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Fld Name /
Item No.
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Instruction
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Items 1 – 5 -
FSA Use Only
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1
Crop
Year
(FSA Use Only)
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Prepopulated with the crop
year in which the loss occurred and a crop insurance indemnity
and/or NAP payment was issued.
Information
obtained from Risk Management Agency (RMA) and FSA records.
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2
Application
Number
(FSA Use Only)
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Application number will be
assigned by the automated system.
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3
Recording
State/Name Code (FSA
Use Only)
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Prepopulated with the
producer/primary policyholder’s recording State name and
FSA code.
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4
Recording
County Name/Code
(FSA Use Only)
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Prepopulated with the
producer/primary policyholder’s recording county name and
FSA code.
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5A
Name
and Address of Recording County FSA Office (Include City, State
and Zip Code)
(FSA Use Only)
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Prepopulated with the name
and address of the producer/primary policyholder’s
recording county office.
Note:
Signed
application must be returned to the recording
county
office listed.
Information
obtained from FSA records.
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5B
Recording
County FSA Office Telephone No. (Include Area Code)
(FSA
Use Only)
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Prepopulated with the
recording county office’s telephone number.
Information
obtained from FSA records.
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Part A - Producer Agreement
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Producer Agreement
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Producers, which include
primary policyholders and any producers with substantial
beneficial interest, agree to provide all information required or
requested by FSA for program participation in ERP Phase 1.
Producers also must certify whether they have experienced a
qualifying loss and they understand that by receiving ERP Phase 1
payments, they are required to purchase crop insurance or NAP
coverage where crop insurance is not available, for the next two
available crop years.
Producers
must obtain crop insurance or NAP, as may be applicable:
Example:
Producer A is issued an ERP payment on June 1, 2022,
For their 2020 corn
and soybean loss. Producer A must
purchase crop
insurance or NAP, as applicable for the
crop,
for both the 2023 and 2024 crop years.
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Part B - Producer Information - Item 6 - (FSA Use Only)
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6
Producer’s
Name, Address (City, State and Zip Code) and Phone Number
(Include Area Code)
(FSA Use Only)
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Prepopulated with the full
name, address, and phone number of the producer/primary
policyholder who is applying for 2020 and/or 2021 ERP Phase 1
benefits.
Information
obtained from RMA and FSA records.
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Part C - Insured Crop Information - Items 7-15
(FSA Use Only)
For questions regarding the information
provided in Items 7-10 and Item 12, please contact your crop
insurance agent.
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7
Physical
State/County Code
(FSA Use Only)
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Prepopulated with the
physical state and county code where the insured crop is located.
Information
obtained from RMA records.
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8
Pay
Unit
(FSA Use Only)
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Prepopulated with the pay
unit of the insured crop.
Information
obtained from RMA records.
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9
Crop
(FSA Use Only)
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Prepopulated with the crop
that received a crop insurance indemnity.
Information
obtained from RMA records.
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10
Gross
Indemnity
(FSA Use Only)
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Prepopulated with the
gross indemnity received from crop insurance for the unit and
crop listed in Items 8 and 9.
Information
obtained from RMA records.
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11
Estimated
ERP Payment (Prior to adjustments)
(FSA
Use Only)
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Prepopulated with the
estimated ERP payment prior to adjustments for the unit and crop
listed in Items 8 and 9. Adjustments may include the following:
Reductions
due to payment limitation
Increased
payment limitation
Increased
payment rate for historically underserved producers with a
CCC-860 on file
ERP payment
factor.
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12
Primary
Policyholder and SBIs
(FSA Use Only)
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Prepopulated with the name
of the producer/primary policyholder who received a crop
insurance indemnity on the unit and crop identified in Items 8
and 9, along with any producers having a substantial beneficial
interest (SBI) as identified on the crop insurance policy.
Information
obtained from RMA records.
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13
Share
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Enter share interest of
producer/primary policyholder and each SBI (if applicable) listed
in Item 12 for the unit and crop identified in Items 8 and 9.
