Instructions For CCC-901

MEMBER'S INFORMATION

Producers are required to complete this form to report information = about=20 their farming operation. This information is used by FSA to determine = the=20 ownership interest of entities for payment limitation purposes.

Submit = the original=20 of the completed form in hard copy or facsimile to the appropriate FSA = servicing=20 office.

Customers who have established = electronic access=20 credentials with USDA may electronically transmit this form to the USDA=20 servicing office, provided that (1) the customer submitting the = form is=20 the only person required to sign the transaction, or (2) the customer = has an=20 approved Power of Attorney (Form FSA-211) on file with USDA to sign for = other=20 customers for the program and type of transaction represented by this=20 form.

Features for transmitting the form = electronically=20 are available to those customers with access credentials only. To establish online access = credentials=20 with USDA, follow the instructions provided at the USDA eForms web=20 site.

All items applicable to the payment entity must be completed by = following=20 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=20 farming operation is located. =20 If in more than one county, enter the name of the county = that has=20 been designated as the administrative county.

Program Year

Enter the current program year, or the year = for which=20 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=20 payment.

Member=92s Name

Enter the names of the members making up the = legal=20 entity listed in Part A. (This=20 could be a person or a legal entity.)

Social Security Number/ Tax ID = Number

Enter the social security number or tax = identification=20 number of the members.

Address

Enter the address of each member of the legal = entity.

Percent Share

Enter the percent share of the legal entity = that each=20 member owns.

Signature Authority

Check =93YES=94 if the member has signature = authority for=20 this entity.

Check =93NO=94 if the member does not have = signature=20 authority for = this=20 entity.

Part B

Embedded Legal Entities =96 If any member listed in Part A, Item 3 = is a legal=20 entity (i.e., part of another partnership, corporation, etc.) list the = members=20 of that legal entity in this item. (If more than one member is a = legal=20 entity, use a separate, supplemental sheet to provide the requested = information=20 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=20 member of the legal entity entered in Part A.

Member=92s Name

Enter the names of the members making up the = legal=20 entity listed in = Part B. (This could be a person or a = legal=20 entity.)

Social Security/Tax ID Number

Enter the social security number or tax = identification=20 number of the members.

Address

Enter the address of each member of the=20 entity.

Percent Share

Enter the percent share of the legal entity = that each=20 member owns.

Signature Authority

Check =93YES=94 if the member has signature = authority for=20 this entity.

Check =93NO=94 if the member does not have = signature=20 authority for =20 this entity.

Part C

Embedded Legal Entities =96 If any member listed in Part B, Item 7 = is a legal=20 entity (i.e., part of another partnership, corporation, etc.) lists the = members=20 of that legal entity in this item. (If more than one member is a = legal=20 entity, use a separate, supplemental sheet to provide the requested = information=20 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=20 member of the legal entity entered in Part B.

Member=92s Name

Enter the names of the members making up the = legal=20 entity listed in = Part C. (This could be a person = or legal=20 entity.)

Social Security/Tax ID Number

Enter the social security number or tax = identification=20 number of the members.

Address

Enter the address of each = member(s).

Percent Share

Enter the percent share of the legal entity = that each=20 member owns.

Signature Authority

Check =93YES=94 if the member has signature = authority for=20 this entity.

Check =93NO=94 if the member does not have = signature=20 authority for =20 this entity.

Part D

Embedded Legal Entities =96 If any member listed in Part C, Item 11 = is a legal=20 entity (i.e., part of another partnership, corporation, etc.) list the = members=20 of that legal entity in this item. =20 (If more than one member is a legal entity, use a separate, = supplemental=20 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=20 member of the legal entity entered in Part C.

Member=92s Name

Enter the names of the members making up the = legal=20 entity listed in Part D. (This=20 could be a person or a legal entity.)

Social Security/ Tax ID Number

Enter the social security number or tax = identification=20 number of the member(s).

Address

Enter the address of each = member(s).

Percent Share

Enter the percent share of the entity that = each member=20 owns.

Signature Authority

Check =93YES=94 if the member has signature = authority for=20 this entity.

Check =93NO=94 if the member does not have = signature=20 authority for =20 this entity.

Part E, Items 1-6 Minor Members or=20 Shareholders

Fld Name / Item=20 No.

Instruction

Minor=20 members

If none of the members listed Parts A-D is a = minor,=20 check =93N/A=94 (not applicable), then GO TO Part F.

1 =96 5

Minor Members or Shareholders

If any member listed in Parts A-D is a minor, = provide=20 the following information about that member:

1) Minor=92s name

2) Minor=92s date of = birth

3) =20 Name=20 of the minor=92s parent or guardian

4) =20 Address of the parent or=20 guardian

5) =20 Taxpayer ID number of the parent or = guardian

Note: If the complete = taxpayer ID=20 number is already on file at

&n= bsp;=20 FSA, only the last 4 digits are required.

6(a) =96 6(d)

Separate Status of Minors =85

a) =20 Check =93YES=94 if any minor listed in = Part E is a=20 producer on a farm and the parent or guardian has no = interest. Check =93NO=94 if the = minor is a=20 producer on a farm and the parent or guardian has an interest in = the=20 farming operation.

b) = Check=20 =93YES=94 if the minor listed in Part E maintains a separate

= household=20 from the parent or guardian and personally carries out all

= farming=20 activities with respect to the minor=92s own farming

= operation,=20 including maintaining separate accounting. Check =93NO=94

= if the=20 minor does not maintain a separate household from the parent

= or=20 guardian and does not personally carry out all farming activities =

= with=20 respect to the minor=92s own farming operation, including

=20 maintaining separate accounting

c) = Check=20 =93YES=94 if the minor listed in Part E who is represented by a =

= court-appointed=20 guardian or conservator, live in a household other

than = the=20 parents=92 household(s), and have a vested ownership in the

= farm. Check =93NO=94 if the = minor, who is=20 represented by a court-

= appointed=20 guardian or conservator, does not live in a separate

= household other=20 than the parents=92 household(s), and does not have a

vested = ownership=20 in the farm.

d) =20 If =93YES=94 is checked for all Items 6(a) = through=20 6(c), write the name of the minor in the space provided at 6(d).=20

Part F, Items 1-3 Certification

Field Name/ Item=20 No.

Instruction

Signature (By)

An individual member, or an authorized = representative=20 of the entity identified in Part A, shall sign the=20 certification.

Title/

Relationship

If an authorized representative for the = entity=20 identified in Part A signs this document, use this field to show = the=20 individual=92s representative capacity. (For example, = =93agent=94 or=20 =93attorney-in-fact.=94)

Date

Enter the date the form was=20 signed.