Highly Erodible Land and Wetland Conservation Certification (State, Local or Tribal Government)

Instructions For AD-1069

GOOD FAITH DETERMINATION - WETLAND ACTIVITY

Producers use this form to request a good faith determination for a wetland violation.

 

Submit the original of the completed form in hard copy or facsimile to the appropriate FSA 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.  If you would like to establish online access credentials with USDA, follow the instructions provided at the USDA eForms web site.

 

Producers must complete Items 1 through 5 and Item 8.

 

Items 1 - 5

Fld. Name/ Item No.	Instruction
1 State and County Name	Enter the State and County name where the farm is located.
2A Producer's Information	Enter the producer’s name and address including Zip code.
2B Producer's Phone	Enter the producer’s phone number including area code.
3 Identification Number	Enter the producer’s social security number or tax ID number.
4 Farm Number	Enter the farm number on which the wetland activity occurred.
5 Crop Year	Enter the crop year for which the good faith determination request is being made.

 

Item 6 is for USDA use only.

 

 

Fld. Name/ Item No.

Instruction

7-8 Good Faith Request and Producer’s Signature

Enter reasons for this good faith determination request.  Include circumstances surrounding the wetland activities, and evidence that the activities were performed in good faith and not as a scheme or device to avoid compliance.   Include producer’s signature and date of request.   If you are mailing or faxing this form, print the form and manually enter your signature. If this form is approved for electronic transmission and you have established credentials with USDA to submit forms electronically, use the buttons provided on the form for transmitting the form to the USDA servicing office.

 

Items 9 - 25 are for USDA use only.