FSA-888 Food Safety Certification for Specialty Crops Program (F

FSA-888

U.S. DEPARTMENT OF AGRICULTURE
Farm Service Agency (FSA)
Commodity Credit Corporation (CCC)

(06-21-22)

FOOD SAFETY CERTIFICATION
FOR SPECIALTY CROPS PROGRAM (FSCSC)
NOTE:

1. Recording State Name/Code

Form Approved - OMB No. 0560-0311
Expiration Date: 12/31/22
2. Recording County Name/Code

3. Program Year

4. Application No.

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 the Commodity Credit Corporation Charter Act (15 U.S.C. 714c(e)). The information will be
used to determine the applicant’s ability to participate in and receive benefits under the Food Safety Certification for Specialty Crops Program. 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 that the applicant is unable to participate in and receive benefits under the Food Safety Certification for Specialty Crops
Program.
Public Burden Statement (Paperwork Reduction Act): According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number.
The valid OMB control number for this information collection is 0560-0311. The time required to complete this information collection is estimated to average 60 minutes per response, including the time for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing and reviewing the collection of information. The provisions of criminal and civil fraud, privacy, and other statutes may be applicable to the information provided. RETURN THIS COMPLETED FORM TO YOUR
COUNTY FSA OFFICE.

PART A – APPLICANT INFORMATION
5. Applicant’s Name

6. Address (City, State and Include Zip Code)

7. Have you participated in FSA programs?
YES

NO

(If “NO”, please fill out AD-2047 and SF-3881)

8. Phone Number (Including Area code)
9. Email Address

PART B – CERTIFICATION INFORMATION & EXPENSES
10. Category of Expenses (Check all that apply) and Expenses (applicant completes columns 10A, 10B, 10C, and 10E):
10A.
Category of Expenses

10B.
Expenses

10C.
Number of Tests

10D.
COC Adjustment of
Expenses

10E.
Other Reimbursement for
Expenses Received

10F.
COC Adjustment of Other
Reimbursement for Expenses
Received

Food Safety Certification

$

$

$

$

Food Safety Plan Development (1st time)

$

$

$

$

Maintaining or updating Food Safety Plan

$

$

$

$

Certification Upload Fees

$

$

$

$

Microbiological Testing – products

$

$

$

$

Microbiological Testing – soil amendments

$

$

$

$

Microbiological Testing - water

$

$

$

$

Training

$

$

$

$

11. Are you a small business?
YES
NO (Small business means a farm that had an average annual monetary value of specialty crops the farm sold during the 3-year period preceding the program
year of more than $250,000 but not more than $500,000.)
12. Are you a very small business?
YES
program year of no more than $250,000.)

NO (Very small business means a farm that had an average annual monetary value of specialty crops the farm sold during the 3-year period preceding the

DATE STAMPED

FSA-888 (06-21-22)

Page 2 of 2

PART C – APPLICANT CERTIFICATION STATEMENT

Each applicant must submit a complete application to an FSA county office to be eligible to receive program benefits. A complete application includes this form
FSA-888, and forms AD-2047, SF-3881, and CCC-860 (if applicable) if the latter were not previously filed with FSA. By signing this application, applicant:
1.

Has completed the food safety plan and certification process and agrees to provide FSA with any documentation required to determine eligibility, and to verify and support all
information provided, including applicant's food safety certificate or plan, if requested by FSA;

2.

Understands the application may be disapproved if the applicant fails to provide a complete application or any information requested by FSA within 30 days of the request;

3.

Agrees to comply with, and acknowledges the applicant is subject to, all provisions of FSCSC as published in the applicable Notice of Funds Availability published in the
Federal Register, and all applicable rules and regulations;

4.

Understands that FSCSC payments are subject to the availability of funding and are subject to proration if total calculated payments to all eligible applicants exceed available
funds. Further understands that late-filed applications received after all funds are obligated will not be paid.

5.

Acknowledges that, if determined eligible and funding is available, the applicant’s expenses may be adjusted, as determined by the FSA County Committee, from the amounts
entered in Item 10 to reflect the eligible expenses as verified by documentation submitted to support the application, if requested by FSA.

6.

Acknowledges that FSA will issue payments for the 2022 program year as applications are processed and approved, but payments for the 2023 program year will not be issued
until after the end of the application period for the FSA National Office to determine if payments for the 2023 program year are subject to proration.

I certify that:
1.

The above information provided by me, or my legal representative is true and correct.

2.

I understand that failure to provide true and correct information may result in the invalidation of this application, a determination of noncompliance or ineligibility, or other
remedies or sanctions. By signing this form, I further acknowledge and understand that any false representation or claims are subject to civil and criminal penalties including,
but not limited to, those under 18 U.S.C. 1001.

3.

I understand that I may not receive duplicate benefits totaling more than 100% of cost for the same eligible expenses and program year from multiple agencies, including FSA.
If it is determined that I have received duplicate benefits, I have no right to retain those payments.

13A. Applicant’s Signature (By)

13B. Title/Relationship of the Individual Signing in the Representative Capacity

13C. Date (MM-DD-YYYY)

14B. Title of Representative or Designee

14D. Determination:

PART D - COUNTY COMMITTEE (COC) DETERMINATION
14A. COC or Designee Signature

14C. Date (MM-DD-YYYY)

APPROVED
DISAPPROVED
In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions 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.