CCC-901 Instruction

Instructions For CCC-901
MEMBER'S INFORMATION
Producers are required to complete this form to report information about their farming
operation. This information is used by FSA to determine the ownership interest of
entities for payment limitation purposes.
Submit the original of the completed form in hard copy or facsimile to the appropriate
FSA servicing office.
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. To establish online access credentials with USDA, follow the
instructions provided at the USDA eForms web site.

All items applicable to the payment entity must be completed by
following the instructions provided below.
Items 1-3
Fld Name /
Item No.

Instruction

1 and 2
County and State
Name

Enter the name of the recording county and State where the farming
operation is located. If in more than one county, enter the name of
the county that has been designated as the recording county.

3
Program Year

Enter the current program year, or the year for which this
information is applicable.

Part A
Legal Entity Name

Enter the name of the legal entity earning the payment.

1
Member’s Name

Enter the names of the members making up the legal entity listed in
Part A. (This could be a person or a legal entity.)

2

Enter the Social Security Number or tax identification number of
the members.

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Fld Name /
Item No.

Instruction

Social Security
Number/ Tax ID
Number
Part A, Items 1-5
3
Address
4
Percent Share

Enter the address of each member of the legal entity.

5
Signature Authority

Check “YES” if the member has signature authority for this entity.
Check “NO” if the member does not have signature authority for
this entity.

Enter the percent share of the legal entity that each member owns.

Part B - Embedded Legal Entities – If any member listed in Part A, Item 3 is a legal entity
(i.e., part of another partnership, corporation, etc.) list the members of that legal entity in
this item. (If more than one member is a legal entity, use a separate, supplemental sheet to
provide the requested information for each embedded legal entity.)
Part B, Items 1-5
Part B
Embedded Legal
Entity Name
1
Member’s Name
2
Social Security/Tax
ID Number
3
Address
4
Percent Share
5
Signature Authority

Page 2 to 5

Enter the name and tax ID number of the embedded legal entity that
is a member of the legal entity entered in Part A.
Enter the names of the members making up the legal entity listed in
Part B. (This could be a person or a legal entity.)
Enter the social security number or tax identification number of the
members.
Enter the address of each member of the entity.
Enter the percent share of the legal entity that each member owns.
Check “YES” if the member has signature authority for this entity.
Check “NO” if the member does not have signature authority for
this entity.

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Fld Name /
Item No.

Instruction

Part C - Embedded Legal Entities – If any member listed in Part B, Item 7 is a legal entity
(i.e., part of another partnership, corporation, etc.) lists the members of that legal entity in
this item. (If more than one member is a legal entity, use a separate, supplemental sheet to
provide the requested information for each embedded legal entity.)
Part C, Items 1-5
Part C
Embedded Legal
Entity Name
1
Member’s Name
2
Social Security/Tax
ID Number
3
Address
4
Percent Share
5
Signature Authority

Enter the name and tax ID number of the embedded legal entity that
is a member of the legal entity entered in Part B.
Enter the names of the members making up the legal entity listed in
Part C. (This could be a person or legal entity.)
Enter the social security number or tax identification number of the
members.
Enter the address of each member(s).
Enter the percent share of the legal entity that each member owns.
Check “YES” if the member has signature authority for this entity.
Check “NO” if the member does not have signature authority for
this entity.

Part D, Items 1-6 Minor Members or Shareholders
Minor members

If none of the members listed Parts A-D is a minor, check “N/A”
(not applicable), then GO TO Part F.

1–5
Minor Members or
Shareholders

If any member listed in Parts A-D is a minor, provide the following
information about that member:
1)
2)
3)
4)
5)

Minor’s name
Minor’s date of birth
Name of the minor’s parent or guardian
Address of the parent or guardian
Taxpayer ID number of the parent or guardian

Note: If the complete taxpayer ID number is already on file at FSA,
only the last 4 digits are required.

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Fld Name /
Item No.

Instruction

6(a) – 6(d)
Separate Status of
Minors …

a) Check “YES” if any minor listed in Part E is a producer on a
farm and the parent or guardian has no interest. Check “NO” if
the minor is a producer on a farm and the parent or guardian has
an interest in the farming operation.

6(a) – 6(d)
Separate Status of
Minors …
(Continued)

b) Check “YES” if the minor listed in Part E maintains a separate
household from the parent or guardian and personally carries out
all farming activities with respect to the minor’s own farming
operation, including maintaining separate accounting. Check
“NO” if the minor does not maintain a separate household from
the parent or guardian and does not personally carry out all
farming activities with respect to the minor’s own farming
operation, including maintaining separate accounting
c) Check “YES” if the minor listed in Part E who is represented by
a court-appointed guardian or conservator, live in a household
other than the parents’ household(s), and have a vested
ownership in the farm. Check “NO” if the minor, who is
represented by a court- appointed guardian or conservator, does
not live in a separate household other than the parents’
household(s), and does not have a vested ownership in the farm.
d) If “YES” is checked for all Items 6(a) through 6(c), write the
name of the minor in the space provided at 6(d).

Part E, Item 7 Foreign Persons
7A
Citizenship Status

7B
Member/Shareholder

Check “YES”, if all members/shareholders are US Citizens. Go to
Part F.
Check “NO”, if one or more members/shareholders is not a US
Citizen. Complete Item 7B.
For each member/shareholder who is not a US Citizen:
(1) Enter name of individual
(2) Check if form I-551 is valid

Part F, Items 1-3 Certification
1
Signature (By)

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An individual member, or an authorized representative of the entity
identified in Part A, shall sign the certification.

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Fld Name /
Item No.

Instruction

2
Title/
Relationship

If an authorized representative for the entity identified in Part A
signs this document, use this field to show the individual’s
representative capacity. (For example, “agent” or “attorney-infact.”)

3
Date

Enter the date the form was signed.

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