AD-2047 Instruction

Instructions for AD-2047
CUSTOMER DATA WORKSHEET
Customers use this form to provide critical customer information to USDA used to
positively identify the customer. Data collected includes contact information, citizenship
status, birthdates for minor children and demographic information. Customers may also
use this form to report changes to their customer record. Submit the original of the
completed form by mail, email, Box, OneSpan, 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 document, (2)
the person signing the document on behalf of another customer has a valid Power of
Attorney (Form FSA-211) on file with USDA to sign for the customer. (3) the person
signing the document on behalf of a legal entity is an authorized representative of the legal
entity.
Features for submitting 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 web site.

Customers must complete Items 1 through 7C.
Fld Name /
Item No.

1
Reason for
Request
2A
Customer’s Full
Name or
Business Name
and Address
2B
Customer
Business Type
2C
Home Telephone
Number
2D
Business
Telephone
Number
2E
Mobile
Telephone
Number

Instruction
Check if this form is being completed for a new customer or if an existing customer
is updating their existing customer record.
Enter customer’s full name exactly as it appears on SSN card, or business name
exactly as it appears on IRS SS-4 or 147-C letter (EIN issuance letter).
Enter customer’s mailing address, including Zip Code.
Enter customer’s business type (Individual, Corporation, LLC, Estate, Revocable
Trust, etc)
Enter customer’s home telephone number, including area code, if applicable.
Enter customer’s business telephone number, including area code, if applicable.

Enter customer’s mobile telephone number, including area code, if applicable.

Fld Name /
Item No.

2F
Email Address
2G
Does the
customer want to
receive sensitive
(but non-PII)
Producer or
Farm Specific
emails?
3A
Tax ID Number
(9 digits) and
Type (SSN, EIN,
etc)
3B
Birthdate
3C
Citizenship
Status (for
Individuals only)
3D
Originating
Country (For
Foreign Entities
Only)
Demographic
Information
Consent

Instruction
Enter customer’s e-mail address, if applicable.
Check YES to receive sensitive (non-personal information) customer or farm
specific related e-mails. Check NO to NOT receive sensitive (non-personal
information) customer or farm specific related e-mails.
Note: Examples of sensitive e-mail subjects include Noninsured Crop Disaster
Assistance Program (NAP) continuous coverage letters,
NAP premium billing information, and acreage report information.
New customers must enter a valid 9-digit Taxpayer Identification Number and type,
if the customer will be applying for a USDA payment or benefit. Existing customers
must enter the last (4) digits of their 9-digit Taxpayer Identification Number.
Enter customer’s birthdate. Required only if the customer is a minor child, under
the age of 18, at the time this form is being completed.
A customer that is an individual person must enter customer’s citizenship status and
citizenship country (if not US)
A customer that is a foreign entity must enter foreign entity’s originating country. A
foreign entity is a legal entity with more than 10 percent ownership interest held by
persons who are not a U.S. citizen or resident alien.
Read consent:
Departmental Regulation 4370-001 provides USDA’s policies for collecting
demographic data, including race, ethnicity and gender. Providing demographic
information on AD-2047 is voluntary and at the discretion of the customer.
Demographic information provided on this form is used by USDA for statistical
purposes only and will not be used to determine an applicant’s eligibility for
programs or services for which they apply. You may disregard providing
information in items 4A, 4B, 4C and 4D if the information has previously been
provided to USDA. A customer identified in Item 2A that is a legal entity must base
responses to the race, ethnicity and gender on the individual person(s) holding at
least 50 percent ownership interest in the legal entity.
Customers may opt to decline providing race, ethnicity or gender information.
To be completed only by customer.

4A
Race
4B
Ethnicity
4C
Gender
(Individual)
4D
Gender (Legal
Entity)

Check customer’s Race or Races. Select as many as applicable. To be completed
only by customer.
Check customer’s Ethnicity. To be completed only by customer.
Check Individual customer’s Gender. To be completed only by customer.
Check Entity’s Gender. To be completed only by a customer that is a legal
entity.

Fld Name /
Item No.

5
Producer is
Customer of One
or More of the
Following
Agencies
6
Is the Customer
a Multi-County
Producer?
7A
Customer
Signature

Instruction
Check the applicable USDA Agency(s) where the customer participates in USDA
programs.

Check YES or NO. If YES, the customer must identify all States and/or Counties in
which the customer has an interest.
The customer’s signature is required when the customer completes any items on this
form. A customer’s signature may be provided using an FSA-211 Power of
Attorney. An authorized representative of a legal entity must sign if the customer is
a legal entity.
A customer’s signature is not required if documentation is received for items 1
through 6 by Fax, Box1, or One Span2 or from a trusted source (i.e. USPS). Such
documentation must be attached to this form.

7B
Title/
Relationship
7C
Date of Record
Change

A customer’s signature is not required if documentation for items 4A, 4B, 4C, or 4D
is provided by phone or in writing. The USDA employee receiving the information
must notate in Item 7A the method the information was obtained if not signed by the
customer. A Receipt for Service is required.
If this form is signed by a person or legal entity representing the customer identified
in Item 2A, enter the signatory’s title or representative capacity to the customer.
Enter the date the customer requesting the change signed the form.

Part B - Items 8A through 12B are for FSA use only.

1[1]

Box is a secure, cloud-based site where FSA documents can be managed and shared. Applicants who
choose to use Box can create a username and password to access their secure Box account, where
documents can be downloaded, printed, manually signed, scanned, uploaded, and shared digitally with
FSA county office staff. This service is available to any FSA customer with access to a mobile device or
computer with printer connectivity. Box does not require software downloads or an eAuthentication
account.
2

OneSpan is a secure eSignature solution for FSA customers. No software downloads or eAuthentication
is required for OneSpan. Applicants interested in eSignature through OneSpan can confirm their identity
through two-factor authentication (2FA). For the second factor of authentication, applicants can use a
text message