521 Emergency Relief Program Phase 2 (ERP Phase 2) Applicati

Form Approved - OMB No. 0560-0309
OMB Expiration Date 00/00/0000

U.S. DEPARTMENT OF AGRICULTURE
Farm Service Agency

FSA-521

(Proposal 11.1)

EMERGENCY RELIEF PROGRAM (ERP)
PHASE 2 APPLICATION
NOTE:

1. Application Number

2. Recording State Name/Code

3. Recording County Name/Code

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 Extending Government Funding and Delivering Emergency Assistance Act (Pub. L. 117-43).
The information will be used to determine eligibility for program benefits. 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 of ineligibility for program benefits. Payments may be made under the program to which the form applies only to the extent permitted by applicable authorities.
Public Burden Statement (Paperwork Reduction Act): Public reporting burden for this collection is estimated to average 60 minutes per response, including reviewing instructions, gathering, and maintaining the data needed, completing (providing the information), and
reviewing the collection of information. You are not required to respond to the collection of information, unless it displays a valid OMB control number. RETURN THIS COMPLETED FORM TO YOUR RECORDING COUNTY FSA OFFICE.

PART A - PRODUCER AGREEMENT
The Farm Service Agency (FSA) will make payments under ERP Phase 2 to eligible producers who meet the requirements of the program, subject to the availability of funds. The following
information is needed for FSA to determine whether the applicant is eligible to receive ERP Phase 2 assistance. By submitting this application, the applicant agrees:
1. To comply with the regulatory requirements in 7 CFR part 760, Subpart S. A copy of these regulations may be found at: https://www.fsa.usda.gov/programs-and-services/emergencyrelief/index
2. That the applicant experienced a decrease in allowable gross revenue due to necessary expenses related to losses of eligible crops due in whole or in part to a qualifying disaster
event that occurred in the 2020 or 2021 calendar year. For ERP, qualifying disaster event means: wildfires, hurricanes (including excessive wind, storm surges, tornadoes, tropical
storms, and tropical depressions that occurred as a direct result of a hurricane), floods (including silt and debris that occurred as a direct and proximate result of flooding), derechos
(including excessive wind that occurred as a direct result of a derecho), excessive heat, winter storms (including excessive wind and blizzards that occurred as a direct result of a
winter storm), freeze (including a polar vortex), smoke exposure, excessive moisture, and qualifying drought, and related conditions, occurring in calendar years 2020 and 2021.
Related conditions mean damaging weather and adverse natural occurrences that occurred concurrently with and as a direct result of a specified qualifying disaster event. “Qualifying
drought” means an area within the county in which the loss occurred was rated by the U.S. Drought Monitor as having a drought intensity of D2 (severe drought) for eight consecutive
weeks or D3 (extreme drought) or higher for any period of time during the applicable calendar years. A list of counties that experienced a qualifying drought in calendar years 2020 and
2021 is available through local FSA service centers and at https://www.fsa.usda.gov/programs-and-services/emergency-relief/index.
3. To provide FSA all information that is necessary to verify the information provided on this form is accurate. Producer is required to retain documentation in support of their application
for 3 years after the date of approval. All information provided to FSA for program eligibility and payment calculation purposes, including certification that a producer suffered an
eligible loss due to a qualifying disaster event, is subject to spot check.
4. To comply with payment attribution and payment eligibility provisions by submitting the following forms within 60 days from the date of the ERP Phase 2 application deadline, as
applicable, if not already on file with FSA for the applicable disaster year:
• CCC-902, Farm Operating Plan for Payment Eligibility
• CCC-901, Member Information for Legal Entities, if applicable
• FSA-510, Request for an Exception to the $125,000 Payment Limitation for Certain Programs (optional)
• CCC-860, Socially Disadvantaged, Limited Resource, Beginning and Veteran Farmer or Rancher Certification (optional)
• AD-1026, Highly Erodible Land Conservation (HELC) and Wetland Conservation (WC) Certification
• AD-2047, Customer Data Worksheet
Failure of an individual, entity, or member of an entity to timely submit all required eligibility documents may result in no payment or a reduced payment.
5. The application will not be considered complete until the applicant has signed Item 27 and completed the FSA-522, Crop Insurance and/or NAP Coverage Agreement.
PART B - PRODUCER INFORMATION
4. Producer Name, Address (City, State, and Zip Code), and Phone Number (include Area Code):

