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Expiration Date: XX/XX/XXXX
FSA-413
(Proposal 23)
U.S. DEPARTMENT OF AGRICULTURE
Farm Service Agency
FOR COUNTY OFFICE USE ONLY
1. Administrative State
Name
EMERGENCY GRAIN STORAGE FACILITY
ASSISTANCE PROGRAM (EGSFP) APPLICATION
2. Administrative County
Code
Name
3. Program Year
Code
4. Application Number
2023
PART A - APPLICANT'S INFORMATION
5A. Applicant's Name (Person or Legal Entity)
5G. Applicant's CCID Number (For County Office Use Only)
5B. Address Line 1
5H. Primary Phone Number
Home
Cell
5C. Address Line 2
5I. Alternate Phone Number
Home
Cell
5D. City
5E. State 5F. Zip
5K. Do you meet the definition of an Underserved Producer?
5L. Disbursement Type
Final
Partial/Final
NO
YES
5J. Email Address (Optional)
5M. Applicant's Signature (By)
5N. Title/Relationship of Individual if Signing in
Representative Capacity
5O. Date of Applicant's
Signature
6. I certify the producer listed in Item 5A is an individual person that is a U.S. Citizen, Resident Alien, Foreign Person or a legal entity
including a corporation, LLC, LP, trust, estate, general partnership or joint venture, or similar type entity, comprised solely of persons
who are U.S. Citizen, Resident Aliens, or Foreign Persons and meet all other EGSFP requirements.
YES
NO
PART B - CONTACT PRODUCER'S INFORMATION
7A. Contact Producer's Name
7B. Address Line 1
7G. Primary Phone Number
Home
Cell
7C. Address Line 2
7H. Alternative Phone Number
Home
Cell
7D. City
7E. State
7F. Zip
7I. Email Address (Optional)
PART C - EGSFP ELIGIBILITY FOR ON-FARM GRAIN STORAGE STRUCTURE AND/OR DRYING/HANDLING
EQUIPMENT INFORMATION
8. Did all applicants harvest grain in an affected county eligible for EGSFP assistance?
YES If YES, list names of affected counties for all applicants:
NO
If NO, explain in remarks.
9. Were all applicants; (1) actively producing and marketing grain when the eligible disaster events occurred; (2) still actively
producing grain; (3) will use the storage, drying/handling equipment for at least 3 years after the EGSFP payment is
issued.
YES
NO
If NO, explain in remarks.
DATE STAMP
FSA-413 (proposal 23)
Page 2 of 5
PART C - EGGSFP ELIGIBILITY FOR ON-FARM GRAIN STORAGE STRUCTURE AND/OR DRYING/HANDLING
EQUIPMENT INFORMATION (Continuation)
10. Completely describe the on-farm grain storage structure and/or drying/handling equipment that will be purchased for the
on-farm grain storage capacity.
11. What is the legal description of where the on-farm grain storage structure will be installed or where the drying/handling
equipment will be stored?
12. List all grain crops produced for the applicant and co-applicants that require on-farm grain storage and drying/handling
equipment.
PART D - CERTIFICATION OF APPLICANT/CO-APPLICANT'S ON-FARM GRAIN STORAGE CAPACITY NEED
The applicant and co-applicants certify to the following on-farm grain storage capacity need below.
13A. Total crop year 2021 and 2022 harvested grain production combined for applicant and co-applicants.
13B. Total on-farm grain storage capacity (Bushels) owned by the applicant and co-applicants.
13C. Total on-farm grain storage capacity (Bushels) needed for applicant and co-applicants.
(Item 13A minus Item 13B)
13D. Total capacity of the on-farm grain storage structure (Bushels) to be constructed. If Item 13D is greater
than Item 13C, then Item 13C will be used to determine the on-farm grain storage capacity need for
EGSFP assistance.
PART E - REQUEST FOR EGSFP ASSISTANCE
14. Applicant and co-applicant's request the estimated dollar amount
for the EGSFP assistance described
in Item 10.
