FSA-1122A Continuation Sheet for Pandemic Assistance Revenue Progr

U.S. DEPARTMENT OF AGRICULTURE
Farm Service Agency

FSA-1122A
(proposal 1)

1.

NOTE:

CONTINUATION SHEET FOR PANDEMIC ASSISTANCE
REVENUE PROGRAM (PARP) ADJUSTED REVENUE

1. Recording State

OMB Control No. 0560-xxxx
OMB Expiration Date: xx/xx/xx
2. Program Year

3. Recording County

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 the Consolidated
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 INFORMATION
5. Producer’s Name and Address (City, State, and Zip Code) and Phone Number (Include Area Code)

6. Are you a new producer who began farming in 2020 that doesn’t have revenue in 2019?
NOTE: Acceptable documentation must be provided within 30 calendar days.
7. Are you are new producer who began farming in 2019 that does not have a full year’s revenue
to report?
NOTE: Acceptable documentation must be provided within 30 calendar days.
8. Did your operation have an increase in operating capacity in 2020 compared to 2018 or 2019
that impacted revenue?
NOTE: Acceptable documentation must be provided within 30 calendar days.

PART B – NEW 2020 PRODUCER

NO. If “Yes”, Complete Parts B and E

YES

NO. If “Yes, Complete Parts C and E

YES

NO.

If “Yes”, Complete Parts D and E

COC USE ONLY

9.
2020 Expected Allowable Gross Revenue

10.
COC Adjusted 2020 Expected Allowable Gross
Revenue

PART C – NEW 2019 PRODUCER WITHOUT FULL YEAR’S REVENUE
11.
Basis of Increase in Production

12.
Percent of Increased Production for
Entire Farming Operation

Example: Added Irrigation System, & Increased Acreage

25%

PART D – 2020 INCREASE IN OPERATION

YES

14.
Basis of Increase in Production

15.
Percent of Increased Production for
Entire Farming Operation

Example: Added Irrigation System, & Increased Acreage

25%

COC USE ONLY

13.
COC Adjusted Percent of Increased Production for
Entire Farming Operation

COC USE ONLY

16.
COC Adjusted Percent of Increased Production for
Entire Farming Operation

PART E – 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. If a new
producer in 2020, I understand that I must provide documentation to the COC within 30 days of signing the PARP application to support my certification of expected
gross revenue. If a new producer in 2019 without a full year’s revenue or had an increase in operation in 2020, I understand that I must provide documentation to the
COC within 30 days of signing the PARP application that supports the increase in operating capacity that would have resulted in a higher revenue for 2020.
17. Signature (By)

18. Title/Relationship of the Individual Signing in the
Representative Capacity

19. Date (MM/DD/YYYY)

PART F – COC DETERMINATION
20. COC or Designee Signature

21. Date (MM/DD/YYYY)

22. Determination
APPROVED

DISAPPROVED

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.

FSA-1122A (Proposal 1)

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General Form Instructions
PARP applicants that are a new producer in 2020, new producer in 2019, or a producer who increased production capacity from 2018
or 2019 to 2020 may seek a COC adjustment to the 2019 revenue. The producer will complete this form in addition to form FSA-1122
and provide acceptable documentation to COC within 30 calendar days of filing the PARP application. Failure to timely provide
acceptable documentation will result in the COC denying the 2019 allowable gross revenue adjustment.

New Producer in 2020:
Producers who began their farm operation in 2020 will certify their actual allowable gross revenue from 2020 on form FSA-1122 and
their expected allowable gross revenue in 2020 on this form. Acceptable documentation must be provided within 30 calendar days of
filing the PARP application. Acceptable documentation includes, but is not limited to financial documents, sales contracts or purchase
agreements, documentation supporting production capacity, use of existing production capacity or physical alterations that
demonstrate production capacity. The documentation must demonstrate an expected level of gross revenue.

New Producer in 2019:
A new producer in 2019 is a producer who began farming in 2019 that does not have a full year’s gross revenue to report for 2019.
The producer will certify their 2019 and 2020 actual allowable gross revenue on form FSA-1122. The producer may seek a new
producer factor to adjust their 2019 gross revenue by completing this form.

Increased Operating Capacity from 2018 or 2019 to 2020
A producer who increased the operating capacity of their farming operation will not have 2018 or 2019 gross revenue that reflects their
2020 operating capacity and gross revenue. The producer will certify their 2018 or 2019 and 2020 actual allowable gross revenue on
form FSA-1122. The producer may seek an expanded operation factor to adjust their 2018 or 2019 revenue by completing this form.
The following table describes the types of evidence and provides examples that document the expected revenue had:
•
•

the new producer in 2019 been operating at full capacity in 2019
the same capacity in 2018 or 2019 as in 2020 if the operation increased capacity.

Basis or Reason for
Increase
Added production capacity to
the farm operation

Examples and Evidence include but not
limited to
Added land (purchase or lease agreements, FSA-578)

Acres

Added livestock (purchase documents)

Head

Added greenhouse (purchase documents, construction
contracts)
Increased the use of existing
production capacity

Double-cropping existing land (FSA-578)
Beginning production on high density blocks or orchards
(evidence that supports farming practices)
Increased the number of turns in a chicken house (purchase
and sales documents)

Making physical alterations to
existing production capacity

Unit of Measure includes
but not limited to

Number
Acres
Bushels, pounds, tons, etc.

Turns

Adding irrigation to existing land (FSA-578, equipment
purchases)

Bushels, pounds, tons

Beginning production on certified organic acreage (FSA-578,
OCCSP, Organic Certification documents)

Bushels, pounds, tons

FSA-1122A (Proposal 1)

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Detailed Form Instructions

Item 1

Enter the FSA Recording State.

Item 2

Program Year is 2020.

Item 3

Enter the FSA Recording County.

Item 4

Application number will be assigned by the automation system.

PART A – PRODUCER INFORMATION
Item 5

Enter producer name, address, and telephone number.

Item 6

Provide response if applicant is a new producer in 2020 without allowable gross revenue in 2019.

Item 7

Provide response if applicant is a new producer in 2019 without a full year’s allowable gross revenue to report.

Item 8

Provide response if applicant is an applicant that increased operating capacity from 2018 or 2019 to 2020.

PART B – NEW 2020 PRODUCER
Item 9

Producer will certify their expected allowable gross revenue for 2020.

COC USE ONLY
Item 10

COC will record its determination for adjusting the applicant’s 2019 allowable gross revenue.

PART C – NEW 2019 PRODUCER WITHOUT FULL YEAR’S REVENUE
Item 11

Enter the name of the basis of increase that did not have a full year’s revenue in 2019.

Item 12

Enter the percent of increase requesting for the specified basis of increase.

COC USE ONLY
Item 13

COC adjustment to the applicant’s percent of increase for the specified basis of increase.

PART D – 2020 INCREASE IN OPERATION
Item 14

Enter the name of the basis of increase that had an increase in operation from 2018 or 2019.

Item 15

Enter the percent of increase requesting for the specified basis of increase.

COC USE ONLY
Item 16

COC adjustment to the applicant’s percent of increase for the specified basis of increase.

PART E – PRODUCER CERTIFICATION
Item 17

Enter signature for the applicant identified in Item 5.

Item 18

Enter the title/relationship to the applicant identified in item 5.

Item 19

Enter the date form FSA-1122A is signed.

PART F - COC DETERMINATION
Item 20

Enter COC or designee’s signature.

Item 21

Enter COC or designee’s signature date.

Item 22

Record COC or designee’s determination.