Submit the original of the
completed form in hard copy or facsimile to the appropriate USDA servicing
office.
Producers who have established
electronic access credentials with USDA may electronically transmit this form
to the USDA servicing office, provided that the producer submitting the
form is the only person required to sign the transaction.
Features for transmitting the
form electronically are available to those producers 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.
Fld Name / |
Instruction |
1 Name |
Enter
the applicant’s name. |
2 Production
Cycle |
Enter
the beginning and ending date of the production cycle and check the
appropriate box to indicate if information provided is for projected or
actual income and expense. |
A – Income (Crop Sales) |
|
1A Description |
Enter
a description for each crop. |
1B
Acres |
Enter
the number of acres planned or actually produced. |
1C Yield |
Enter
the projected or actual yield per acre for each crop described in Item 1A. |
1D %
Share |
Enter
the share percent of ownership for each crop described in Item 1A. |
1E #
Units |
Enter
the number of units (Item 1B x Item
1C). |
Fld Name / |
Instruction |
1F Farm
Use |
Enter
the amount that will be used on the farm. |
1G #
Units |
Enter
the number of units for each crop to be purchased or purchased for sale. |
1H $/Unit |
Enter
the price per unit for each crop to be purchased or purchased for sale. |
1I Total
$ |
Enter
the total amount for each crop to be purchased or purchased for sale (Item 1G x Item 1H). |
1J #
Units |
Enter
the number of units to be sold or sold for each crop. |
1K $/Unit |
Enter
the price per unit for each crop to be sold or sold. |
1L Total
$ |
Enter
the total amount for each crop to be sold or sold. (Item 1J x Item 1K). |
2. Livestock and Poultry Sales |
|
2A Description |
Enter
a description for each type of livestock. |
2B Purch/Raised |
Check
(P) Purchased or (R) Raised for each type of livestock. |
2C #
Units |
Enter
the number of units for each livestock. |
2D Weight |
Enter
the average weight per unit of livestock to be purchased or purchased for
sale. |
2E $/Unit |
Enter the $/Unit for each type of livestock to be
purchased or purchased for sale. |
2F Total
$ |
Enter
the Total $ for each type of livestock to be purchased or purchased for
sale. (Items 2C x 2D x 2E). |
2G Death
Loss |
Enter
the loss due to death for each type of livestock. |
2H #
Units |
Enter
the number of units of livestock to be sold or sold. |
2I Weight |
Enter
the average weight per unit of livestock to be sold or sold. |
2J $/Unit |
Enter
the $/Unit for each livestock to be sold or sold. |
2K Total
$ |
Enter
the Total $ amount for each livestock to be sold or sold. (Items 2H x 2I x 2J) |
Fld Name / |
Instruction |
3. Dairy Livestock Sales |
|
3A Description |
Enter
a description for each type of dairy livestock. |
3B Purch/Raised |
Check
(P) Purchased or (R) Raised for each type of dairy livestock. |
3C #
Head |
Enter
# Head of dairy livestock for each type described in Item 3A. |
3D Weight |
Enter
the average weight per unit of dairy livestock to be purchased or purchased. |
3E $/Unit |
Enter
the $/Unit for each type dairy livestock to be purchased or purchased. |
3F Total
$ |
Enter
the Total $ amount for each type of dairy livestock to be purchased or
purchased. (Items 3C x 3D x 3E) |
3G Death
Loss |
Enter
the loss due to death for each type of dairy livestock. |
3H #
Units |
Enter
the number of units of dairy livestock to be sold or sold. |
3I Weight |
Enter
the average weight per unit of dairy livestock to be sold or sold. |
3J $/Unit |
Enter
the $/Unit for each type dairy livestock to be sold or sold. |
3K Total
$ |
Enter
the Total $ amount for each type of dairy livestock to be sold or sold. (Items 3H x 3I x 3J) |
4. Milk Sales |
|
4A Description |
Enter
type of milk. |
4B #Head |
Enter
the number of livestock to be produced or in production. |
4C Production/ Head/Year |
Enter
the production per head per year for the operating year. |