FSA-521 (Proposal 11.1)

Page 2 of 4

PART C - 2020 DISASTER YEAR REVENUE CERTIFICATION
5.
% of Expected
Revenue from
Specialty & High
Value Crops

6.
% of Expected
Revenue from
Other Crops

7.
Benchmark Year

8.
Benchmark
Revenue

COC USE ONLY
9.
Representative
Revenue Year

2018

2020

2019
Adjusted

2021

10.
Disaster Year
Revenue

11.
COC Adjusted %
of Expected
Revenue from
Specialty & High
Value Crops

12.
COC Adjusted %
of Expected
Revenue from
Other Crops

17.
% of Expected
Revenue from
Other Crops

18.
Benchmark Year

19.
Benchmark
Revenue

15.
COC Approved or
Disapproved

Disapproved

COC USE ONLY
20.
Representative
Revenue Year

2018

2021

2019

2022

Adjusted

14.
COC Adjusted
Disaster Year
Revenue

Approved

PART D - 2021 DISASTER YEAR REVENUE CERTIFICATION
16.
% of Expected
Revenue from
Specialty & High
Value Crops

13.
COC Adjusted
Benchmark
Revenue

21.
Disaster Year
Revenue

22.
COC Adjusted %
of Expected
Revenue from
Specialty & High
Value Crops

23.
COC Adjusted %
of Expected
Revenue from
Other Crops

24.
COC Adjusted
Benchmark
Revenue

25.
COC Adjusted
Disaster Year
Revenue

26.
COC Approved or
Disapproved

Approved
Disapproved

PART
PARTEE- -PRODUCER
PRODUCERCERTIFICATION
CERTIFICATION
I hereby sign and acknowledge under penalty of perjury in accordance with 28 U.S.C. § 1746 and 18 U.S.C. § 1621 that all information on this application, whether entered by me or by
someone else on my behalf, is true and correct. I understand that if any information is determined to be in error, the application may be denied, and such errors may result in a determination
of ineligibility in whole or in part.
27A. Signature (By)

27B. Title/Relationship of the Individual Signing in the
Representative Capacity

27C. Date
(MM/DD/YYYY)

PART F - COUNTY COMMITTEE (COC) DETERMINATION
28A. COC or Designee Signature

28B. Date
(MM/DD/YYYY)

In accordance with Federal civil rights law and USDA civil rights regulations and policies, the USDA, its agencies, offices, and employees 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.

Date Stamp

FSA-521 (Proposal 11.1)

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HOW TO DETERMINE ALLOWABLE GROSS REVENUE
Table 1 provides guidance for:
• Determining allowable gross revenue source
• What to include/exclude when determining allowable gross revenue

Table 1.
Allowable Revenue Source:

Include Gross Revenue from the Following Sources:

Exclude Gross Revenue from the Following Sources:

Schedule F Line 1c
“Sales of purchased livestock and other resale items,” or information
that could be reported on a Schedule F

Sales of eligible crops purchased for resale that had a change in
characteristic due to the time held, such as:
• A plant purchased at a size of 2 inches and sold as an 18inch plant after 4 months

Sales of livestock

Schedule F Line 2
“Sales of livestock, produce, grains, and other products you raised,”
or information that could be reported on a Schedule F

Sales of eligible crops grown and sold in the United States and its
Territories by the applicant

Sales of animals and their by-products:
• Animals for consumption by the owner, lessee, or contract
grower
• Eggs
• Milk
• Mink including pelts
• Revenue from animals for show, sport, or recreational
purposes
• Wild free-roaming animals
• Revenue from raised breeding livestock (Schedule 4797
Part 1, Column (d) or (g) or other information that could be
reported on a Schedule F)

Sales of eligible crops grown by the applicant resulting from value
added through post-production activities that could have been
reported on IRS Schedule F
For example:
• Strawberries into jam

Sales of aquatic species that are grown:
• As food for human or livestock consumption
• For industrial or biomass uses
• As fish raised as feed for fish that are consumed by humans Sales of agricultural commodities resulting from value added through
• As ornamental fish propagated and reared in an aquatic
post-production activities if reported on Schedule C
medium
Commodities not grown in the United States and its Territories

