Instructions For CCC-901

MEMBER'S INFORMATION

Producers are required to complete this form to report information about their farming operation. This information is used by FSA to determine the ownership interest of entities for payment limitation 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.  To establish online access credentials with USDA, follow the instructions provided at the USDA eForms web site.

All items applicable to the payment entity must be completed by following the instructions provided below.

Items 1-3

Fld Name /
Item No.

Instruction

1 and 2

County and State Name

Enter the name of the county and State where the farming operation is located.  If in more than one county, enter the name of the county that has been designated as the administrative county.  

3

Program Year

Enter the current program year, or the year for which this information is applicable.

Part A, Items 1-5

Fld Name /
Item No.

Instruction

Part A

Legal Entity Name

Enter the name of the legal entity earning the payment.

 

 

1

Member’s Name

Enter the names of the members making up the legal entity listed in Part A. (This could be a person or a legal entity.)

2

Social Security Number/ Tax ID Number

Enter the social security number or tax identification number of the members.

3

Address

Enter the address of each member of the legal entity.

4

Percent Share

Enter the percent share of the legal entity that each member owns.

5

Signature Authority

Check “YES” if the member has signature authority for this entity.

Check “NO” if the member does not have signature authority for       this entity.

Part B

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

Part B, Items 1-5

Fld Name /
Item No.

Instruction

Part B

Embedded Legal Entity Name

Enter the name of the embedded legal entity that is a member of the legal entity entered in Part A.

 

1

Member’s Name

Enter the names of the members making up the legal entity listed in  Part B. (This could be a person or a legal entity.)

2

Social Security/Tax ID Number

Enter the social security number or tax identification number of the members.

3

Address

Enter the address of each member of the entity.

4

Percent Share

Enter the percent share of the legal entity that each member owns.

5

Signature Authority

Check “YES” if the member has signature authority for this entity.

Check “NO” if the member does not have signature authority for        this entity.

Part C

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

Part C, Items 1-5

Field Name /
Item No.

Instruction

Part C

Embedded Legal Entity Name

Enter the name of the embedded legal entity that is a member of the legal entity entered in Part B.

 

1

Member’s Name

Enter the names of the members making up the legal entity listed in  Part C. (This could be a person or  legal entity.)

2

Social Security/Tax ID Number

Enter the social security number or tax identification number of the members.

3

Address

Enter the address of each member(s).

4

Percent Share

Enter the percent share of the legal entity that each member owns.

5

Signature Authority

Check “YES” if the member has signature authority for this entity.

Check “NO” if the member does not have signature authority for        this entity.

Part D

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

Part D, Items 1-5

Fld Name /
Item No.

Instruction

Part D

Embedded Legal Entity Name

Enter the name of the embedded legal entity that is a member of the legal entity entered in Part C.

 

1

Member’s Name

Enter the names of the members making up the legal entity listed in Part D. (This could be a person or a legal entity.)

2

Social Security/ Tax ID Number

Enter the social security number or tax identification number of the member(s).

3

Address

Enter the address of each member(s).

4

Percent Share

Enter the percent share of the entity that each member owns.

5

Signature Authority

Check “YES” if the member has signature authority for this entity.

Check “NO” if the member does not have signature authority for        this entity.

 

Part E, Items 1-6  Minor Members or Shareholders

Fld Name / Item No.

Instruction

 Minor members

If none of the members listed Parts A-D is a minor, check “N/A” (not applicable), then GO TO Part F.

1 – 5

Minor Members or Shareholders

If any member listed in Parts A-D is a minor, provide the following information about that member:

 

   1)   Minor’s name

   2)   Minor’s date of birth

3)       Name of the minor’s parent or guardian

4)       Address of the parent or guardian

5)      Taxpayer ID number of the parent or guardian

 

   Note: If the complete taxpayer ID number is already on file at

             FSA, only the last 4 digits are required.

6(a) – 6(d)

Separate Status of Minors …

a)   Check “YES” if any minor listed in Part E is a producer on a farm and the parent or guardian has no interest.  Check “NO” if the minor is a producer on a farm and the parent or guardian has an interest in the farming operation.

 

b)  Check “YES” if the minor listed in Part E maintains a separate

      household from the parent or guardian and personally carries out all

      farming activities with respect to the minor’s own farming

      operation, including maintaining separate accounting.  Check “NO”

      if the minor does not maintain a separate household from the parent

      or guardian and does not personally carry out all farming activities

      with respect to the minor’s own farming operation, including

      maintaining separate accounting

 

c)  Check “YES” if the minor listed in Part E who is represented by a  

     court-appointed guardian or conservator, live in a household other

     than the parents’ household(s), and have a vested ownership in the

     farm.  Check “NO” if the minor, who is represented by a court-

     appointed guardian or conservator, does not live in a separate

     household other than the parents’ household(s), and does not have a

     vested ownership in the farm. 

 

d)   If “YES” is checked for all Items 6(a) through 6(c), write the name of the minor in the space provided at 6(d).

Part F, Items 1-3 Certification

Field Name/ Item No.

Instruction

1

Signature (By)

An individual member, or an authorized representative of the entity identified in Part A, shall sign the certification.

2

Title/

Relationship

If an authorized representative for the entity identified in Part A signs this document, use this field to show the individual’s representative capacity.  (For example, “agent” or “attorney-in-fact.”)

 

3

Date

Enter the date the form was signed.