4D Total
Production |
Enter
the total production per year. (Item 4B
x Item 4C) |
4E Price |
Enter the current market price for the type of
milk produced. |
4F Sales
$ |
Enter the total annual sales. (Item 4D x Item 4E) |
Fld Name / |
Instruction |
5. Livestock Product Sales |
|
5A Description |
Enter
the type of livestock producing the commodity. (Sheep, Goats, Poultry etc.) |
5B Production |
Enter
the type of commodity produced. (Wool,
Eggs etc.) |
5C Measure |
Enter
the unit the commodity is to be sold or sold, such as weight or numbers. (Pounds of Wool, Dozens of Eggs) |
5D #
Units |
Enter
the # Units to be sold or sold. |
5E $/Unit |
Enter
the $/Unit to be sold or sold. |
5F Total
$ |
Enter
the Total $ for livestock products to be sold or sold. (Item 5D x Item 5E) |
6 Ag
Program Payments |
Enter
all farm program subsidy payments to be received or received during the
production cycle. (Separate by program). |
7 Crop
Insurance Proceeds |
Enter
all crop insurance payments to be received or received during the production
cycle. |
8 Custom
Hire Income |
Enter
income from custom work performed during the production cycle. |
9 Other
Income |
Enter
any other farm income received during the production cycle. (Gas
tax refunds, Rebates, etc.) |
10 Total
Income |
Enter
the total income from Item 1 through Item 9. |
B – Expenses (11 – 33) Enter
the expense amount associated with each item listed in Item 11 through Item
31. Include expenses financed with 30-60 day credit, credit cards, and open
store accounts. Historical
records should be used as a guide.
Expenses should be realistic.
Expenses entered should reflect what is being produced as provided in
A above (Item 1 through Item 5). |
|
32 Interest |
Enter
the interest expense to be paid during the production cycle. (Include
annual operating interest and all term note interest.) |
33 Total
Expenses |
Enter
the total expenses from Item 11 through Item 32. |
Fld Name / |
Instruction |
C - Non-Operating |
|
34 Owner
Withdrawal |
Enter
the total for family living expenses.
Include all household operating expenses and all non-farm debt
payments. |
35 Income Taxes |
Enter
the State and Federal income tax to be paid or paid during the production
cycle. |
36 Non-Farm Income |
Enter
all income from non-farm sources. |
37 Non-Farm Expenses |
Enter
all expenses associated with non-farm businesses. |
D - Capital |
|
38 Capital
Sales |
Enter the dollar amount to be received or received from the sale of depreciable items (equipment, breeding livestock) and real estate during the production cycle. |
39
Capital
Contributions |
Enter inflows of capital that are not the result of business operations or other income. Note: Capital contributions usually include gifts, inheritance, lottery winnings, the gift-value of substantial asset purchases for less than market value, and the capital contributions of entity members. Caution: Ensure that capital contributions are not double-counted in capital sales. |
40
Capital
Expenditures |
Enter the purchase of depreciable items (equipment, breeding livestock) and real estate during the production cycle. |
41 Capital
Withdrawals |
Enter outflows of capital that are
not the result of business operations or owner withdrawals. Note: Capital withdrawals usually include gifts,
the gift-value of substantial sales of assets for less than market value, and
withdrawals of capital by entity members. Caution: Ensure that capital withdrawals are not
double-counted in capital expenditures. |
Fld Name / |
Instruction |
E - Warning |
|
42A
Signature |
After reading the warning,
enter signature. If faxing or mailing the
form, print the form and manually enter your signature. This form is approved for electronic
transmission. If 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. Electronic transmission may
only be completed if you are the only person required to sign this form. |
42B Date |
Enter the date the form is
signed by the applicant. |