FSA-2309ins

Instructions for FSA-2309

CERTIFICATION OF DISASTER LOSSES

Used by applicants to provide information pertaining to their losses caused by a designated disaster.

Submit the original of the completed form in hard copy or facsimile to the appropriate USDA Office. Customers who have established electronic access credentials with USDA may electronically transmit this form to the USDA office, provided that the customer submitting the form is the only person required to sign the transaction.

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.

Applicants must complete Items 1, 4, 5A through 5E, 6 through 11D, and 12A and 12B.

FSA completes Items 2, 3, 5F, 5G and 11E.

Items 1 and 4 are completed by the applicant.

Item No./ Fld Name	Instruction
1 Applicant’s Name	Enter applicant’s name.
4 Date(s) and Nature of Disaster	Enter the date(s) and nature of the designated disaster.

Items 2 and 3 are for FSA use only.

Items 5A through 5E are completed by the applicant.

Item No./ Fld Name	Instruction
5A(1) Crop Production	List cash crops.
5A(2) Crop Production	List feed crops.
5A(3) Crop Production	List other crops (i.e. pasture).
5(B) Units	Enter the unit of crop production, i.e. tons, bushels, or lbs.
5C Acres	Enter the number of acres for the crops listed in Item 5A.
5D Yield	Enter the yield per acre for the crops listed in Item 5A.
5E 3 Year Actual Production	Enter the year (i.e. (1) Year 2002, (2) Year 2003 and (3) Year 2004) and the yield per acre and source code for each of the 3 years.

Items 5F through 5G are for FSA use only.

Items 6 through 11D are completed by the applicant.

Item No./ Fld Name	Instruction
6 Enterprise	Enter the single farming enterprise that suffered disaster losses and is essential to the success of the total farming operation.
7A (1) Dwelling(s)	Enter a description of the damages and losses to the property. (Attach actual estimate for repair or replacement of the damaged property.)
7A (2) Dollar Value	Enter estimated dollar value of losses for dwelling(s).
7B (1) Household Furnishings, Equipment, Personal Effects	Enter a description of the damages and losses to the property. (Attach actual estimate for repair or replacement of the damaged property.)
7B (2) Dollar Value	Enter estimated dollar value of losses for household furnishings, equipment and personal effects.
7C (1) Farming Buildings	Enter the description of the damages and losses to the farming building(s). (Specify the type of building and attach estimates for the repair or replacement of the damaged building(s).)
7C (2) Dollar Value	Enter the estimated dollar value of the losses for the buildings.
7D (1) Farm Machinery/ Equipment	Enter the description of the damages and losses to farm machinery. (Specify the make, model and year and attach actual estimate for repair or replacement of the damaged machinery and equipment.)
7D (2) Dollar Value	Enter the estimated dollar value of the losses for the farm machinery and equipment.

Item No./ Fld Name	Instruction
7E (1) Supplies, Stored Crops and Livestock Products	Enter the description of the damages and losses to supplies, harvested or stored crops, and livestock products.
7E (2) Dollar Value	Enter the estimated dollar value of the losses for supplies, harvested or stored crops, and livestock products.
7F (1) Livestock and Poultry	Enter the description of the damages and losses to livestock and poultry. (Specify the type and number damaged or destroyed.)
7F (2) Dollar Value	Enter the estimated dollar value of the losses to livestock and poultry.
7G (1) Aquatic Organisms	Enter the description of the damage and losses to aquatic organisms. (Specify the type and number damaged or destroyed.)
7G (2) Dollar Value	Enter the estimated dollar value of the losses to aquatic organisms.
7H (1) Perennial Crops	Enter the description of damage and losses to perennial crops. (Specify the types and number.)
7H (2) Dollar Value	Enter the estimated dollar value of the losses to perennial crops. (Include the cost to clear debris, prepare the land for replanting, and to reestablish the crop.)
7 I (1) Other Farm Property	Enter the description of damage and losses to other farm property, e.g., fences, land damage, debris removal.
7 I (2) Dollar Value	Enter the estimated dollar value of the losses to other farm property.
8 Total Physical Losses	Enter the total dollar amount of claimed physical losses.

Item No./ Fld Name	Instruction
9 Remarks	Use this space to add any additional information.
10A Source	List the source of any claims or settlements, such as insurance claims and settlements, or any other compensation such as disaster program payments or FCIC settlements received or to be received for losses incurred by the disaster.
10B Crop or Property	Enter the crop or property for which the payment was received.
10C Dollar Amount	Enter the dollar amount received for the losses incurred by the disaster.
10D Total Compensation	Enter the sum total of all entries in Column C.
11A Farm Number	List the FSA Farm Number.
11B Farm Location	Enter the County where farm is located.
11C Name of Farm Operator	Enter the name of farm operator as reflected in FSA records.
11D Operator’s Share	Enter the operator’s percentage of ownership in the crops produced on each farm.

Item 11E is for FSA use only.

Items 12A and 12B are completed by the applicant.

Item No./ Fld Name	Instruction
12A Signature	Enter the applicant’s signature. If you are mailing or faxing this form, print the form and manually enter your signature. This form is approved for electronic transmission; if you have established credentials with USDA to submit forms electronically, use the buttons provided on the form for transmitting the form to the USDA office.
12B Date	Enter the date the applicant signed the form.