Form FSA-1122 Pandemic Assistance Revenue Program Application

FSA-1122

U.S. DEPARTMENT OF AGRICULTURE
Farm Service Agency

(proposal 3)

PANDEMIC ASSISTANCE REVENUE
PROGRAM (PARP) APPLICATION
NOTE:

1. Recording State

Form Approved - OMB No. 0560-XXXX
OMB Expiration Date: XX/XX/2021
2. Program Year

3. Recording County

2020
4. Application Number

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 7 CFR Part 9, and
theConsolidated Appropriations Act (Pub. L 116-260) . 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, or USDA may not conduct or sponsor
a collection of information unless it displays a valid OMB control number. RETURN THIS COMPLETED FORM TO LOCAL USDA-FARM SERVICE AGENCY OFFICE.

PART A – PRODUCER AGREEMENT
The Department of Agriculture (USDA) will make payments under the PARP to producers who meet the requirements of the program. The following information is needed in order
for USDA to make a determination that the applicant is eligible to receive a PARP payment. By submitting this application, and upon approval by USDA, the applicant agrees:
1.
2.
3.
4.

5.
6.
6A.

To comply with regulations set forth in 7 CFR Part 9, subpart D;
That a PARP payment will only be made with respect to revenue lossess for commodities grown in the US, unless the commodity is grown outside the US by a US producer
and intended to be marketed for commercial production in the US;
To provide to USDA all information that is necessary to verify that the information provided on this form is accurate and to allow USDA representative access to all
documents and records of the producer, including those in the possession of a third-party such as a warehouse operator, processor or packer;
To comply with maximum payment limitation, adjusted gross income, and other provisions applicable to the PARP by completing forms:
• CCC-902, Farm Operating Plan for Payment Eligibility (NOTE: Only Parts A and B of the form are required)
• CCC-901, Member Information for Legal Entities, if applicable
• CCC-941, Average Adjusted Gross Income (AGI) Certification and Consent to Disclosure of Tax Information
• FSA-1123, Certification of 2020 Adjusted Gross Income, optional
• CCC-860, Socially Disadvantaged, Limited Resource, Beginning and Veteran Farmer or Rancher Certification, optional
• AD-2106, Form to Assist in Assessment of USDA Compliance With Civil Rights Laws, optional
• AD-2047, Customer Data Worksheet, optional;
To provide USDA all eligibility documents required for program participation within 60 days from the date the applicant signs this application. Failure of an individual, entity,
or member of an entity to timely submit all eligibility documents required may result in no payment or a reduced payment;
To comply with the provisions of the Food Security Act of 1985 that protect highly erodible land and wetlands. All applicants must complete and submit all portions of form
AD-1026, Highly Erodible Land Conservation (HELC) and Wetland Conservation (WC) Certification unless:
i.
The applicant does not participate in USDA benefits subject to HELC and WC compliance except Federal Crop Insurance or PARP, and
ii.

6B.
7.

The applicant only has an interest in land devoted to the production of agricultural commodities that are perennial crops, excluding sugar cane, such as tree fruits, tree
nuts, grapes, olives, native pasture and perennial forage. If the applicant produces alfalfa, the applicant must contact the Natural Resources Conservation Service to
determine if such production qualifies as the production of a perennial crop; and
iii.
The applicant has not converted a wetland after December 23, 1985; or
i.
The applicant does not own or rent land devoted to an agricultural activity including cropland, rangeland, pastureland or forestland;
ii.
The applicant is a producer of livestock, nursery crops, honey or similar commodity that is not produced from tillage of land;
If the applicant meets either the conditions in Item 6A (certification with box 5B on AD-1026) or 6B Certification (certification with box 5A on AD-1026), the applicant is only
required to complete Parts A and D of form AD-1026.

8.

If the applicant identifies as being a new producer or has an increase in operation they must complete supplemental worksheet FSA-1122 A.

9.

If applicant receives assistance through the Coronavirus Food Assistance Program 1 or 2, Pandemic Livestock Indemnity Program, or Spot Market Hog Pandemic Program
after their PARP payment is calculated, their PARP payment will be recalculated and the applicant must refund any resulting overpayment.

