 CFR Part 9, the
CARES Act (Pub. L. 116-136), and 15 U.S.C. 714b and 714c. The information will be used to determine eligibility for program benefits. The information collected on this form may be disclosed to
other Federal, State, and 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). Providing the requested information is voluntary. However, failure to furnish
the requested information will result in a determination of ineligibility for program benefits. Payments may be made under the program to which the form applies only to the extent permitted by
applicable authorities.
Public Burden Statement (Paperwork Reduction Act): Public reporting burden for this collection is estimated to average 60 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 USDA 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.

PART A – PRODUCER AGREEMENT

The Department of Agriculture (USDA) will make payments under the CFAP 2 to producers who meet the requirements of the program. The following information is needed in
order for USDA to make a determination that the applicant is eligible to receive a CFAP 2 payment. By submitting this application, and upon its approval by USDA, the applicant
agrees:
1.
To comply with regulations set forth in 7 CFR Part 9 and any applicable Notice of Funds Availability published by USDA. Copies of these documents may be found at
www.regulations.gov/docket?D=FSA-2020-0004.
2
3
4.
5.

That the applicant is in the business of farming at the time of application.
That payments for producers who began farming in 2020, for which 2019 production or sales is required, must provide actual 2020 production or sales information, as
applicable.
That a CFAP 2 payment will only be made with respect to a commodity produced in the United States and intended to be marketed for commercial production;
To provide to USDA all information that is necessary to verify that the information provided on this form is accurate, and to allow USDA representatives access to all
documents and records of the producer, including those in the possession of a third-party such as a warehouse operator, processor or packer;

6.

To comply with maximum payment limitation and adjusted gross income provisions applicable to the CFAP 2 by completing forms:
• CCC-902, Farm Operating Plan for Payment Eligibility (NOTE: Only Parts A and B of the form are required).
• CCC-901, Member Information for Legal Entities, if applicable
• CCC-941, Average Adjusted Gross Income (AGI) Certification and Consent to Disclosure of Tax Information
• CCC-942, Certification of Income from Farming, Ranching and Forestry Operations (optional)

7.

To provide to USDA all information required for program participation within 60 days from the date the applicant signs this application. Failure of an individual, entity, or
member of an entity to timely submit all information required may result in no payment or a reduced payment.

8.

To comply with the provisions of the Food Security Act of 1985 that protect highly erodible land and wetlands. All applicants must complete and submit all portions of form
AD-1026, Highly Erodible Land Conservation (HELC) and Wetland Conservation (WC) Certification unless:

8A.

8B.
9.

i.
ii.

The applicant does not participate in USDA benefits subject to HELC and WC compliance except Federal Crop Insurance or CFAP, and
The applicant only has an interest in land devoted to the production of agricultural commodities that are perennial crops, excluding sugarcane, such as tree fruits,
tree nuts, grapes, olives, native pasture and perennial forage. If the applicant produces alfalfa, the applicant must contact the Natural Resources Conservation
Service to determine if such production qualifies as the production of a perennial crop; and

iii. The applicant has not converted a wetland after December 23, 1985; or
i. The applicant does not own or rent land devoted to an agricultural activity including cropland, rangeland, pastureland or forestland;
ii. The applicant is a producer of livestock, nursery crops, honey or similar commodity that is not produced from tillage of land
If the applicant meets either the conditions in section 8A (certification with box 5 B on AD-1026) or 8B (certification with box 5 A on
AD-1026), the applicant is only required to complete Parts A and D of form AD-1026.

PART B – PRODUCER INFORMATION
5. Producer’s Name, Address (City, State and Zip Code) and Phone Number (Include Area Code)

PART C – DAIRY PRODUCTION
6.
Unit of Measure

7.
Total Production

(April 1, 2020 – August 31, 2020)

COC USE ONLY

8.
COC Adjusted
Total Production
(April 1, 2020 –
August 31, 2020)

9.
Estimated Total
Production
(Sept. 1, 2020 –
Dec. 31, 2020)

LBS
10A. If you are no longer producing milk, what is the last date milk was produced?
(MM/DD/YYYY):
NOTE: If you cease producing milk before Dec.31, 2020, or if you are a seasonal dairy , you are required to notify the
FSA County office of the date you stopped producing milk.