15A. Applicant/Co-Applicant's Name
PART F - REMARKS
16. Enter any remarks.
15B. Applicant/Co-Applicant's Share of Item 13A
FSA-413 (proposal 23
Page 3 of 5
)
PART G - EGSFP AGREEMENT
The undersigned applicant and co-applicants request assistance under the Emergency Grain Storage Facility Assistance Program
(EGSFP). The undersigned certifies that all of the information entered on this form, whether personally entered by the undersigned or
not, or by someone else, is true and correct. The undersigned certifies and acknowledges that the grain production and storage capacity
on this form is accurately identified by the applicant and the co-applicant's share. The undersigned understands the information entered
on this form may be subject to verification by spot-check. The failure to certify any information on this form and application accurately
may result in loss of program benefits. Additionally, by signing this form, the undersigned (1) agrees to comply with all terms and
conditions associated with EGSFP as stated in the notice of funds availability; (2) certify they have documentation to support this
application and that FSA can demand documentation to support the application for 3 years after the date of application;
(3) agrees FSA will determine whether the documentation meets program requirements; (4) authorizes FSA access to the site of the onfarm grain storage structure and/or drying/handling equipment; (5) agrees that the on-farm grain storage structure and/or drying/handling
equipment described must have a useful life of at least 3 years; (6) understands that any grain storage structure and/or grain drying/
handling equipment purchased or constructed prior to the EGSFP NOFA publication date will be determined ineligible for an EGSFP
payment; (7) understands EGSFP payments made to an eligible person or legal entity, other than a joint venture or general partnership,
may not exceed $125,000; (8) FSA will determine if the self-certified cost for the on-farm grain storage structure and drying and handling
equipment is reasonable based on general construction, labor, and supply rates for the respective areas; (9) within 30 calendar days of
signing this application agree to complete and submit the following forms, if not already on file with FSA:
• Manual Form CCC-902-I, Farm Operating Plan for an Individual, as applicable
• Manual Form CCC-902E, Farm Operating Plan for an Entity, as applicable
• CCC-901, Member Information for Legal Entities (if applicable)
• AD-1026, Highly Erodible Land Conservation (HELC) and Wetland Conservation (WC) Certification
• AD-2047, Customer Data Worksheet
• CCC-860, Socially Disadvantaged, Limited Resource, Beginning and Veteran Farmer of Rancher Certification (if applicable)
This application will not be considered complete until the applicant and co-applicants that have a share of the EGSFP production have
completed all required items and signed in Part A or the continuation page, as applicable. Failure of an individual, entity, or member of
an entity to timely submit all information required may result in no payment or a reduced payment.
EGSFP payments will be subject to the availability of funding.
PART H - COC/STC - DETERMINATION (FOR COUNTY OFFICE USE ONLY)
17A. COC/STC Action on
Request for EGSFP Assistance
Approved
17B. Signature of COC/STC
Representative
17C. Title/Position of COC/STC
Representative
17D. Date Signed
Disapproved
PART I - REQUEST FOR EGSFP PARTIAL PAYMENT (If Applicable)
18. The undesigned request a partial EGSFP payment in the amount of
. The undersigned certify they
(a) have read and understand the EGSFP requirement in Part G - EGSFP AGREEMENT; (b) completed a commensurate share,
up to 50 percent, of the construction or purchase of the eligible on-farm grain storage structure and/or drying/handling equipment
as described in Part C; (c) understand an FSA employee may inspect and verify the amount of construction completed and/or
purchased, before or after a partial EGSFP payment is disbursed; (d) understand the payment requested in this item will be
based on applicant/co-applicant's share, cost-share factor and provisions in Part G.
19B. Title/Relationship of Individual if Signing in 19C. Date of Applicant/
19A. Applicant/Co-Applicant's Signature (By)
a Representative Capacity
Co-Applicant's Signature
PART J - COC/STC DETERMINATION - EGSFP PARTIAL PAYMENT (If Applicable)
(FOR COUNTY OFFICE USE ONLY)
20A. COC/STC Determination
Approved
Disapproved
20B. Signature of COC/STC
Representative
20C. Title/Position of COC/STC
Representative
20D. Date Signed
FSA-413 (proposal 23)
Page 4 of 5
PART K - REQUEST FOR EGSFP FINAL PAYMENT
21. The undersigned request an EGSFP FINAL payment in the amount of
. The undersigned certify
(a) they have read and understand the EGSFP requirements in Part G - EGSFP AGREEMENT, (b) completed construction or
purchase of the eligible on-farm grain storage structure and/or drying/handling equipment as described in Part C; (c) understand
an FSA employee may inspect and verify construction of the on-farm grain storage structure is complete and/or the drying/
handling equipment is purchased, before or after a final EGSFP payment is disbursed (d) they understand the payment amount
requested will be based on applicant/co-applicant's share, cost-share factor and provisions in Part G.
22. Does the EGSFP PARTIAL payment request and EGSFP FINAL payment (if applicable) exceed the EGSFP estimated
request in Item 14?
YES
NO
If YES, the EGSFP payment increase must be approved in Part M.