PART B – PRODUCER INFORMATION

5. Producer Name, Address (City, State and Zip Code) and Phone Number (Include Area Code)

PART C – ALLOWABLE GROSS REVENUE
6.
2018 Allowable Gross
Revenue

7
2019 Allowable Gross
Revenue

AGENCY USE ONLY
8.
2020 Allowable Gross
Revenue

9.
COC Adjusted 2018
Allowable Gross
Revenue

10.
COC Adjusted 2019
Allowable Gross
Revenue

11.
COC Adjusted 2020
Allowable Gross Revenue

PART D – PRODUCER 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 the foregoing is true and correct.
12A. Signature (By)

12B. Title/Relationship of the Individual Signing in the
Representative Capacity

PART E – COUNTY COMMITTEE (COC) DETERMINATION
13. COC or Designee Signature

14. Date (MM/DD/YYYY)

12C. Date (MM/DD/YYYY)

15. Determination
APPROVED

DISAPPROVED

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.

FSA-1122 (proposal 3)

Page 3 of 3

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.
INCLUDE gross revenue from the following sources:
(1) Sales of agricultural commodities produced by the applicant, including the
portion of sales resulting from value added through post-production activities. (Sched.
F Line 1C, or other comparable Federal tax form)
NOTE: include income from:
•
•

•
•

inventory carried over from the prior tax year
post-production activities (value added) i.e., grapes into wine or strawberries
into jam.
Commodities not grown in the U.S. (if grown by U.S. producer and marketed
in the U.S.)
IC-DISC income from the sale of agricultural commodities.

(2) Sales of agricultural commodities purchased for resale, less the cost or other basis
of such commodities. (Sched. F Line 2, or other comparable Federal tax form)

EXCLUDE gross revenue from the following sources:
(1) Pandemic Assistance from:
•
•
•
•

(2) Animals for consumption by the owner, lessee, or contract grower
(3) Wild free-roaming animals
(4) Horses and other animals used for racing or wagering
(5) Aquatic species that are NOT grown:
•
•
•

NOTE: The sale of eligible aquatic species must be
raised by a commercial operator and in water in a controlled environment.
(3) The taxable amount of cooperative distributions directly related to the sale of
agricultural commodities produced by the applicant. (Sched F – Line 3a, or other
comparable Federal tax form)
(4) Payments received under the following agricultural programs regardless of crop
year or program year (Sched F Line 4a & 4b, or other comparable Federal tax form):
•
•
•
•
•
•

ARC/PLC
BCAP
DMC
LDP, MLG, Certificate Exchanges
MFP
MPP Dairy

(5) CCC loans reported under election if elected to be treated as income and reported
to IRS. (Schedule F Line 5a, or other comparable Federal tax form)
(6) Crop insurance proceeds received from FCIC or a private plan of insurance
regardless of crop year (as reported to IRS). (Schedule F Line 6, or other comparable
Federal tax form)
(7) Federal disaster program payments under the following programs (Schedule F
Line 6, or other comparable Federal tax form):
•
•
•
•
•
•
•
•
•

2017 WHIP
ELAP
LFP
LIP
NAP
Milk Loss Program
On-Farm Storage Loss Program
TAP
WHIP+

(8) Payments issued through grant agreements with FSA for losses of agricultural
commodities

CFAP 1
CFAP 2
PLIP
Spot Market Hog Pandemic Program

•

as food for human or livestock consumption,
for industrial or biomass uses,
as fish raised as feed for fish that are
consumed by humans, or
as ornamental fish propagated and reared in
an aquatic medium.

(6) Cannabis sativa L. and any part of that plant including the seeds, thereof and all
derivatives, extracts, cannabinoids, isomers, acids, salts, and salts of isomers, weather
growing or not, with a delta-9 tetrahydrocannabinol concentration of not more than
0.3 percent on a dry weight basis, that is grown under a license or other required
authorization issued by the applicable governing authority that permits the production
of hemp
(7) Timber
(8) Resale of items not held for characteristic change
(9) Income from a pass-through entity such as an S Corporation or LLC
(10) Conservation Program payments
(11) Any pandemic assistance payments that were not for the loss of agricultural
commodities or the loss of revenue from agricultural commodities, including, but not
limited to:
•
•
•

cost-share assistance
loss of buildings,
etc.

(12) Custom hire income (Sched F Line 7, or other comparable Federal tax form)
(13) Net gain from hedging or speculation
(14) Wages, salaries, and tips
(15) Cash rent
(16) Rental of equipment or supplies

(9) Revenue from raised breeding livestock (Sched 4797 Part 1 column (d) or (g), or
other comparable Federal tax form)
(10) Revenue earned as a contract producer of an agricultural commodity
(11) NOAA grants and State program funds providing direct payments for the loss of
agricultural commodities or the loss of revenue from agricultural commodities; and
(12) Other revenue directly related to the production of agricultural commodities that
IRS requires the applicant to report as income including but not limited to:
•
•
•

Federal and State gas/fuel tax credits
Income from by-passed (unharvested) acres
Commodity specific income received from State or local governments.

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.