Form Ccc-857 Agriculture Risk Coverage (Arc) And Price Loss Coverage (Plc) Program Election

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(See Page 2 for Privacy Act and Paperwork Reduction Act Statements)
CCC-857
U.S. DEPARTMENT OF AGRICULTURE
1. Program Years: 2014 through 2018
(10-31-14)
Commodity Credit Corporation
2A. County FSA Office Name and Address (Including Zip Code)
AGRICULTURE RISK COVERAGE (ARC) AND PRICE
2B. County FSA Office Telephone
2C. County FSA Office FAX Number
LOSS COVERAGE (PLC) PROGRAM ELECTION
(Including Area Code)
Number
(Including Area Code)
3. State Code
4. County Code
5. Farm Number
THIS ELECTION must be made by all current producers on the farm, and must occur by the end of the election period announced by FSA to be effective for
this farm beginning with the 2014 crop year, under the terms of 7 CFR Part 1412. If an ARC or PLC election is not made, the election shall default to PLC for
all covered commodities on the farm, starting with the 2015 crop year, and the farm is not eligible for any 2014 ARC or PLC payments. All current producers on
the farm must sign this election, and by doing so, unanimously agree and acknowledge that: (1) this election is irrevocable for the covered commodities and the
farm, or any resulting farm(s) of a reconstitution; (2) this farm may not be combined with any other farm that has base acres and does not have the same
program election applicable for each and all covered commodities on all farms intended to be combined; (3) even though they may have made an election, they
must annually enroll the farm in the ARC or PLC program in order to receive ARC or PLC benefits for that crop year;(4) they must comply with the regulations
at 7 CFR Part 1412; and (5) that ARC or PLC benefits are subject to change based upon changes to law. In addition, by signing this form, all current producers
on the farm certify as to the accuracy of the information set out on this form. FSA’s acceptance of this signed form and use of the form does not equate to
FSA’s approval of the election. If FSA later determines this election was invalid under 7 CFR Part 1412, the elections on this form will not apply to the farm.
Annual enrollment in the ARC or PLC program is a separate action from this election and must be performed each crop year.
6. ARC-IC Election
This election, if made, is applicable for the farm and all covered commodities. Program
Individual Agriculture Risk Coverage (ARC-IC)
elections, by crop, in Item 7 cannot be made if ARC-IC is elected for the farm.
7. Election for PLC and ARC-CO (Check only ONE box per crop, if no selection was made in Item 6.)
ARC-
ARC-
ARC-
Crop
PLC
N/A
Crop
PLC
N/A
Crop
PLC
N/A
CO
CO
CO
Barley
Grain Sorghum
Rice, Long Grain
Rice, Medium
Canola
Lentils
Grain
Corn
Mustard Seed
Safflower
Crambe
Oats
Sesame Seed
Flaxseed
Peanuts
Soybeans
Garbanzo, Large
Peas, Dry
Sunflower Seed
Garbanzo, Small
Rapeseed
Wheat
8A. Producer’s Name and Address (Including Zip Code)
8B. Email Address
8C. Telephone Number (Including Area Code)
8D. Signature of Producer (By)
8E. Title/Relationship of the Individual Signing in the
8F. Date
(MM-DD-YYYY)
Representative Capacity
FOR FSA USE ONLY
9A. Signature of CCC Representative
9B. Date
(MM-DD-YYYY)
10. Remarks
The U.S. Department of Agriculture (USDA) prohibits discrimination against its customers, employees, and applicants for emplo yment on the basis of race, color, national origin, age, disability, sex, g ender identity,
religion, reprisal, and where applicable, political beliefs, marital status, familial or parental status, sexual orientation, or all or part of an individual’s income is derived from any public assistance program, or
protected genetic infor mation in employment or in any program or activity conducted or funded by the Department. (Not all prohibited bases will apply to all programs and/or employment activities.) Persons with
disabilities, who wish to file a program complaint, write to the address below or if you require alternative means of communication for program information (e.g., Braille, large print, audiotape, etc.) please contact
USDA’s TARGET Center at (202) 720-2600 (voice and TDD). Individuals who are deaf, hard of hearing, or hav e speech disabilities and wish to file either an EEO or program complaint, please contact USDA
through the Federal Relay Service at (800) 877-8339 or (800) 845-6136 (in Spanish).
If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found online at , or at
any USDA office, or call (866) 632-9992 to request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint form or letter by mail to U.S.
Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, by fax (202) 690-7442 or email at program.intake@usda.gov . USDA is an equal
opportunity provider and employer.

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