ccc901 instruction

Instructions For CCC-901

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Instructions For CCC-901
MEMBER'S INFORMATION
Producers are required to complete this form to report information about their farming
operation. This information is used by FSA to determine the ownership interest of entities for
payment limitation purposes.
Submit the original of the completed form in hard copy or facsimile to the appropriate FSA
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.� To establish online access credentials with USDA, follow the instructions
provided at the USDA eForms web site.

All items applicable to the payment entity must be completed by following
the instructions provided below.
Items 1-3
Fld Name /
Item No.
1 and 2
County and State
Name

Instruction
Enter the name of the recording county and State where the farming
operation is located.� If in more than one county, enter the name of
the county that has been designated as the recording county.��

3
Program Year

Enter the current program year, or the year for which this information
is applicable.

Part A
Legal Entity Name

Enter the name of the legal entity earning the payment.

1
Member�s Name

Enter the names of the members making up the legal entity listed in
Part A. (This could be a person or a legal entity.)

2
Social Security
Number/ Tax ID
Number

Enter the Social Security Number or tax identification number of the
members.

Part A, Items 1-5
3

Enter the address of each member of the legal entity.

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Instructions For CCC-901

Address
4
Percent Share
5
Signature Authority

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Enter the percent share of the legal entity that each member owns.
Check �YES� if the member has signature authority for this entity.
Check �NO� if the member does not have signature authority
for������ this entity.

Part B - Embedded Legal Entities � If any member listed in Part A, Item 3 is a legal entity
(i.e., part of another partnership, corporation, etc.) list the members of that legal entity in this
item.� (If more than one member is a legal entity, use a separate, supplemental sheet to
provide the requested information for each embedded legal entity.)
Part B, Items 1-5
Part B
Embedded Legal
Entity Name
1
Member�s Name
2
Social Security/Tax ID
Number
3
Address
4
Percent Share
5
Signature Authority

Enter the name and tax ID number of the embedded legal entity that is
a member of the legal entity entered in Part A.
Enter the names of the members making up the legal entity listed in
Part B. (This could be a person or a legal entity.)
Enter the social security number or tax identification number of the
members.
Enter the address of each member of the entity.
Enter the percent share of the legal entity that each member owns.
Check �YES� if the member has signature authority for this entity.
Check �NO� if the member does not have signature authority
for������� this entity.

Part C - Embedded Legal Entities � If any member listed in Part B, Item 7 is a legal entity
(i.e., part of another partnership, corporation, etc.) lists the members of that legal entity in
this item.� (If more than one member is a legal entity, use a separate, supplemental sheet to
provide the requested information for each embedded legal entity.)
Part C, Items 1-5
Part C
Embedded Legal
Entity Name
1
Member�s Name
2
Social Security/Tax ID
Number

Enter the name and tax ID number of the embedded legal entity that is
a member of the legal entity entered in Part B.
Enter the names of the members making up the legal entity listed in�
Part C. (This could be a person or legal entity.)
Enter the social security number or tax identification number of the
members.

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Instructions For CCC-901

3
Address
4
Percent Share
5
Signature Authority

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Enter the address of each member(s).
Enter the percent share of the legal entity that each member owns.
Check �YES� if the member has signature authority for this entity.
Check �NO� if the member does not have signature authority
for������� this entity.

Part D, Items 1-6� Minor Members or Shareholders
�Minor members

If none of the members listed Parts A-D is a minor, check �N/A�
(not applicable), then GO TO Part F.

1�5
Minor Members or
Shareholders

If any member listed in Parts A-D is a minor, provide the following
information about that member:
�� 1)�� Minor�s name
�� 2)�� Minor�s date of birth
3) �Name of the minor�s parent or guardian
4) �Address of the parent or guardian
5) Taxpayer ID number of the parent or guardian
Note: If the complete taxpayer ID number is already on file at FSA,
��������� only the last 4 digits are required.

6(a) � 6(d)
Separate Status of
Minors �

a) Check �YES� if any minor listed in Part E is a producer on a
farm and the parent or guardian has no interest.� Check �NO� if
the minor is a producer on a farm and the parent or guardian has an
interest in the farming operation.

6(a) � 6(d)
Separate Status of
Minors � (Continued)

b)� Check �YES� if the minor listed in Part E maintains a separate
����� household from the parent or guardian and personally
carries out
����� all farming activities with respect to the minor�s own
farming
����� operation, including maintaining separate accounting.�
Check
����� �NO� if the minor does not maintain a separate
household from
����� the parent or guardian and does not personally carry out
all
����� farming activities with respect to the minor�s own
farming
����� operation, including maintaining separate accounting
c)� Check �YES� if the minor listed in Part E who is represented

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Instructions For CCC-901

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by a court-appointed guardian or conservator, live in a household
other than the parents� household(s), and have a vested ownership
in the farm.� Check �NO� if the minor, who is represented by a
court- appointed guardian or conservator, does not live in a
separate household other than the parents� household(s), and does
not have a vested ownership in the farm.�
d) If �YES� is checked for all Items 6(a) through 6(c), write the
name of the minor in the space provided at 6(d).
Part E, Item 7 Foreign Persons
7A
Citizenship Status

7B
Member/Shareholder

Check �YES�, if all members/shareholders are US Citizens. Go to
Part F.
Check �NO�, if one or more members/shareholders is not a US
Citizen.� Complete Item 7B.
For each member/shareholder who is not a US Citizen:
(1)� Enter name of individual
(2)� Check if form I-551 is valid

Part F, Items 1-3 Certification
1
Signature (By)

An individual member, or an authorized representative of the entity
identified in Part A, shall sign the certification.

2
Title/
Relationship

If an authorized representative for the entity identified in Part A signs
this document, use this field to show the individual�s representative
capacity.� (For example, �agent� or �attorney-in-fact.�)

3
Date

Enter the date the form was signed.

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