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. If you would
like to establish online access credentials with USDA, follow the instructions
provided at the USDA eForms web site.
Part D Item 21B and Part E are for FSA use only.
Fld Name/Item No. |
Instruction |
|
1 Name, Address, and Telephone Number of Contact Producer |
Enter the contact producer’s name, address (including Zip Code) and telephone number (including Area Code). |
|
2 ID Number of Contact Producer |
Enter the ID number of the contact producer. |
|
3 Crop Year |
Enter the crop year of the commodity for which the payment is requested. |
|
Part A, 4 - 13 Producer's Terms and Conditions |
All producers requesting this Items 4 through 8 and 10 through 13. Enter a checkmark (U) in either the “YES” or the “NO” checkbox, and enter the producer's initials in the "Initials" checkbox for each of the items. Item 9. Enter a checkmark (U) in the applicable checkbox identifying if you are the “Original / first owner”, the “Second owner” or "Other owner" of the unshorn lambs that produced the unshorn pelt and enter initials in the applicable box for each of the item. NOTE: If you are an "Other owner" state which type of other owner you are in the applicable space. Item 13. Enter a checkmark (U) in the applicable checkbox to the question “Are you or any co-applicant delinquent on any federal non tax debt?” If “YES”, provide details. All producers signing the |
|
Part B, 14 Herd Certification |
Enter the total number of unshorn lambs in the producer’s current herd or flock. |
|
Part C 15 - 19 Producer's Certification |
Items 15 through 19. All producers requesting this NOTE: Item 16 is the signature and date field. If you are mailing or faxing this form, print the form and manually enter your signature and enter the date of the signature in Item 18. If this form is approved for electronic transmission and you have established credentials with USDA to submit forms electronically, use the buttons provided on the form for transmitting the form to the USDA servicing office. |
|
Part D, 20 Production Evidence |
If the producer requests payment and provides production evidence, check the applicable box and attach the production evidence to the payment request. No further action is necessary. If the producer is certifying to the quantity, Items 20, 21 (completed by FSA), and 21A through 21C are required. |
|
Part D, 21A Date Delivered, Sold, or Slaughtered |
Enter the applicable date the unshorn lambs were delivered for slaughter, sold for slaughter, or slaughtered for personal use. |
|
Part D, Item 21B ( |
|
|
Part D, 21C Number of Unshorn Pelts Requested |
Enter the number of unshorn pelts requested. This can be by day or a total of each day as applicable. |