Instructions for FSA-2309Instructions for FSA-2309 CERTIFICATION OF DISASTER LOSSES Used by applicants to provide information pertaining to their losses caused by a designated disaster. Submit the original of the completed form in hard copy or facsimile to the appropriate USDA Office. Customers who have established electronic access credentials with USDA may electronically transmit this form to the USDA office, provided that the customer submitting the form is the only person required to sign the transaction. 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. Applicants must complete Items 1, 4, 5A through 5E, 6 through 11D, and 12A and 12B. FSA completes Items 2, 3, 5F, 5G and 11E. Items 1 and 4 are completed by the applicant. Item No./ Fld NameInstruction 1 Applicant’s NameEnter applicant’s name. 4 Date(s) and Nature of DisasterEnter the date(s) and nature of the designated disaster. Items 2 and 3 are for FSA use only. Items 5A through 5E are completed by the applicant. Item No./ Fld NameInstruction 5A(1) Crop ProductionList cash crops. 5A(2) Crop ProductionList feed crops. 5A(3) Crop ProductionList other crops (i.e. pasture). 5(B) UnitsEnter the unit of crop production, i.e. tons, bushels, or lbs. 5C AcresEnter the number of acres for the crops listed in Item 5A. 5D YieldEnter the yield per acre for the crops listed in Item 5A. 5E 3 Year Actual ProductionEnter the year (i.e. (1) Year 2002, (2) Year 2003 and (3) Year 2004) and the yield per acre and source code for each of the 3 years. Items 5F through 5G are for FSA use only. Items 6 through 11D are completed by the applicant. Item No./ Fld Name Instruction 6 EnterpriseEnter the single farming enterprise that suffered disaster losses and is essential to the success of the total farming operation. 7A (1) Dwelling(s)Enter a description of the damages and losses to the property. (Attach actual estimate for repair or replacement of the damaged property.) 7A (2) Dollar ValueEnter estimated dollar value of losses for dwelling(s). 7B (1) Household Furnishings, Equipment, Personal EffectsEnter a description of the damages and losses to the property. (Attach actual estimate for repair or replacement of the damaged property.) 7B (2) Dollar ValueEnter estimated dollar value of losses for household furnishings, equipment and personal effects. 7C (1) Farming BuildingsEnter the description of the damages and losses to the farming building(s). (Specify the type of building and attach estimates for the repair or replacement of the damaged building(s).) 7C (2) Dollar ValueEnter the estimated dollar value of the losses for the buildings. 7D (1) Farm Machinery/ EquipmentEnter the description of the damages and losses to farm machinery. (Specify the make, model and year and attach actual estimate for repair or replacement of the damaged machinery and equipment.) 7D (2) Dollar ValueEnter the estimated dollar value of the losses for the farm machinery and equipment. 7E (1) Supplies, Stored Crops and Livestock ProductsEnter the description of the damages and losses to supplies, harvested or stored crops, and livestock products. 7E (2) Dollar ValueEnter the estimated dollar value of the losses for supplies, harvested or stored crops, and livestock products. 7F (1) Livestock and PoultryEnter the description of the damages and losses to livestock and poultry. (Specify the type and number damaged or destroyed.) 7F (2) Dollar ValueEnter the estimated dollar value of the losses to livestock and poultry. 7G (1) Aquatic OrganismsEnter the description of the damage and losses to aquatic organisms. (Specify the type and number damaged or destroyed.) 7G (2) Dollar ValueEnter the estimated dollar value of the losses to aquatic organisms. 7H (1) Perennial CropsEnter the description of damage and losses to perennial crops. (Specify the types and number.) 7H (2) Dollar ValueEnter the estimated dollar value of the losses to perennial crops. (Include the cost to clear debris, prepare the land for replanting, and to reestablish the crop.) 7 I (1) Other Farm Property Enter the description of damage and losses to other farm property, e.g., fences, land damage, debris removal. 7 I (2) Dollar ValueEnter the estimated dollar value of the losses to other farm property. 8 Total Physical LossesEnter the total dollar amount of claimed physical losses. 9 RemarksUse this space to add any additional information. 10A SourceList the source of any claims or settlements, such as insurance claims and settlements, or any other compensation such as disaster program payments or FCIC settlements received or to be received for losses incurred by the disaster. 10B Crop or PropertyEnter the crop or property for which the payment was received. 10C Dollar AmountEnter the dollar amount received for the losses incurred by the disaster. 10D Total CompensationEnter the sum total of all entries in Column C. 11A Farm NumberList the FSA Farm Number. 11B Farm LocationEnter the County where farm is located. 11C Name of Farm OperatorEnter the name of farm operator as reflected in FSA records. 11D Operator’s ShareEnter the operator’s percentage of ownership in the crops produced on each farm. Item 11E is for FSA use only. Items 12A and 12B are completed by the applicant. Item No./ Fld Name Instruction 12A SignatureEnter the applicant’s signature. If you are mailing or faxing this 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 office. 12B DateEnter the date the applicant signed the form.