Subject: Instructions for CCC-526
From: <Saved by Windows Internet Explorer 7>
Date: Fri, 15 Oct 2010 16:01:45 -0400

Instructions
for CCC-926

Average
Adjusted Gross Income (AGI) Statement

This
certification statement is to be used for 2009 and subsequent
years.

This form is used to certify compliance with
the adjusted gross income provision   for the receipt of commodity,
conservation and price support program benefits.    See page 2 of the form for
eligibility requirements and definitions.
Submit the original of the completed form in hard copy or facsimile to
the appropriate USDA 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.
Submit this completed form to the address
specified in Item 1.

Complete
Items 1 through 8; sign and date in Items 9 through
11.

Fld Name /
Item No.

Instruction

1

County FSA Office or
Service…

Enter the
name, address of the county Farm Service Agency or Service Center office that
this form will be submitted.

2

Person or
Legal Entity’s…

Enter the
person or legal entity’s name and address for commodity, conservation and
price support program benefits.

3

ID

No.

Enter the last
4 digits the social security or tax identification number of the person or
legal entity represented in Item 2.

4

Select the
year for which…

Enter a
checkmark next the year for which program benefits are requested.  (Select only
one.)

The year
selected indicates the 3-year period that will be used in the
determination of the average adjusted gross income for payment
eligibility.

5

Average adjusted gross non-farm income of
$500,000…

Average adjusted gross non-farm income of $500,000 or
less for the applicable 3-year period for the program year selected in
Item 4.

Check the
appropriate response.  Select
A for “YES” or select B for “NO.”

6

Average adjusted gross farm income of $750,000…

Average adjusted gross farm income of $750,000 or less
for the applicable 3-year period for the program year selected in Item
4.

Check the
appropriate response.  Select
A for “YES” or select B for “NO.”

7

Average adjusted gross non-farm income of $1
million…

Average adjusted gross non-farm income of $1 million or
less for the applicable 3-year period for the program year selected in
Item 4.

Check the
appropriate response. Select A for “YES” or select B for
“NO.”

8

Was the Average adjusted gross farm income…

Was the Average adjusted gross farm income for the
applicable 3-year period selected in Item 4 at least 66.66% of the average
adjusted gross income (both farm and nonfarm income). Check the appropriate response.  Select A for “YES” or select B for
“NO.”

If “YES” is
checked, and if income includes the sale of farm equipment or production
inputs and services to farmers, ranchers, foresters and farming
operations, please review the definition of Farm Income on Page 2.

9

Signature

Read the
acknowledgments, responsibilities and authorizations, before affixing
signature.

For all types
of entities, the form must be signed by a duly authorized representative
with an acceptable Power of Attorney or evidence of authority on file with
FSA.

10

Title/Re-lationship

Enter the
title or relationship if signing in a representative capacity.

11

Date

Enter the
signature date in month, day and
year.

Read
General Information on Average Adjusted Gross Income, Page
2