2017 WHIP and QLA

2017 Wildfires and Hurricanes Indemnity Program (2017 WHIP) (Florida Citrus Block Grant) and Quality Loss Adjustment (QLA) Program

CCC-942 instruction

2017 WHIP and QLA

OMB: 0560-0291

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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.
1
Program Year

2
Return
Completed Form
To
3
Individual or
Legal Entity�s
Name and
Address
4
Taxpayer
Identification

Instruction
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.
Enter the name and address of the FSA county office or USDA
service center where the completed CCC- 942 will be submitted.�
Enter the individual�s or legal entity�s name and address.�

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

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7/13/2021

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Number
5
Signature
6
Title/
Relationship
7
Date

Read the acknowledgments, responsibilities and authorizations,
before signing.� (INDIVIDUAL OR ENTITY)
Enter title or relationship to the legal entity identified in Item3.

Enter the signature date in month, day and year.�

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.

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

7/13/2021

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

7/13/2021


File Typeapplication/pdf
File Titlehttps://forms.sc.egov.usda.gov/eForms/instruction?FileType=Revi
AuthorMaryAnn.Ball
File Modified2021-07-13
File Created2021-07-13

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