FSA-211-211A Corporation - Risk Management Agency

This form is available electronically.

FSA-211 (11-25-14)

U. S. DEPARTMENT OF AGRICULTURE Farm Service Agency – Natural Resources Conservation Service - Commodity Credit Corporation - Federal Crop Insurance Corporation – Risk Management Agency POWER OF ATTORNEY

THE UNDERSIGNED does hereby appoint the following grantee:

(1)

     

of the following address: (2)

     

     

in the county of: (3)

     

in the State of:

(4)

     

the attorney-in-fact for (5)

     

(insert grantor’s name) in connection with the Farm Service Agency, Natural Resources Conservation Service Agency, or Commodity Credit Corporation programs checked below. NOTE: This power of attorney form is not valid for FSA Farm Loan Program purposes.

A. FSA, NRCS and CCC PROGRAMS (Check applicable programs)

TRANSACTIONS for FSA, NRCS, and CCC PROGRAMS (Check applicable actions)

1. All current programs.

10. Marketing Assistance Loans and Loan Deficiency Payments.

1. All actions.

2. All current and all future programs.

11. Margin Protection Program for Dairy Producers (MPP/Dairy).

2. Signing applications, agreements, and contracts.

3. Agricultural Risk Coverage/Price Loss Coverage (ARC/PLC).

12. Farm Storage Facility Loan Program.

3. Making reports.

4. Biomass Crop Assistance Program (BCAP).

13. Conservation Reserve Program (CRP).

4. Conducting all marketing assistance loan and LDP transactions.

5. Tree Assistance Program (TAP).

14. NRCS Conservation Programs.

5. AGI Certification.

6. Livestock Indemnity Program (LIP).

15. Emergency Conservation Program (ECP).

6. Routing Banking Accounts.

7. Livestock Forage Disaster Program (LFP).

16. Emergency Forest Restoration Program (EFRP).

7. Other (Specify):

8. Emergency Assistance for Livestock Honey Bees, and Farm-Raised Fish (ELAP).

17. Other (Specify):

     

9. Noninsured Crop Disaster Assistance Program (NAP).

     

This form may also be used to grant authority to an attorney-in-fact to act on the grantor’s behalf with respect to FCIC crop insurance policies. Checking any of the FCIC transactions does not have any impact as to the FSA, NRCS or CCC transactions checked above:

C. INSURED CROPS/STATE/COUNTY (Enter “All” or specify each crop, state, county and year(s))

D. CROP INSURANCE TRANSACTIONS (Check applicable actions)

1.

     

1. All actions.

5. Making transfers and cancellations.

2.

     

2. Making applications for insurance.

6. Making contract changes.

3.

     

3. Reporting crop acreage and production reports.

7. Other (Specify):

4.

     

4. Reporting a notice of damage or loss and making claim for indemnity.

     

This Power of Attorney is valid in all counties in the United States unless otherwise noted. This power of attorney shall remain in full force and effect until (1) written notice of its revocation has been duly served upon FSA, NRCS or CCC as appropriate; (2) death of the undersigned grantor; or (3) incompetence or incapacitation of the undersigned grantor. The undersigned grantor shall provide separate written notice of revocation to the applicable crop insurance agent. This power of attorney shall not be effective until properly executed and served to a USDA Service Center.

AUTHORIZED SIGNATURES

6A. Signature of Grantor (Individual)

6B. Signature Date (MM-DD-YYYY)      

6C. For Grantor’s Signature Continuation, check here if FSA-211A is attached.

7A. Signature of Grantor (Partnership, Corporation, Trust, etc.) (By)

7B. Title/Relationship of Individual Signing in the Representative Capacity      

7C. Signature Date (MM-DD-YYYY)      

8. Notary Public (this form shall be acknowledged by a notary Public unless witnessed by a FSA employee or a corporate seal of grantor is affixed).

Signature (a)

the state of (b)

     

the County of (c)

     

FOR FSA USE ONLY

9A. Witness Signature (FSA Employee Only)

9B. Signature Date (MM-DD-YYYY)

9C. Official Position

     

     

10. This power of attorney was served to (a)

     

USDA Service Center,

State of (b)

     

and became effective this (c)

     

day of (d)

     

, (e)

     

.

