2017 WHIP and QLA

Instructions For CCC-566

Page 1 of 2

Instructions For FSA-895
Crop Insurance and/or NAP Coverage Agreement
This information will be used to determine eligibility for WHIP+ and/or QLA Program benefits
on an insurable crop and/or on a noninsurable crop.� Producers are required to purchase
insurance, or NAP Coverage, as applicable, on that crop(s), trees, bushes, or vines for the next two
consecutive crop years following the crop year for which the benefits are requested, according to
the producer�s certification on this form.
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 2, and 1A through 2B.
Fld Name /
Item No.

Instruction

1
Certification
Statement

Check only if applying for WHIP+ and/or QLA Program benefits on at
least one insurable crop. The producer certifies to purchase crop
insurance at a level of 60/100 or the equivalent for the crop(s), trees,
bushes or vines for the next two consecutive years following the crop
year which the benefits are requested, and if the certification statement
in Item 1 applies.

2
Certification
Statement

Check only if applying for WHIP+ and/or QLA Program benefits on at
least one insurable crop. The producer certifies to purchase NAP
Coverage at a level of 60/100 the crop(s), trees, bushes or vines for the
next two consecutive years following the crop year which the benefits
are requested and if the certification statement in Item 2 applies.

3A
Producer�s
Name
3B
Signature

Enter the producer�s name.
If you are mailing or faxing this form, print the form and manually
enter your signature. If this form is approved for electronic transmission
and you have established credentials with USDA to submit forms
electronically, use the buttons provided on the form for transmitting the
form to the USDA servicing office.

https://forms.sc.egov.usda.gov/eForms/instruction?FileType=RevisionInstruction&FileNa...

7/13/2021

Instructions For CCC-566

Page 2 of 2

3C
Date

Enter the date producer signs the agreement.

4A
County FSA
Office Name and
Address
4B
Telephone No.

Enter County FSA Office name and address.

Enter County FSA Office telephone number including area code.

https://forms.sc.egov.usda.gov/eForms/instruction?FileType=RevisionInstruction&FileNa...

7/13/2021