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.
Items 1A - 7D are for FSA use only.
Items 8A - 21B
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Fld Name /Item No. |
Instruction |
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8A Crop Name |
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Crop Type |
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9 What disaster event
caused loss? |
Enter disaster event
that caused loss, such as tornado, hurricane, drought, flood, disease,
aflatoxin, virus, insect infestation, etc.�� |
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10B Ending disaster date |
Enter ending date of the disaster event. |
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11 When
was loss apparent? |
Enter date when damage or loss of crop was apparent. |
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12 For
the crop type entered in Item 8, was there � |
Enter
a checkmark in either the "YES" or "NO" checkbox to
answer the question to Item 12. |
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13 Check
type of loss suffered as a result of the event identified in Item 9. |
Enter a checkmark to identify the type of loss suffered as a result of the event identified in Item 9:� that is, prevented planting, and or damaged crop, and or low yield. Appraisal is required for damaged/low yield crop before destruction to be eligible for NAP benefits. |
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14 |
Check the applicable practice of Irrigated or Non-Irrigated identified in Item 8.� If both practices are used, check both. |
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15A &B |
If� "Prevented Planting" is checked in Item 13, enter intended but prevented acreage in Item A.� If planted acreage, enter the acreage in Item B. |
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For intended but
prevented acreage entered in Item 15� |
For intended but prevented acreage entered in Item 15, provide evidence of purchase, delivery, and or arrangement for seed, chemicals, fertilizer, and land preparation measures for acreage affected. NOTE:� COC
may require attachment of expense receipts to verify preparation measures. |
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If "Low
Yield" is checked in Item 13, enter total crop acreage and affected crop
acreage. |
If "Low Yield" is checked in Item 13, enter total crop acreage and affected crop acreage. |
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18 What cultivation
practices have been and will be employed on damaged crop acreage? |
If damaged crop and or low yield is checked in Item 13, explain cultivation practices for expected crop production, before and after date of damage, on affected crop acreage. |
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19 What will be done with
damaged� crop acreage? |
Describe what will be done with damaged crop acreage (include dates), that is, will be destroyed, replanted to another crop, not harvested, not planted.� If crop is harvested, provide production evidence to the local FSA County Office. |
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20 What has been done
with prevented planted or damaged crop acreage? |
Describe what has been done with prevented planted or damaged crop acreage (include dates), that is, will be destroyed, replanted to another crop, not harvested, not planted. If crop is harvested, provide production evidence to the local FSA County Office. |
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21 Producer Certifies� |
Producer
will read the certification statement in Item 21 before signing in Item 21
A.� The producer is certifying that all
information in Part B is correct and acknowledges receipt of� copy of this form. |
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21A & B Producer's
Signature and Date |
Producer shall sign and date certifying to information on form. NOTE:� As long as 1 person having an interest in the farming operation files a timely notice of loss, according to paragraph 401, all producers having an interest will be considered timely filed. If
you are mailing or faxing this form, print the form and manually enter your
signature.� 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. |
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Items
22A - 58 are for FSA use only. Part
G, Certification and Application for Payment, should be read by the Producer certifying
that all information provided is true and correct before signing Items 59A
and 58B. |
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59A & B Producer's
Signature and Date |
Producer shall sign and date certifying to information on the form.� Each producer with a share in the farming relationship must complete and sign a separate CCC-576, Part G for their share of eligible NAP benefits. If
you are mailing or faxing this form, print the form and manually enter your
signature.� 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. |
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