NOTE:

The following statement is made in accordance with the Privacy Act of 1974 (5 USC 552a - as amended).  The authority for requesting the information identified on this form is 7 CFR Part 718, the Commodity Credit Corporation Charter Act (15 U.S.C. 714 et seq.), the Federal Crop Insurance Act (7 U.S.C. 1501 et seq.), the Food, Conservation, and Energy Act of 2008 (Pub. L. 110-246), and the Agricultural Act of 2014 (Pub. L. 113-79).  The information will be used to enable a producer (grantor) to appoint an individual/organization to serve as an attorney-in-fact (grantee) that is authorized to on behalf of the producer, conduct business with USDA concerning Farm Service Agency, Natural Resources Conservation Service, Commodity Credit Corporation, Federal Crop Insurance Corporation, and Risk Management Agency programs.  The information collected on this form may be disclosed to other Federal, State, Local government agencies, Tribal agencies, and nongovernmental entities that have been authorized access to the information by statute or regulation and/or as described in applicable Routine Uses identified in the System of Records Notice for USDA/FSA-2, Farm Records File (Automated), USDA/NRCS-1, Landowner, Operator, Producer, Cooperator, or Participant Files, and USDA/FCIC-10, Policyholder.  Providing the requested information is voluntary.  However, failure to furnish the requested information will result in a determination of producer ineligibility to participate in and receive benefits under Farm Service Agency, Natural Resources Conservation Service, Commodity Credit Corporation, Federal Crop Insurance Corporation, and Risk Management Agency programs. This information collection for FSA commodity and conservation programs in Titles I and II of the Agricultural Act of 2014 (Pub. L. 113-79) are exempt from the Paperwork Reduction Act (PRA) as specified in the Agricultural Act of 2014, Title I, Subtitle F, Administration, and Title II, Subtitle G, Funding Administration.   For the EFRP, this information collection is exempted from the PRA, as specified in the Fiscal Year 2010 Supplemental Appropriations Act (Public L. 111-212).  For the FSFL, this information collection is exempted from the PRA as it is required for the administration of the Food, Conservation, and Energy Act of 2008 (see Pub. L. 110-246, Title I, Subtitle F-Administration). For those FSA, CCC, and NRCS programs that are not exempt from PRA, FSA may not conduct or sponsor, and a person is not required to respond to a collection of information unless this collection of information has a valid OMB control number, which is 0560-0190 for this information collection, and the average time required to complete this information collection is 15 minutes per response. RETURN THIS COMPLETED FORM TO THE APPLICABLE USDA SERVICE CENTER.

The U.S. Department of Agriculture (USDA) prohibits discrimination against its customers, employees, and applicants for employment on the basis of race, color, national origin, age, disability, sex, gender 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 information 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 have 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 http://www.ascr.usda.gov/complaint_filing_cust.html, 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.

This form is available electronically.

FSA-211A (11-25-14)

U. S. DEPARTMENT OF AGRICULTURE Farm Service Agency – Natural Resources Conservation Service - Commodity Credit Corporation - Federal Crop Insurance Corporation – Risk Management Agency POWER OF ATTORNEY SIGNATURE CONTINUATION SHEET

Attachment Pages

  

of

  

Attach to Form FSA-211

NOTE:

