FSA1122eGov_ 1

Instructions For FSA-1122
PANDEMIC ASSISTANCE REVENUE PROGRAM (PARP)
APPLICATION
This form will be used for applicants to apply for PARP benefits.
Submit the original of the completed form in hard copy, by email or facsimile to the
appropriate USDA servicing office. https://offices.sc.egov.usda.gov/locator/app
Customers who have established electronic access credentials with USDA may
electronically transmit this form to the USDA servicing office, provided that (1) the
customer submitting the form is the only person required to sign the transaction, or (2)
the customer has an approved Power of Attorney (Form FSA-211) on file with USDA to
sign for other customers for the program and type of transaction represented by this
form.
Features for transmitting the form electronically are available to those customers with
access credentials only. If you would like to establish online access credentials with
USDA, follow the instructions provided at the USDA eForms website
https://forms.sc.egov.usda.gov/eForms/welcomeAction.do?Home.
Producers must complete the following items: items 5 through 8, items 12A through 12C, if
applicable.
FSA will complete fields noted as “Agency Use Only.”
Item No. /
Field Name

Instruction

1
Recording State

Enter the producer’s recording state.

2
Program Year

The program year will be 2020.

3
Recording
County

Enter the producer’s recording county.

4
Application
Number

Application Number will be assigned by the automated system.

Page 1 of 3

As of: XX-XX-2020

Item No. /
Field Name
Part A
Producer
Agreement

Instruction
For Informational Purposes:
Applicants who are an individual person must complete automated CCC-902 or
manual CCC-902, Parts A and B, and provide name, address, taxpayer
identification number, and citizenship status. An individual who is not a U.S.
resident or lawful alien must also report contributions of labor, capital, and land
contributions to the farming operation.
Applicants who are a legal entity, including General Partnership or Joint
Venture, must complete automated CCC-902 or manual CCC-901 and provide
the name, address and taxpayer identification number for the legal entity and all
members, partners or stockholders with an ownership interest. If any member,
partner or stockholder is not a U.S. resident or lawful alien, CCC-902 must be
completed to report contributions of labor to the legal entity.

Part B – Producer Information
5
Enter the producer’s name, address, including ZIP code, and phone number,
Producer’s
including area code.
Name, Address
(City, State, and
Zip Code), and

Phone Number
(Including Area
Code)

Part C – Gross Revenue
6
2018 Gross
Revenue
7
2019 Gross
Revenue

Enter the total Gross Revenue for 2018

8
2020 Gross
Revenue
9
COC Adjusted
2018 Gross
Revenue

Enter the total Gross Revenue for 2020

10
COC Adjusted
2019 Gross
Revenue

COC may enter the adjusted total Gross Revenue for 2019, if applicable.

(COC USE ONLY)

(COC USE ONLY)

Page 2 of 3

Enter the total Gross Revenue for 2019

COC may enter the adjusted total Gross Revenue for 2018, if applicable.
Note: An entry is only required when COC determines the total 2018 Gross
Revenue is different than what is certified to by the producer in Item 6.

Note: An entry is only required when COC determines the total 2019 Gross
Revenue is different than what is certified to by the producer in Item 7.

As of: XX-XX-2020

Item No. /
Field Name
11
COC Adjusted
2020 Gross
Revenue

(COC USE ONLY)

Instruction
COC may enter the adjusted total Gross Revenue for 2020, if applicable.
Note: An entry is only required when COC determines the total 2020 Gross
Revenue is different than what is certified to by the producer in Item 8.

Part D – Producer Certification
12A
Producer applying for PARP benefits must sign.
Signature (By)
12B
Title/Relationship of the
Individual
Signing in the
Representative
Capacity
12C
Date

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.
Enter the date the FSA-1122 is signed in Item 12A.

(MM/DD/YYYY)

Part D – County Committee (COC) Determination – COC USE ONLY
13
COC or
Designee
Signature

COC or their representative will sign.

14
Date
(MM/DD/YYY)

Enter the date COC or their representative signs the FSA-1122.

15
Determination

COC or their representative will check () either “Approved” or “Disapproved”

(COC USE
ONLY)

(COC USE
ONLY)

(COC USE
ONLY)

Page 3 of 3

Important: FSA-1122 will be approved or disapproved as certified by the
producer after applicable COC adjustment fields are completed.

As of: XX-XX-2020