Fsa-1140 Marketing Assistance For Specialty Crops (masc) Applicat

FSA-1140
(Proposal)

OMB Approved No: 0503-0028
OMB Expiration Date: 2027

FOR COUNTY OFFICE USE ONLY
1. Recording State
2. Recording County

U.S. DEPARTMENT OF AGRICULTURE
Farm Service Agency

Name

MARKETING ASSISTANCE FOR SPECIALTY CROPS (MASC) APPLICATION

Code

3. Program Year

Name

Code

4. Application Number

INSTRUCTIONS: Return this completed form to your County FSA Office

PART A – PRODUCER AGREEMENT

The Department of Agriculture (USDA) will make MASC payments to producers who meet the requirements of the program. The following information is needed for USDA
to make a determination that the applicant is eligible to receive a MASC payment. By submitting this application, and upon approval by USDA, the producer agrees:
1. To comply with the Notice of Funds Availability (NOFA) published by FSA. A copy of this document may be found at:[insert program website].
2. That they are in the business of producing a specialty crop at the time of application and are entitled to an ownership share and share in the risk of producing a
specialty crop that will be sold in calendar year 2025;
3. That a MASC payment will only be made with respect to sales for specialty crops grown by the producer in the United States;
4. To comply with payment limitation, adjusted gross income, and other applicable rules by submitting the following as required by the NOFA:
• FSA-1141, Marketing Assistance for Specialty Crops (MASC) New Producer Expected Sales Worksheet, and supporting documentation, if applicable
• CCC-902, Farm Operating Plan for Payment Eligibility
• CCC-901, Member Information for Legal Entities, if applicable
• CCC-941, Average Adjusted Gross Income (AGI) Certification and Consent to Disclosure of Tax Information
• CCC-942, Certification of Income from Farming, Ranching and Forestry Operations
• AD-1026, Highly Erodible Land Conservation (HELC) and Wetland Conservation (WC) Certification
• AD-2047, Customer Data Worksheet.

PART B – PRODUCER INFORMATION
1. Producer’s Name (Person or Legal Entity)

2. Information Line

3A. Address Line 1

4A. Primary Phone Number

Home

Cell

3B. Address Line 2

4B. Alternate Phone Number

Home

Cell

3C. City

3D. State

3E. Zip

5. Email Address
DATE STAMP

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FSA-1140 (Proposal 4)

PART C – SALES
6. Year

7. Total Specialty Crop Sales
2023

2024

2025 (new producer only)

$

FOR COUNTY OFFICE USE ONLY
8. COC Adjusted Sales
$

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.
9A. Producer’s Signature
9B. Title/Relationship of Representative
9C. Date (MM/DD/YYYY)

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

11. Date (MM/DD/YYYY)

12. Determination
Approved
Disapproved

Privacy Act Statement: 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 the Commodity Credit Corporation (CCC) Charter Act (15 U.S.C. 714c(e)). 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. Send comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden by emailing to: [email protected] (OMB NO. 0503-0028).
Non-Discrimination Statement: 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 How to File a Program Discrimination Complaint 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. 202509410; (2) fax: (202) 690-7442; or (3) email: mailto:[email protected].
USDA is an equal opportunity provider, employer, and lender.