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File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
File Title	This form is available electronically
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File Modified	2026-06-12
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This form is available electronically. Form Approved - OMB No. 0560-0082
OMB Expiration Date: XX/XX/XXXX
FSA-848B U.S. DEPARTMENT OF AGRICULTURE
(06-16-25) Farm Service Agency

COST-SHARE PERFORMANCE CERTIFICATION AND PAYMENT

(See Page 3 for Privacy Act and Burden Statements.)
1. ST. & CO. Code :

2. County Office Name, Address and Telephone Number
THIS CERTIFICATION AND REQUEST FOR PAYMENT is submitted by the undersigned owners, operators, tenants, and/or producers (who individually will herein be referred to as "the Participant"). By signing this form, the Participant agrees to the following: 1) the Participant requested cost-share assistance to perform practice(s) designed to meet the objectives of the program referenced on FSA-848; 2) the Participant agrees that this practice(s) would not be performed without Federal cost-sharing; and, 3) for the practice(s) approved, the Participant agrees to refund all or part of the funds paid to him/her, as determined appropriate by the Approving Official, if, before expiration of the lifespan of the specified practice(s), the Participant (a) destroys the approved practice(s), or (b) voluntarily relinquishes control of or title to, the land on which the approved practice(s) has been established, and the new owner and/or operator of the land does not agree in writing to properly maintain the practice(s) for the remainder of its life span. The Participant further agrees that if he or she began the practice(s) before receiving written approval, he or she may be denied cost-share funding. Further, the Participant hereby authorizes a representative of USDA to have access to the practice site area(s). Further, the participant understands that form FSA-848B-1 is by reference incorporated herein. BY SIGNING THIS CERTIFICATION, THE PARTICIPANT ACKNOWLEDGES RECEIPT OF THE FOLLOWING FORMS: FSA-848B AND ANY ADDENDUM THERETO.

3. Application Number

4. Agreement Number

5. Program Year

6. Disaster ID Number

7. Program Code

8. Contract ID (If applicable)

NOTE: To receive payment or credit for any cost-shares earned on these practice(s), report performance below, by completing Items 9 and
10, and file with the issuing FSA county office by the practice expiration date(s) listed on the FSA-848A.

9. PRACTICES PERFORMED
A.
Farm No.
B.
Tract No.
C.
Field No.
D.
Practice Control No.
E.
Practice Units
F.
Practice Extent Approved
G.
Is the Practice Complete?
(YES or NO)
H.
Acres Served
I.
Approved
Cost-Share
J.
Total Installation Cost
K.
If practice is not complete and cost-share is still requested for this practice, list codes for completed components.
L. TOTALS:
Instructions to participant To receive payment or credit for any cost-shares earned on this agreement, report performance on page 1; and file with the issuing FSA county office by the practice expiration dates.
10. Certification BY PArticipant. I certify that the above information is true and correct. I further certify that the entry(ies) in Item 9G show that the practice(s) was performed in accordance with the practice specifications and other requirements.
If Item 9G indicates that the practice is not complete, I request cost-share for the completed components shown in Item 9K. I agree to complete the remaining components approved on the FSA-848A, for this practice(s), by the practice expiration date,
regardless of whether or not cost-share assistance is approved. I agree to refund any cost-share assistance paid to me under this practice(s), if I fail to complete it. I hereby apply for payment to the extent that the Approving Official has determined that the
practice has been performed and further certify that this payment is not a duplicate of any other earned by me. I agree to maintain and use the practice(s) for the minimum maintenance period established for the practice(s). I agree to refund all or part of
the cost-share assistance paid to me, as determined by the Approving Official, if before expiration of the practice lifespan specified above, (a) I destroy the practice installed, or (b) voluntarily relinquish control or title to the land on which the installed
practice(s) have been established and the new owner and/or operator of the land does not agree in writing to properly maintain the practice(s) for the remainder of these lifespan. I understand that FSA-848 and FSA-848A and any addendum thereto are by
reference incorporated herein and with this form constitutes the entire agreement between the parties.
A(1) Did you and the other participants on this agreement bear all the expense (except for program cost sharing) for
performing this practice?

