Instructions For CCC-501A

MEMBER'S INFORMATION

Producers use this form to report information about their farming operation that is used by FSA to determine the structure of entities for payment 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. If you would like to establish online access credentials with USDA, follow the instructions provided at the USDA eForms web site.

Producers must complete all items applicable to the payment entity following the instructions provided below.

Items 1-2

Fld Name / Item No.	Instruction
1 Program Year	Leave this item blank.
2 County and State	Enter the name of the county and State where you farm. If you farm in more than one county, enter the name of the county that has been designated as your control county.

Part A and items 3-6

Fld Name / Item No.	Instruction
Part A Entity Name	Enter the name of the entity earning the payment.
3 Member’s Name	Enter the names of the members making up the entity listed in part A. (This could be an individual or an entity.)
4 Social Security Number/ Employer ID Number	Enter the social security number or employer identification number of the members. (If a member has both types of identification numbers, enter both.)
5 Address	Enter the address of each member of the entity.
6 Percent Share	Enter the percent share of the entity that each member owns.

Part B

Embedded Entities – If any member listed in Part A, item 3 is an entity (i.e., part of another partnership, corporation, etc.) list the members of that entity in this item. (If more than one member is an entity, use a separate, supplemental sheet to provide the requested information for each embedded entity.)

Part B and items 7-10

Fld Name / Item No.	Instruction
Part B Embedded Entity Name	Enter the name of the embedded entity that is a member of the entity entered in Part A.
7 Member’s Name	Enter the names of the members making up the entity listed in part B. (This could be an individual or an entity.)
8 Social Security/ Employer Identification Number	Enter the social security number or employer identification number of the members. (If a member has both types of identification numbers, enter both.)
9 Address	Enter the address of each member of the entity.
10 Percent Share	Enter the percent share of the entity that each member owns.

Part C

Embedded Entities – If any member listed in Part B, item 7 is an entity (i.e., part of another partnership, corporation, etc.) list the members of that entity in this item. (If more than one member is an entity, use a separate, supplemental sheet to provide the requested information for each embedded entity.)

Part C and items 11-14

Fld Name / Item No.	Instruction
Part C Embedded Entity Name	Enter the name of the embedded entity that is a member of the entity entered in Part B.
11 Member’s Name	Enter the names of the members making up the entity listed in part C. (This could be an individual or an entity.)
12 Social Security/ Employer Identification Number	Enter the social security number or employer identification number of the members. (If a member has both types of identification numbers, enter both.)
13 Address	Enter the address of each member(s).
14 Percent Share	Enter the percent share of the entity that each member owns.

Part D

Embedded Entities – If any member listed in Part C, item 11 is an entity (i.e., part of another partnership, corporation, etc.) list the members of that entity in this item. (If more than one member is an entity, use a separate, supplemental sheet to provide the requested information for each embedded entity.)

Part D and items 15-18

Fld Name / Item No.	Instruction
Part D Embedded Entity Name	Enter the name of the embedded entity that is a member of the entity entered in Part C.
15 Member’s Name	Enter the names of the members making up the entity listed in part D. (This could be an individual or an entity.)
16 Social Security/ Employer Identification Number	Enter the social security number or employer identification number of the member(s). (If a member has both types of identification numbers, enter both.)
17 Address	Enter the address of each member(s).
18 Percent Share	Enter the percent share of the entity that each member owns.

Part E

Embedded Entities – If any member listed in Part D, item 15 is an entity (i.e., part of another partnership, corporation, etc.) list the members of that entity in this item. (If more than one member is an entity, use a separate, supplemental sheet to provide the requested information for each embedded entity.)

Part E and items 19-22

Fld Name / Item No.	Instruction
Part E Embedded Entity Name	Enter the name of the embedded entity that is a member of the entity entered in Part D.
19 Member’s Name	Enter the names of the members making up the entity listed in part E. (This could be an individual or an entity.)
20 Social Security/ Employer Identification Number	Enter the social security number or employer identification number of the members. (If a member has both types of identification numbers, enter both.)
21 Address	Enter the address of each member(s).
22 Percent Share	Enter the percent share of the entity that each member owns.

Part F – Use Part F to list any member(s) that own more than a 50 percent share of other entities.

Part F and items 23-30

Fld Name / Item No.	Instruction
Part F Embedded Entity Name	Enter the name of the embedded entity that is a member of the entity entered in Part E.
23 & 27 Member’s Name	Enter the names of the members making up the entity listed in part F. (This could be an individual or an entity.)
24 & 28 Social Security/ Employer Identification Number	Enter the social security number or employer identification number of the member(s). (If a member has both types of identification numbers, enter both.)
25 & 29 Address	Enter the address of each member(s).
26 & 30 Percent Share	Enter the percent share of the entity that each member owns.

Part G – Certification and items 31-33

The person authorized to sign for the payment entity must read the certification and sign the document, enter their title, and date the form.