Note:
Share is assumed to be 100 percent to the producer/primary
policyholder unless otherwise designated. If the ERP payment is
divided for the unit and crop listed in Items 8 and 9, shares
must total 100 percent.
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14
In return for receiving
an ERP payment on this crop, I agree to purchase crop insurance
or NAP as provided in Part A.
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Each producer/primary
policyholder and SBI (if applicable) listed in Item 12 with a
share interest in the unit and crop identified in Items 8 and 9
must answer “Yes” or “No” agreeing to
purchase crop insurance or NAP on the crop listed in Item 9.
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15
I certify that I had a
qualifying loss as defined in Part A.
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Producer/primary
policyholder listed in Items 5 and 12 must answer “Yes”
or “No” to certify that the unit and crop listed in
Items 8 and 9 had a qualifying loss.
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Part D – NAP Crop Information - Items 16-23 (FSA Use Only)
For questions regarding information
provided in Items 16-21, please contact your administrative FSA
County Office.
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16
Admin
State/County Code
(FSA Use Only)
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Prepopulated with the
administrate State and county code.
Information
obtained from FSA records.
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17
Unit
(FSA Use Only)
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Prepopulated with the NAP
unit number associated to the crop which received a NAP payment.
Information
obtained from FSA records.
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18
Crop
(FSA
Use Only)
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Prepopulated with the crop
which received a NAP payment for the crop year identified in Item
1.
Information
obtained from FSA records.
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19
Pay
Group
(FSA Use Only)
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Prepopulated with the pay
group associated to the crop listed in Item 18.
Information
obtained from FSA records.
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20
NAP
Payment
(FSA Use Only)
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Prepopulated with the
producer’s NAP payment received for the crop identified in
Items 18 and 19, for the crop year identified in Item 1.
Information
obtained from FSA records.
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21
Calculated
ERP Payment (Prior to adjustments)
(FSA Use Only)
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Prepopulated with the
total calculated ERP payment prior to any adjustments such as:
NAP
indemnity
NAP
service fees and premiums
Reductions
due to payment limitation
Increased
payment limitation
Increased
payment rate for historically underserved producers with a
CCC-860 on file
ERP payment
factor.
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22
In
return for receiving an ERP payment on this crop, I agree to
purchase crop insurance or NAP as provided in Part A.
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Answer “Yes”
or “No” agreeing to purchase crop insurance or NAP on
the crop listed in Items 18 and 19.
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23
I
certify that I had a qualifying loss as defined in Part A.
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Answer “Yes”
or “No” to certify that the unit and crop listed in
Items 17 through 19 had a qualifying loss.
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Part E - Producer Certifications - Items 24 - 25
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24A
Producer/Primary
Policyholder’s Signature (By)
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Producer/Primary
policyholder requesting an ERP Phase 1 payment must sign
certifying to the information in Parts C and D.
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24B
Title/Relationship of
Individual Signing in a Representative Capacity
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Enter title and/or
relationship to the individual when signing in a representative
capacity.
Note:
If the
producer signing is not signing in a representative
capacity, this field
should be left blank.
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24C
Date
(MM-DD-YYYY)
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Enter the date the FSA-520
is signed in Item 24A.
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24D
SBI Signature (By)
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SBIs (if applicable)
requesting an ERP Phase 1 payment, must sign certifying to the
information in Part C.
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24E
Title/Relationship of
Individual Signing in a Representative Capacity
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Enter title and/or
relationship to the individual when signing in a representative
capacity.
Note:
If the
producer signing is not signing in a representative capacity,
this
field should be left blank.
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24F
Date
(MM-DD-YYYY)
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Enter the date the FSA-520
is signed in item 24D.
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25A
FSA
Representative’s Signature
(FSA
Use Only)
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FSA representative will
sign and date the final printed application after it has been
reviewed and entered into the software.
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25B
Date
Signed
(MM-DD-YYYY)
(FSA
Use Only)
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Enter the date the FSA
representative signs the FSA-520 in Item 25A.
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