YES NO
B(1) During the current fiscal year Oct. 1 – Sep. 30, have you received or will you or any participant on this
agreement receive a cost-share payment under the same program on this or any other farm other than
through this FSA-848B?

YES NO
A(2) If “NO”, report name(s) and addresses of other person(s) or agency who bore any part of the expenses. Also, show
kind, extent and value of their contribution.
B(2) If “YES”, report State, County, and amount by farm.
C. Participant Signature (By)
D. Title/Relationship of the Individual If Signing in a Representative Capacity
E. Date (MM-DD-YYYY)

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, 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 State or local Agency that administers the program or contact USDA through the Telecommunications Relay Service at 711 (voice and TTY). Additionally, program information may be made available in languages other than English.

FSA-848B (06-16-25) Page 2
11. AGREEMENT INFORMATION
EMERGENCY PROGRAMS ONLY
A. Program Code
B. Program Year
C. ST. & CO. Code
D. Agreement Number
E. Contract ID
F. Disaster ID
12. PRACTICE EXTENT PERFORMED
A.
Farm No.
B.
Tract No.
C.
Field No.
D.
Practice Control No.
E.
Practice Units
F.
Practice Extent Approved
G.
Practice Extent Performed
H.
Acres Served
I.
Approved
Cost-Share
J.
Total Installation Cost
K.
Cost-Share
Earned
L. TOTALS:
13. COMPONENT EXTENT PERFORMED
A.
Farm No.
B.
Tract No.
C.
Field No.
D.
Practice Control No.
E.
Component No.
F.
Component Title
G.
Component Units
H.
Component Extent Approved
I.
Approved
Cost-Share
J.
Component Extent Performed
K.
Cost-Share
Earned
14. TECHNICAL PRACTICE EXTENT APPLIED
A.
Farm No.
B.
Tract No.
C.
Field No.
D.
Practice Control No.
E.
Technical
Practice Code
F.
Technical Practice Title
G.
Technical
Practice Units
H.
Technical Practice
Cost-Shared
I.
Technical Practice Extent Planned
J.
Technical Practice Extent Applied
YES NO
YES NO
YES NO
15.
Performance Certification
A. Signature of Technical Service Provider or Participant
B. Date
C. Affiliation
D. Practice Control Number
E. Performance Statement

FSA-848B (06-16-25) Page 3
16. AGREEMENT INFORMATION
EMERGENCY PROGRAMS ONLY
A. Program Code
B. Program Year
C. ST. & CO. Code
D. Agreement Number
E. Contract ID
F. Disaster ID
17. COST-SHARE DETAILS
A.
Farm No.
B.
Tract No.
C.
Field No.
D.
Practice Control No.
E.
Component
No.
F.
Participant’s Name
G.
Program Accounting Code
H.
Partial or
Final Payment for Practice
I.
Partial or Final Payment for Agreement
J.
Cost-Share Earned
18. USDA USE ONLY – Performance Approval
A. Signature of FSA Representative
B. Date (MM-DD-YYYY)
C. Total Approved
Cost-Share
D. Current Earned
Amount
E. If Final, Total Cost-
Share Earned

NOTE:
The following statement is made in accordance with the Privacy Act of 1974 (5 U.S.C. 552a - as amended). The authority for requesting the information identified on this form is 7 CFR Part 701, 7 CFR Part 1410, the Commodity Credit Corporation Charter Act (15 U.S.C. 714 et seq.), and 16 U.S.C. § 2201-2206. The information will be used to determine eligibility to participate in and receive benefits under a cost-share assistance program through documentation of the participant’s agreement to comply with the terms and conditions contained in the cost-share performance certification and payment request. The information collected on this form may be disclosed to other Federal, State, 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 to participate in and receive benefits under a cost-share assistance program.
Public Burden Statement (Paperwork Reduction Act): According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0560-0082. The time required to complete this information collection is estimated to average 3 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. 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]. RETURN THIS COMPLETED FORM TO YOUR COUNTY FSA OFFICE.
By signing this form, the Participant acknowledges and understands that any false representation or claims are subject to civil and criminal penalties including, but not limited to those under 18 U.S.C. 1001.

