Part A - General
Information
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1
Agency Name
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Check box for applicable
agency (Check only one box) – FSA or NRCS.
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2
Producer’s
(Assignor's) Name and Address
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Enter producer’s
(assignor’s) name and address including Zip Code.
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3
Assignee’s Name
and Address
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Enter the assignee’s
name and address including Zip Code.
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4
Producer’s
(Assignor’s)
Tax Identification
Number
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Enter the producer’s
(assignor's) 9-digit tax identification number (TIN).
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5
Assignee’s Tax
Identification No.
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Enter assignee’s
9-digit TIN (e.g.; enter the social security number when the
assignee is an individual OR enter the employer Tax ID when the
assignee is a company or a financial institution.
NOTES:
Assignee
must provide tax identification information to the County
office.
If
the assignee wishes to receive payment by EFT, the assignee
must complete Item 6 of this form.
If
the assignee is a financial institution, the TIN must be used
to identify the type for a financial institution is "E"
(E=employer ID number)
The
bank routing number is not acceptable as the TIN
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6
Assignee’s
Electronic Fun Transfer Information
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Enter the assignee’s
electronic fund transfer information.
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Part B – FSA
Applicable Program(s)
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7
Program
(FSA use only)
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Select the applicable
program category:
(Make
sure to write the type of cover for ARC: individual or County)
Conservation
Reserve Program Annual Rent (CRP)
Coronavirus
Food Assistance Program (CFAP)
Coronavirus
Food Assistance Program 2.0 (CFAP2)
Emergency
Assistance Honeybees and Farm-Raised Fish (ELAP)
Livestock
Forage Program (LFP)
Livestock
Indemnity Program (LIP)
eLoan
Deficiency Web Payment (eLPD)
Noninsured
Crop Disaster Assistance Program (NAP)
Wildfires and
Hurricanes Indemnity Program Plus (WHIP+)
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8
Assigned Amount of
Each Applicable Year
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Enter the applicable
program years and the total assignment amount for the selected
program category.
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9
State, County and
Reference Number, If Applicable
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Enter applicable State,
County, and Reference Number, if applicable. If the State and
County is not specified, the assignment will be applicable to
all counties
in which the producer is associated. State, County, and
Reference Number is necessary only
if the assignor expects multiple payments for the same program
category to be assigned to different assignees.
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Part B – FSA
Applicable Program(s) Continued
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10
Other
Programs Name
(FSA use only)
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Enter the names of any
other program code (s) not listed under Item 7.
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11
Contract
Year
Crop
Year
Program
Year or Payment Year
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Enter the year of the
applicable program year or payment year of the assigned program
name entered in Item 10.
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12
Assigned Amount
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Enter the estimated
amount of payment that benefits are to be assigned.
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13
State and County
Reference Number if Applicable
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Enter the State, County,
and Reference Number, if applicable. If
the State and County is not specified, the assignment will be
applicable to all
counties in
which the producer is associated. State, County, and Reference
Number is necessary only
if the assignor expects multiple payments for the same program
code to be assigned to different assignees.
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Part C – NRCS
Use only
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14 – 17
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NRCS Use
only
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Part
D - Representation of Assignor and Assignee
The
producer (Assignor) and Assignee shall read the certification
statement carefully.
NOTE: By
signing both parties acknowledge and agree to the terms and
conditions set forth in Part D.
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18A-18C
Producer’s
(Assignor's), Signature (By)
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Ensure that the producer
(assignor) or representative signs in Item 18A.
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18B
Title/Relation of the
Individual if Signing in Representative Capacity
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If Item 18A is signed by
a representative, enter title/relationship to the producer
(assignor).
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18C
Date
(MM-DD-YYYY)
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Ensure that
producer/representative enters the date.
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19A
Assignee’s,
Signature (By)
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Ensure that the assignee
or representative signs in Item 19A.
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19B
Title/Relation
of the Individual if Signing in Representative Capacity
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If Item 19A is signed by
a representative, enter title/relationship to the assignee.
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19C
Date
(MM-DD-YYYY)
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Ensure that
assignee/representative enters the date in Item 19C.
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Part E - Revocation of
Assignment
The assignee must
complete Part E to revoke an existing Assignment of Payment.
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20A
Assignee's Signature
(By)
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Ensure that the assignee
or representative signs in Item 20A.
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20B
Title/Relation of the
Individual if Signing in Representative Capacity
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If Item 20A is signed by
a representative, enter title/relationship to the assignee.
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20C
Date
(MM-DD-YYYY)
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Ensure that
assignee/representative enters the date in Item 20C.
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Items 21, 22 and 23 are
for FSA For County Office Use Only
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21
Receiving State and
County
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Enter receiving State and
County name and identification code.
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22
Date
Filed
(MM-DD-YYYY)
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Enter the date that Form
CCC-36, Assignment of Payment is filed.
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23
Time Filed
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Enter the time that Form
CCC-36, Assignment of Payment is filed.
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Page 3,
Special Provisions
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Producer (Assignor) and
assignee must read the Special Provisions Relating to
Assignments, and Privacy Act and Public Burden Statements on
Page 3 of Form
CCC-36.
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24A
FSA County Office Name
and Address
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Enter the FSA County
office name and address.
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24B
Telephone Number
(Including area code)
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Enter the FSA County
office telephone number.
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Copy of Form CCC-36
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A copy of the CCC-36
shall be sent via e-mail to the applicable party as follow:
County
FSA Committee
Assignee
Participant
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Additional Information
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Assignee
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An assignee
is a person or entity to which the assignment of a payment is
made.
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Assignment
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An assignment
is the transfer of the right to receive a cash payment from an
assignor who is participating in FSA, NRCS, or CCC farm programs
to an assignee.
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Assignor
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An assignor
is any person who:
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