Emergency Relief Program (ERP) Phase 2

Instructions For FSA-510
REQUEST FOR AN EXCEPTION TO THE $125,000 PAYMENT
LIMITATION FOR CERTAIN PROGRAMS
Customers use this form to certify 75% of their average Adjusted Gross Income
(AGI) is from farming, ranching or forestry operations and request an increase to
the $125,000 payment limitation. Data collected includes contact information,
producer’s election of the program year for which benefits are requested,
producer’s certification of at least 75% of the customer’s average AGI for the three
tax years immediately preceding the year for which benefits are requested was
derived from farming, ranching or forestry operations and affirmation from a
licensed Certified Public Accountant or attorney.
Submit the original of the completed form in hard copy, by email or facsimile to the
appropriate USDA servicing office. https://offices.sc.egov.usda.gov/locator/app
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 2 through 7. Licensed CPA or
Attorney must complete items 8 through 11.
Items 1-7
Fld Name /
Item No.
1
Return
Completed
form to:
2
Name and
Address of
Individual or
Legal Entity

Page 1 of 3

Instruction
Enter the name and address of the FSA county office or USDA service
center where the completed FSA-510 will be submitted.
Enter your name, or name of the entity, and your complete mailing
address including zip code. If you are completing this form on behalf of
a general partnership or joint venture, only enter the name and address of
one member per form. Each member must complete a separate form.

As of: (XX-XX-22_Proposal 1)

Fld Name /
Item No.
3
Taxpayer
Identification
Number
4
Requirements
for Payment
Limitation
Exception for
Certain
Program
4A
Program Year
4B
YES

4C
NO

Instruction
Enter your Social Security Number (SSN) or Employer Identification
Number (EIN). The SSN or EIN must be the taxpayer identification
number associated with the individual or legal entity entered in item 2.
Read the information provided in item 4 including the included bullet
points before completing items 4A and 4B or 4C.

Enter the program year for which you are requesting benefits. Only one
year may be entered per form. If you need to complete the certification
for more than one year, a separate form must be completed for each year.
Place a mark in the box beside 4B if you are certifying that you meet the
requirements provided in Item 4 and you are requesting the increased
payment limitation amount applicable to the program you have applied
for or for which you intend to complete a program application.
Only place a mark in Item 4B or Item 4C.
Place a mark in the box beside 4C if you either do not meet the
requirements provided in Item 4 or you do not want to request the
increased payment limitation amount applicable to the program you have
applied for or for which you intend to complete a program application.
Only place a mark in Item 4B or Item 4C.

5
Signature

Read the acknowledgements and certifications before signing.

6
Title/Relations
hip of the
Individual
Signing in a
Representative
Capacity for a
Legal Entity

If you are signing in a representative capacity for the individual or legal
entity identified in item 2, enter your title or relationship to the individual
or legal entity. If you are signing for yourself and your name is recorded
in item 2, leave this blank.

Page 2 of 3

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.

As of: (XX-XX-22_Proposal 1)

Fld Name /
Item No.
7
Date

Instruction
Enter the signature date in month, day and year.

Items 8-11 must be completed by a Licensed CPA or Attorney
Fld Name /
Item No.

Instruction

8
Signature

Read the acknowledgements and certifications before signing.

9
Title

Enter CPA or Attorney as applicable for the induvial signing in item 8.

10
State/License
Number

Enter the applicable state you are licensed to practice in, followed by
your associated individual license number.

11
Date

Enter the signature date in month, day and year.

Page 3 of 3

Enter your signature to indicate your certification the two statements
provided in Part C of this form are met.

As of: (XX-XX-22_Proposal 1)