This form is available electronically. Form Approved - OMB No. 0560-0082
OMB Expiration Date: 12/31/2026
FSA-848B-1 U.S. DEPARTMENT OF AGRICULTURE
(06-16-25) Farm Service Agency

CONTINUATION SHEET FOR COST-SHARE PERFORMANCE CERTIFICATION AND PAYMENT
NOTE:
The following statement is made in accordance with the Privacy Act of 1974 (5 U.S.C. 552a - as amended). The authority for requesting the information identified on this form is 7 CFR Part 701, 7 CFR Part 1410, the Commodity Credit Corporation Charter Act (15 U.S.C. 714 et seq.), and 16 U.S.C. § 2201-2206. The information will be used to determine eligibility to participate in and receive benefits under a cost-share assistance program through documentation of the participant’s agreement to comply with the terms and conditions contained in the cost-share performance certification and payment request. The information collected on this form may be disclosed to other Federal, State, 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 to participate in and receive benefits under a cost-share assistance program.
Public Burden Statement (Paperwork Reduction Act): According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0560-0082. The time required to complete this information collection is estimated to average 2 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. 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]. RETURN THIS COMPLETED FORM TO YOUR COUNTY FSA OFFICE.
By signing this form, the Participant acknowledges and understands that any false representation or claims are subject to civil and criminal penalties including, but not limited to those under 18 U.S.C. 1001.
1. AGREEMENT INFORMATION
EMERGENCY PROGRAMS ONLY
A. Program Code
B. Program Year
C. ST. & CO. Code
D. Agreement Number
E. Contract ID
F. Disaster ID
2. PRACTICES PERFORMED
A.
Farm No.
B.
Tract No.
C.
Field No.
D.
Practice Control No.
E.
Practice Units
F.
Practice Extent Approved
G.
Is the Practice Complete?
(YES or NO)
H.
Acres Served
I.
Approved
Cost-Share
J.
Total Installation Cost
K.
If practice is not complete and cost-share is still requested for this practice, list codes for completed components.
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, 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 State or local Agency that administers the program or contact USDA through the Telecommunications Relay Service at 711 (voice and TTY). 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, Mail Stop 9410, 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-848B-1 (06-16-25) Page 2
3. AGREEMENT INFORMATION
EMERGENCY PROGRAMS ONLY
A. Program Code
B. Program Year
C. ST. & CO. Code
D. Agreement Number
E. Contract ID
F. Disaster ID
4. PRACTICE EXTENT PERFORMED
A.
Farm No.
B.
Tract No.
C.
Field No.
D.
Practice Control No.
E.
Practice Units
F.
Practice Extent Approved
G.
Practice Extent Performed
H.
Acres Served
I.
Approved
Cost-Share
J.
Total Installation Cost
K.
Cost-Share
Earned
5. COMPONENT EXTENT PERFORMED
A.
Farm No.
B.
Tract No.
C.
Field No.
D.
Practice Control No.
E.
Component No.
F.
Component Title
G.
Component Units
H.
Component Extent Approved
I.
Approved
Cost-Share
J.
Component Extent Performed
K.
Cost-Share
Earned
6. TECHNICAL PRACTICE EXTENT APPLIED
A.
Farm No.
B.
Tract No.
C.
Field No.
D.
Practice Control No.
E.
Technical
Practice Code
F.
Technical Practice Title
G.
Technical
Practice Units
H.
Technical Practice
Cost-Shared
I.
Technical Practice Extent Planned
J.
Technical Practice Extent Earned
YES NO
YES NO
YES NO
7.
Performance Certification

A. Signature of Technical Service Provider or Participant
B. Date
C. Affiliation
D. Practice Control Number
E. Performance Statement

FSA-848B-1 (06-16-25) Page 3
8. AGREEMENT INFORMATION
EMERGENCY PROGRAMS ONLY
A. Program Code
B. Program Year
C. ST. & CO. Code
D. Agreement Number
E. Contract ID
F. Disaster ID
9. COST-SHARE DETAILS
A.
Farm No.
B.
Tract No.
C.
Field No.
D.
Practice Control No.
E.
Component
No.
F.
Participant’s Name
G.
Program Accounting Code
H.
Partial or
Final Payment for Practice
I.
Partial or Final Payment for Agreement
J.
Cost- Share Earned