The following statement is made in accordance with the Privacy Act of 1974 (5 USC 552a - as amended).  The authority for requesting the information identified on this form is 7 CFR Part 718, the Commodity Credit Corporation Charter Act (15 U.S.C. 714 et seq.), the Federal Crop Insurance Act (7 U.S.C. 1501 et seq.), the Food, Conservation, and Energy Act of 2008 (Pub. L. 110-246), and the Agricultural Act of 2014 (Pub. L. 113-79).  The information will be used to enable a producer (grantor) to appoint an individual/organization to serve as an attorney-in-fact (grantee) that is authorized to on behalf of the producer, conduct business with USDA concerning Farm Service Agency, Natural Resources Conservation Service, Commodity Credit Corporation, Federal Crop Insurance Corporation, and Risk Management Agency programs.  The information collected on this form may be disclosed to other Federal, State, Local government agencies, Tribal agencies, and nongovernmental entities that have been authorized access to the information by statute or regulation and/or as described in applicable Routine Uses identified in the System of Records Notice for USDA/FSA-2, Farm Records File (Automated), USDA/NRCS-1, Landowner, Operator, Producer, Cooperator, or Participant Files, and USDA/FCIC-10, Policyholder.  Providing the requested information is voluntary.  However, failure to furnish the requested information will result in a determination of producer ineligibility to participate in and receive benefits under Farm Service Agency, Natural Resources Conservation Service, Commodity Credit Corporation, Federal Crop Insurance Corporation, and Risk Management Agency programs. This information collection for FSA commodity and conservation programs in Titles I and II of the Agricultural Act of 2014 (Pub. L. 113-79) are exempt from the Paperwork Reduction Act (PRA) as specified in the Agricultural Act of 2014, Title I, Subtitle F, Administration, and Title II, Subtitle G, Funding Administration.   For the EFRP, this information collection is exempted from the PRA, as specified in the Fiscal Year 2010 Supplemental Appropriations Act (Public L. 111-212).  For the FSFL, this information collection is exempted from the PRA as it is required for the administration of the Food, Conservation, and Energy Act of 2008 (see Pub. L.. 110-246, Title I, Subtitle F-Administration). For those FSA, CCC, and NRCS programs that are not exempt from PRA, FSA may not conduct or sponsor, and a person is not required to respond to a collection of information unless this collection of information has a valid OMB control number, which is 0560-0190 for this information collection, and the average time required to complete this information collection is 15 minutes per response. RETURN THIS COMPLETED FORM TO THE APPLICABLE USDA SERVICE CENTER.

1. Name of Attorney-In-Fact (Item (1) from FSA-211)      

2. Name of Grantor (Item (5) from FSA-211)      

AUTHORIZED SIGNATURES

3A. Signature of Grantor (By)

3B. Title/Relationship of Individual Signing in the Representative Capacity      

3C. Signature Date      

3D. Witness Signature (FSA Employee Only)

3E. Signature Date      

3F. Official Position      

3G. Notary Public (this form shall be acknowledged by a Notary Public unless witnessed by a FSA employee or a corporate seal of grantor is affixed).

Signature:

the State of

     

the County of

     

4A. Signature of Grantor (By)

4B. Title/Relationship of Individual Signing in the Representative Capacity      

4C. Signature Date      

4D. Witness Signature (FSA Employee Only)

4E. Signature Date      

4F. Official Position      

4G. Notary Public (this form shall be acknowledged by a Notary Public unless witnessed by a FSA employee or a corporate seal of grantor is affixed).

Signature:

the State of

     

the County of

     

5A. Signature of Grantor (By)

5B. Title/Relationship of Individual Signing in the Representative Capacity      

5C. Signature Date      

5D. Witness Signature (FSA Employee Only)

5E. Signature Date      

5F. Official Position      

5G. Notary Public (this form shall be acknowledged by a Notary Public unless witnessed by a FSA employee or a corporate seal of grantor is affixed).

Signature:

the State of

     

the County of

     

6A. Signature of Grantor (By)

6B. Title/Relationship of Individual Signing in the Representative Capacity      

6C. Signature Date      

6D. Witness Signature (FSA Employee Only)

6E. Signature Date      

6F. Official Position      

6G. Notary Public (this form shall be acknowledged by a Notary Public unless witnessed by a FSA employee or a corporate seal of grantor is affixed).

Signature:

the State of

     

the County of

     

7A. Signature of Grantor (By)

7B. Title/Relationship of Individual Signing in the Representative Capacity      

7C. Signature Date      

7D. Witness Signature (FSA Employee Only)

7E. Signature Date      

7F. Official Position      

7G. Notary Public (this form shall be acknowledged by a Notary Public unless witnessed by a FSA employee or a corporate seal of grantor is affixed).

Signature:

the State of

     

the County of

     

The U.S. Department of Agriculture (USDA) prohibits discrimination against its customers, employees, and applicants for employment on the basis of race, color, national origin, age, disability, sex, gender 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 information 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 have 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 http://www.ascr.usda.gov/complaint_filing_cust.html, 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.