23A. Applicant/Co-Applicant's Signature (By)
23B. Title/Relationship of Individual if Signing in 23C. Date of Applicant/
a Representative Capacity
Co-Applicant's Signature
PART L - COC/STC DETERMINATION - EGSFP FINAL PAYMENT (FOR COUNTY OFFICE USE ONLY)
24A. COC/STC Determination
Approved
24B. Signature of COC/STC
Representative
24C. Title/Position of COC/STC
Representative
24D. Date Signed
Disapproved
PART M - COC/STC DETERMINATION - REQUEST FOR EGSFP INCREASE (If Applicable)
(FOR COUNTY OFFICE USE ONLY)
25A. COC/STC Determination
Approved
Disapproved
26A. Signature of COC/STC Representative
25B. Final Approved EGSFP assistance if total of EGSFP payments exceeds
EGSFP assistance requested in Item 14.
$
26B. Title/Position of COC/STC Representative
26C. Date Signed
FSA-413 (proposal 23)
Page 5 of 5
NOTE: Privacy Act Statement: 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 CCC Charter Act. The information will be used to determine
eligibility to participate and receive benefits under the Emergency Grain Storage Facility Assistance Program. The information
collected on this form may be disclosed to other Federal, State, 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 of ineligibility concerning the processing
of the Emergency Grain Storage Facility Assistance Program payment request.
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-XXXX. The time required to complete this information
collection is estimated to average 20 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
appropriate criminal and civil fraud, privacy, and other statutes may be applicable to the information provided.
Non-Discrimination Statement: 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.
OMB Control Number: XXXX
Expiration Date: XX/XX/XXXX
FSA-413-1 U.S. DEPARTMENT OF AGRICULTURE
Farm Service Agency
(Proposal 23)
FOR COUNTY OFFICE USE ONLY
1. Administrative State
Name
CONTINUATION SHEET FOR EMERGENCY GRAIN
STORAGE FACILITY ASSISTANCE PROGRAM
(EGSFP) APPLICATION
2. Administrative County
Code
3. Program Year
Name
Code
4. Application Number
2023
PART A - CO-APPLICANT'S INFORMATION (Co-Applicant's must complete FSA-413-1 Continuation Sheet for EGSFP Application)
5A. Co-Applicant's Name (Person or Legal Entity)
5G. Co-Applicant's CCID Number (For County Office Use Only)
5B. Address Line 1
5H. Primary Phone Number
Home
Cell
5C. Address Line 2
5I. Alternate Phone Number
Home
Cell
5D. City
5E. State 5F. Zip
5J. Email Address (Optional)
5K. Do you meet the definition of an Underserved Producer?
NO
YES
5L. Co-Applicant's Signature (By)
5M. Title/Relationship of Individual if Signing in a 5N. Date of Co-Applicant's
Representative Capacity
Signature
6. I certify the producer listed in Item 5A is an individual person that is a U.S. Citizen, Resident Alien, Foreign Person or a legal entity,
including a corporation, LLC, LP, trust, estate, general partnership or joint venture, or similar type entity, comprised solely of persons
who are U.S. Citizen, Resident Aliens, or Foreign Persons and meet all other EGSFP requirements.
YES
NO
PART B - CO-APPLICANT'S INFORMATION (Co-Applicant's must complete FSA-413-1 Continuation Sheet for EGSFP Application)
5A. Co-Applicant's Name (Person or Legal Entity)
5G. Co-Applicant's CCID Number (For County Office Use Only)
5B. Address Line 1
5H. Primary Phone Number
Home
Cell
5C. Address Line 2
5I. Alternate Phone Number
Home
Cell
5D. City
5E. State 5F. Zip
5J. Email Address (Optional)
5K. Do you meet the definition of an Underserved Producer?
YES
NO
5L. Co-Applicant's Signature (By)
5M. Title/Relationship of Individual if Signing in
a Representative Capacity
5N. Date of Co-Applicant's
Signature
6. I certify the producer listed in Item 5A is an individual person that is a U.S. Citizen, Resident Alien, Foreign Person or a legal entity,
including a corporation, LLC, LP, trust, estate, general partnership or joint venture, or similar type entity, comprised solely of persons
who are U.S. Citizen, Resident Aliens, or Foreign Persons and meet all other EGSFP requirements.
YES
NO
FSA-413-1 (proposal 23)
NOTE:
Page 2 of 2
Privacy Act Statement: 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 CCC Charter Act. The information will be used to determine
eligibility to participate and receive benefits under the Emergency Grain Storage Facility Assistance Program. The information
collected on this form may be disclosed to other Federal, State, 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 of ineligibility concerning the processing
of the Emergency Grain Storage Facility Assistance Program payment request.
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-XXXX. The time required to complete this information
collection is estimated to average 20 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
appropriate criminal and civil fraud, privacy, and other statutes may be applicable to the information provided.
Non-Discrimination Statement: 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.
| File Type | application/pdf |
| File Modified | 2023-03-06 |
| File Created | 2023-03-06 |