Submit the original of the completed form in hard copy, email, facsimile, or electronically via Box or OneSpan to the appropriate United States Department of Agriculture (USDA) Farm Service Agency (FSA) servicing office, which may be found here: https://offices.sc.egov.usda.gov/locator/app
Applicants 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 applicants with access credentials only. If you would like to establish online access credentials with USDA, follow the instructions provided at the USDA eForms website: https://forms.sc.egov.usda.gov/eForms/welcomeAction.do?Home.
Applicants must complete the following items: Items 5 through 12C
Item No. / Field Name |
Instruction |
1 Recording State |
Enter the applicant’s recording state.
The recording State is the state where the payments will be issued for the applicant. This doesn’t limit an applicant from going to only this state. The applicant can apply in any USDA service center in the USA, but the recording state will be assigned upon applying.
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2 Program Year |
The program year will be 2020.
This field is automatically populated.
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3 Recording County |
Enter the applicant’s recording county.
The recording county is the county where the payments will be issued for the applicant. This doesn’t limit an applicant from going to only this county/state. The applicant can apply in any USDA service center in the USA, but the recording county will be assigned upon applying.
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4 Application Number
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Application Number will be assigned by the automated system. |
Part A Timber Harvester/Hauler Agreement |
For Informational Purposes:
The Timber Harvester/Hauler agreement provides what is required to be eligible for PATHH assistance.
Applicants must complete the following applicable forms to seek participation in the PATHH program:
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Part B – Timber Harvester/Hauler Information |
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5 Applicant’s Name, Address (City, State, and Zip Code), and Phone Number (Including Area Code) |
Enter the applicant’s name, address, including ZIP code, and phone number, including area code. |
Part C – Timber Harvester/Hauler Revenue |
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6 Timber Business Type
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Displays the Timber Business Types eligible for PATHH
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7 Principal Business Code
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Enter the principal business code also known as the NAICS code associated with the applicable timber business type in item 6. Applicant should provide the principal business code listed on their tax return. If the applicant does not have the correct code on their tax return, the applicant should put “NA” in item 7 and will need to provide justification as to why this is the case. |
8. 2019 Gross Revenue (Jan 1, 2019 – Dec 1, 2019) |
Enter the gross revenue received from January 1, 2019 through December 1, 2019 for the applicable timber business type in item 6. Note: this period is not a full calendar year.
If the applicant/business operation originated after January 1, 2019, the gross revenue from the origination date to December 1, 2019 should be entered in this box. |
9 2020 Gross Revenue (Jan 1, 2020 -Dec 1, 2020) |
Enter the gross revenue received from January 1, 2020 through December 1, 2020 for the applicable timber business type in item 6. Note: this period is not a full calendar year.
If the applicant/business operation dissolved before December 1, 2020, the gross revenue from January 1, 2020 to the dissolution date should be entered in this box. |
10 Origination Date 2019 (Only complete if business operation originated after January 1, 2019) |
If the applicant/business operation listed in item 5 did not originate until after January 1, 2019, then the applicant must enter the origination date of the business operation for the applicable timber business type in item 6.
Note: Seasonal timber harvesting or hauling businesses are considered in business for the entire time from January 1, 2019 to December 1, 2019. |
11 Dissolution Date 2020 (Only complete if business operation dissolved prior to December 1, 2020) |
If the applicant/business operation listed in item 5 dissolved before December 1, 2020, then the applicant must enter the date the business operation dissolved for the applicable timber business type in item 6.
Note: Seasonal businesses are considered in the business for the entire time from January 1, 2020 to December 1, 2020. |
12 Agency Adjusted 2019 Revenue (AGENCY USE ONLY) |
The Farm Service Agency may enter the adjusted 2019 Gross Revenue, if applicable.
Note: An entry is only required when the Agency determines 2019 Gross Revenue is different than what is certified to by the applicant in Item 8. |
13 Agency Adjusted 2020 Revenue (AGENCY USE ONLY) |
The Farm Service Agency may enter the adjusted 2020 Gross Revenue, if applicable.
Note: An entry is only required when the Agency determines 2020 Gross Revenue is different than what is certified to by the applicant in Item 9. |
14 Agency Adjusted 2019 Origination Date (AGENCY USE ONLY) |
The Farm Service Agency may enter the adjusted 2019 Origination Date, if applicable.
Note: An entry is only required when the agency determines the origination date is different than what is certified to by the applicant in Item 10. |
15 Agency Adjusted 2020 Dissolution Date (AGENCY USE ONLY) |
The Farm Service Agency may enter the adjusted 2020 Dissolution Date, if applicable.
Note: An entry is only required when the agency determines the dissolution date is different than what is certified to by the applicant in Item 11. |
Part D – Timber Harvester/Hauler Certification |
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All applicants must check “Yes” or “No” to certify that they are an individual person that is a US Citizen or Resident Alien; or a legal entity, including corporation, LLC, LP, trust, estate, general partnership or joint venture, or similar type entity, comprised solely of persons who are U.S. Citizens or Resident Aliens; or is an Indian Tribe or Tribal organization, as defined in section 4 (b) of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304).
Only timber hauler applicants must check “Yes” or “No” to certify that they have provided the IRS Form 2290, Heavy Highway Vehicle Use Tax Return, for logging vehicles for 2019 or that they hauled timber on tribal land in 2019 and are not required to complete the IRS Form 2290.
Only timber hauler applicants must check “Yes” or “No” to certify that they have provided the IRS Form 2290, Heavy Highway Vehicle Use Tax Return, for logging vehicles for 2020 or that they hauled timber on tribal land in 2020 and are not required to complete the IRS Form 2290.
All applicants must certify, by signing the application that they are not a residential or commercial tree care business; landscape service; trucking business that does not transport trees or logs; timber brokers; and/or United States Federal, State, and local government. |
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16A Signature (By)
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Applicant applying for PATHH Program benefits must sign. |
16B Title/Relationship of the Individual Signing in the Representative Capacity |
Enter title and/or relationship of the individual to the entity when signing in a representative capacity.
Note: If the applicant signing is not signing in a representative capacity, this field should be left blank. |
16C Date (MM/DD/YYYY) |
Enter the date the FSA-1118 is signed in Item 12A. |
Part E – County Committee (COC) Determination – AGENCY USE ONLY |
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17A COC or Designee Signature (AGENCY USE ONLY) |
COC or their representative will sign.
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17B Date (MM/DD/YYY) (AGENCY USE ONLY) |
Enter the date COC or their representative signs the FSA-1118. |
18 Determination (AGENCY USE ONLY) |
COC or their representative will check (ü) either “Approved” or “Disapproved”.
Important: FSA-1118 will be approved or disapproved as certified by the Applicant after applicable Agency adjustment fields are completed. |
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File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
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Author | Preferred Customer |
File Modified | 0000-00-00 |
File Created | 2021-07-07 |