Schedule F Line 3a
“Cooperative distributions,” Form 1099-PATR, or information that
could be reported on a Schedule F
Schedule F Line 4a
“Agricultural program payments", Form 1099-G, or information that
could be reported on a Schedule F

The taxable amount of cooperative distributions directly related to the Distributions that are not directly related to the sale of eligible crops
sale of eligible crops produced by the applicant such as:
that are not produced by the applicant
• Per-unit allocations paid to patrons for gross grain sales
• Agriculture Risk Coverage (ARC) and Price Loss Coverage
• Conservation Program Payments
(PLC) Program
• Dairy Margin Coverage (DMC) Program
• Biomass Crop Assistance Program (BCAP)
• Marketing Assistance Loan (MAL)
• Loan Deficiency Payment (LDP) Program
• Market Loan Gains (MLG) - repayment of Commodity
Pandemic Assistance payments including, but not limited to:
• cost-share assistance
Credit Corporation (CCC) loan less than the original
amount
• loss of buildings
• Market Facilitation Program (MFP)
• livestock portion
• Seafood Trade Relief Program (STRP)
• Coronavirus Food Assistance Program (CFAP) • For the applicable disaster year only- Emergency Relief
CFAP 1 and CFAP 2
Program (ERP) Phase 1 payments issued to another
• Pandemic Livestock Indemnity Program (PLIP)
person or entity for the applicant's share of an eligible crop,
• Spot Market Hog Pandemic Program (SMHPP)
regardless of the tax year in which the payment would be
reported to the IRS

FSA-521 (Proposal 11.1)
Allowable Revenue Source:

Page 4 of 4
Include Gross Revenue from the Following Sources:

Schedule F Line 5a - 5c
“Commodity Credit Corporation (CCC) loans reported under election,”
Form 1099-A, or information that could be reported on a Schedule F

• CCC loans reported under election if elected to be treated
as income and reported to IRS when all or part of the
production is used as collateral to secure the loan
• Forfeited CCC loans

Schedule F Line 6
“Crop insurance proceeds and federal crop disaster payments” or
information that could be reported on a Schedule F

• Crop insurance proceeds less administrative fees and
premiums
• Noninsured Crop Disaster Assistance Program (NAP)
payments less administrative fees and premiums
• 2017 Wildfire and Hurricanes Indemnity Program (WHIP)
Payments- impacts Benchmark Year Revenue (2018, 2019)
• On-Farm Storage Loss Program (OFSLP)
• Emergency Assistance for Livestock, Honeybees, and Farm
Raised Fish Program (ELAP) - payments specific to
aquaculture
• Payments through grant agreements with FSA for
losses of eligible crops
• Grants from the Department of Commerce, National
Oceanic and Atmospheric Administration (NOAA), and
State program funds for the direct loss of eligible crops or
the loss of revenue for eligible crops

Schedule F Line 7
“Custom hire (machine work) income,” or information that could be
reported on a Schedule F
Schedule F Line 8
“Other income, including federal and state gasoline or fuel tax
credit or refund,” or information that could be reported on a
Schedule F

Exclude Gross Revenue from the Following Sources:

• Emergency Assistance for Livestock, Honeybees, and Farm
Raised Fish Program (ELAP)- payments specific to
livestock and honeybees
• Emergency Livestock Relief Program (ELRP)
• Emergency Relief Program (ERP) Phase 1 Payments
• Livestock Forage Disaster Program (LFP)
• Livestock Indemnity Program (LIP)
• Milk Loss Program
• Quality Loss Adjustment (QLA) Program
• Tree Assistance Program (TAP)
• Wildfire and Hurricanes Indemnity Program (WHIP/WHIP+)

Custom hire income

Other revenue directly related to the production of eligible crops that
the IRS requires the applicant to report such as but not limited to:
• Commodity specific income received from state or local
governments

• Federal and State gas/fuel tax credits
• Income from by-passed (unharvested) acres
• Income from a pass-through entity such as an S
Corporation or Limited Liability Company (LLC)
• Certificate Exchanges
• Net gain from hedging or speculation
• Wages, salaries, and tips
• Cash rent
• Rental of equipment or supplies
• Revenue earned as a contract producer

Note: An applicant is not required to have filed a Schedule F to determine allowable gross revenue. If an applicant did not file a Schedule F, the applicant will use the applicable federal tax
form filed to determine allowable gross revenue in the same manner as if a Schedule F was filed.