PART D – EGGS/BROILERS PRODUCTION
11.
Commodity

12.
Unit of Measure

BROILERS

HEAD

DRIED EGGS

LBS

FROZEN EGGS

LBS

LIQUID EGGS

LBS

SHELL EGGS

DOZEN

COC USE ONLY

10B.
COC Adjusted Last Date Milk was Produced

COC USE ONLY

13.
2019 Total Production

14.
COC Adjusted
2019 Total Production

AD-3117 (proposal 3)

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PART E – LIVESTOCK INVENTORY (Excluding Breeding Stock)
15.
Livestock

COC USE ONLY

16.
Inventory
(Excluding Breeding Stock)
(Highest on a Date Between
April 16, 2020 – August 31, 2020)

17.
COC Adjusted Inventory
(Excluding Breeding Stock)
(Highest on a Date Between
April 16, 2020 – August 31, 2020)

CATTLE
HOGS/PIGS
SHEEP

PART F – SALES COMMODITIES
18.
Commodity

COC USE ONLY

19.
2019 Total Commodity Sales

20.
COC Adjusted
2019 Total Commodity Sales

AQUACULTURE
CROPS (Excluding Part G Crops)
NURSERY/FLORICULTURE CROPS
MISCELLANEOUS
OTHER LIVESTOCK
(Excluding Breeding Stock)
TOBACCO

PART G – ACREAGE-BASED CROPS
21.
Crop

COC USE ONLY

22.
Total 2020 Reported
Acres

PART H – CONTRACT PRODUCER REVENUE
27.
Commodity

28
2019 Revenue

23.
COC Adjusted
Total 2020 Reported
Acres

29.
2020 Revenue

24.
Weighted Insurance
Approved Yield

25.
COC Adjusted
Weighted Insurance
Approved Yield

26.
85% of Weighted
County Yield

COC USE ONLY

30
COC Adjusted
2019 Revenue

31
COC Adjusted
2020 Revenue

PART I – INCREASED PAYMENT LIMITATION FOR CORPORATIONS, LIMITED LIABILITY COMPANIES (LLCS), LIMITED
PARTNERSHIPS, TRUSTS & ESTATES

32. Applicants who are corporations, LLCs, and limited partnerships, trusts or estates may seek an increase in the per-person payment limitation from $250,000 to either

A.

$500,000, if such entity has two members, partners, stockholders, beneficiaries or heirs who each provided at least 400 hours or more of personal labor or active personal
management, or combination thereof, to the farming operation as defined in 7 CFR Part 1400, or a maximum of $750,000 if such entity has three members, partners,
stockholders, beneficiaries or heirs who each provided at least 400 hours or more of personal labor or active personal management, or combination thereof, to the farming
operation as defined in 7 CFR Part 1400. The applicant must identify the names of members, partners, stockholders, beneficiaries or heirs who provided at least 400 hours of
active personal labor or active personal management, or combination thereof, to the farming operation identified in Part B Item 5:

B.

C.

PART J – PRODUCER CERTIFICATION
I hereby sign and acknowledge under penalty of perjury in accordance with 28 U.S.C. § 1746 and 18 U.S.C. § 1621 that the foregoing is true and
correct.
33A. Signature (By)

PART K – COC DETERMINATION
34. Payment Part

33B. Title/Relationship of the Individual Signing in the Representative Capacity

35. COC or Designee Signature

36. Date (MM/DD/YYYY)

33C. Date

(MM/DD/YYYY)

37. Determination

CARES

APPROVED

DISAPPROVED

CCC

APPROVED

DISAPPROVED

In accordance with Federal civil rights law and USDA civil rights regulations and policies, the USDA, its agencies, offices, and employees 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.