Form Ccc-931 - Average Adjusted Gross Income (Agi) Certification And Consent To Disclosure Of Tax Information Page 2
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CCC-931 (12-07-11)
Page 2 of 2
GENERAL INFORMATION ON AVERAGE ADJUSTED GROSS INCOME –PART A
Individuals or legal entities that receive benefits under most commodity and conservation programs administered by CCC cannot have incomes that exceed certain limits set by
law. For entities, both the entity itself, and its members cannot exceed the income limitations. If a member, whether an individual or an entity, of an entity exceeds the limitations,
payments to that entity will be commensurately reduced according to that member’ s direct or indirect ownership share in the entity. (All members of the entity must also submit
this form to verify income limitations are met.)
Adjusted Gross Income is the individual’ s or legal entity’ s IRS-reported adjusted gross income consisting of both farm and nonfarm income. A three year average of that income
will be computed for the three years of the relevant base period identified on the first page of this form to determine eligibility for the applicable program year. For 2012 only,
individuals or legal entities with average adjusted gross income greater than $1 million shall be ineligible for direct payments under the Direct and Counter-cyclical Program
Adjusted Gross Farm Income is the part of the yearly adjusted gross income that is farm income. The amount is computed separately for each year and then averaged. Farm
income means income related to the following: production of crops, livestock, fish and aquaculture for food; the feeding and rearing of livestock; products produced or derived
from livestock; production of specialty crops and unfinished raw forestry products; processing packing, storing and transporting farm, ranch and forestry commodities including
renewable energy; production of farm-based renewable energy; the sale of land used for agriculture; sale of land or sale of easements and development rights to agricultural land,
water and hunting rights, and environmental benefits; rental or lease of land or equipment used in farming, ranching, forestry operation; payments and benefits from risk
management practices, crop insurance indemnities, catastrophic risk protection plans, conservation program and government farm program payments. Individuals or legal
entities with average adjusted gross farm income greater than $750,000 shall be ineligible for direct payments under the Direct and Counter-cyclical Program
Adjusted Gross Nonfarm Income is the difference for the year between the filer’ s adjusted gross income and the filer’ s adjusted gross farm income. The difference is computed
separately for each year and then averaged. Individuals or legal entities with average adjusted gross nonfarm income that exceeds $500,000 shall be ineligible for commodity
program payments, price support benefits, disaster assistance programs, and for the Milk Income Loss Compensation Program. Additionally, individuals or legal entities with
average adjusted gross nonfarm income exceeding $1 million will be ineligible for new contracts or participation in conservation programs after October 1, 2008, unless at least
66.66% of their total average adjusted gross income (sum of farm and nonfarm income) is generated from activities related to farming.
HOW TO DETERMINE ADJUSTED GROSS INCOME
Individual –Internal Revenue Service (IRS) Form 1040 filers, specific lines on that form represent the adjusted gross income and the income from farming, ranching, or forestry
operations.
Trust or Estate –the adjusted gross income is the total income and charitable contributions reported to IRS.
Corporation –the adjusted gross income is the total of the final taxable income and any charitable contributions reported to IRS.
Limited Partnership (LP), Limited Liability Company (LLC), Limited Liability Partnership (LLP) or Similar Entity –the adjusted gross income is the total income from trade
or business activities plus guaranteed payments to the members as reported to the IRS.
Tax-exempt Organization –the adjusted gross income is the unrelated business taxable income excluding any income from non-commercial activities as reported to the IRS.
GENERAL INFORMATION ON CONSENT TO DISCLOSURE OF TAX INFORMATION –PART B
This consent allows IRS’ s access to, and use of, certain items of return information to perform calculations, using a methodology prescribed by the USDA, that will
assist USDA in its verification of a program participant’ s compliance with the adjusted gross income (AGI) limitations necessary for participation in, and receipt of,
commodity, conservation, price support or disaster program benefits. This consent also permits the USDA to receive certain items of return information for its
eligibility determination.
This consent authorizes the disclosure of these items of return information for only the time period specified. Each item of information requested on this form is
needed for the IRS to (1) locate, and verify, your tax information; (2) perform the requisite Average AGI calculations; and (3) provide the USDA with the legal entity’ s
name and Taxpayer Identification Number (TIN), the type of return from which the specified items were located for use in the calculation, and whether or not the
average AGI is above or below eligibility requirements. The IRS will not provide the USDA with any of the items specified on this consent form that it uses to perform
the calculations or the average AGI figure.
This form can only be signed by the person authorized under state law to sign this consent for the legal entity identified in Item 2. An approved Power of Attorney
(Form FSA-211) on file with USDA cannot be used as evidence of signature authority when completing this form.
INSTRUCTIONS FOR COMPLETION OF CCC-931
Item No./Field name
Instruction
Enter the name and address of the FSA county office or USDA service center where the completed CCC-931 will be
1.
Return Completed Form To
submitted.
2.
Person or Legal Entity’ s
Enter the person’ s or legal entity’ s name and address for commodity, conservation, price support, or disaster program
Name and Address
benefits. Enter the name and address as it appeared on the IRS tax returns filed for the taxable years specified in Item 4.
In the format provided, enter the complete taxpayer identification number of the person or legal entity identified in Item 2.
3.
Taxpayer Identification
Number
This will be either a Social Security Number or Taxpayer Identification Number.
Select the year for which program benefits are being requested. The selection indicates the 3-year period used for the
4.
Program Year
determination of the average adjusted gross income for payment eligibility and the years for which this consent allows
access to tax information.
Select the box next to the response that describes the average adjusted gross income for the applicable 3-year period for
5.
Average Adjusted Gross
Income
the program year selected in Item 4. Select only one response.
Select the appropriate response to indicate whether or not at least 66.66 percent of the average adjusted gross income
6.
Average Adjusted Gross
was derived from farming, ranching, or forestry operations during the applicable 3-year period selected in Item 4.
Income from Farming,
Select “ YES” or “ NO” as applicable.
Ranching or Forestry
Select the box next to the response that describes the average adjusted gross farm income for the applicable 3-year
7.
Average Adjusted Gross
Farm Income
period for the program year selected in Item 4. Select only one response.
Select the box next to the response that describes the average adjusted gross nonfarm income for the applicable
8.
Average Adjusted Gross
Nonfarm Income
3-year period for the program year selected in Item 4. Select only one response.
Read the acknowledgments, responsibilities and authorizations, before affixing your signature.
9.
Signature
Enter title or relationship to the legal entity identified in Item 2.
10. Title/Relationship
Enter the signature date in month, day and year.
11. Date
This form must be returned to FSA within 90 days of the signature date for the consent to be valid.
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