U.S. USDA Form usda-ccc-846
This form is available electronically.
CCC-846
U.S. DEPARTMENT OF AGRICULTURE
Commodity Credit Corporation
(02-24-04)
APPLICATION FOR APPROVAL OF COOPERATIVE MARKETING ASSOCIATION
FOR LOAN AND LOAN DEFICIENCY PAYMENTS (LDP)
NOTE:
The authority for collecting the following information is Pub. L. 107-171. This authority allows for the collection of information without prior OMB approval mandated by
the Paperwork Reduction Act of 1995. The time required to complete this information collection is estimated to average 16 hours per response, including the time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.
The following statements are made in accordance with the Privacy Act of 1974 (5 USC 552a). The authority for requesting the information is the Agricultural Act of 1949,
as amended, and the Federal Agriculture Improvement and Reform Act of 1996, and the Commodity Credit Corporation (CCC) Charter Act, of 15 USC 714 (m) (a) and 7
CFR Parts 1421, 1425, and 1427. The information will be used on generated reports to County FSA Offices to obtain information concerning producer eligibility and
payment limitation information, and CCC to modify Loan and Loan Deficiency Payment benefits paid to cooperative members. Furnishing the requested information is
necessary to monitor participation in the Loan and Loan Deficiency Payment program. Failure to furnish the requested information will result in denial of further monies
or other benefits may be paid out under this program unless the forms CCC-719, CCC-732, and CCC-734 are completed and filed as required by existing law and
regulations. The information maybe provided to other agencies, IRS, Department of Justice, or other State and Federal law enforcement agencies, and in response to a
court magistrate or administrative tribunal. The provisions of criminal and civil fraud statues, including 18 USC 286, 287, 371, 651, 1001, 15 USC 714m, and 31 USC
3729, maybe applicable to the information provided. RETURN THIS COMPLETED FORM TO THE DIRECTOR, PRICE SUPPORT DIVISION, USDA, FARM SERVICE
AGENCY, STOP 0512, Room 4095-S, 1400 INDEPENDENCE AVENUE, SW, WASHINGTON, DC 20250-0512.
INSTRUCTIONS:
Director, Price Support Division
USDA, FSA, Stop 0512, Room 4095
1400 Independence Avenue, SW
Washington, D.C. 20250-0512
Submit original of this application, Articles of
Incorporation, Uniform Marketing Agreement and
related documents to the:
NOTE: If mailing express delivery, you must include the Room Number in the delivery address or the item will not reach the Price Support Division.
1. Legal Name of Cooperative Marketing Association (CMA)
2. Headquarter's Office Address
3. CMA Program Location
4. State Statute of Incorporation
5. Date of Incorporation (MM-DD-YYYY)
6. State of Incorporation
7. Regular Mail Address
8. Overnight Mail Address
9. Contact Person and Title
10. IRS Tax ID No.
11. Telephone No. (Include area code)
12. FAX No. (Include area code)
A. ACTIVE
13. E-Mail Address
B. INACTIVE
C. TOTAL
14. Number of Voting Members:
A. ACTIVE
II
+
B. OTHER
C. TOTAL
15. Number of Board Members:
A. ACTIVE
II
+
B. INACTIVE
C. UNALLOCATED
+
+
D. OTHERS
E. TOTAL
17. Date Fiscal Year Ends (MM-DD-YYYY)
+
II
16. Amount of Equity:
18. Number of Member Cooperatives
The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, gender, religion, age, disability, political beliefs, sexual orientation,
and marital or family status. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape,
etc.) should contact USDA's TARGET Center at (202) 720-2600 (voice and TDD). To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, Room 326-W, Whitten Building, 1400
Independence Avenue, SW, Washington, D.C. 20250-9410 or call (202) 720-5964 (voice or TDD). USDA is an equal opportunity provider and employer.
CCC-846 (02-24-04) (Page 2 of 3)
19. Requested Authorized Commodity Volume:
1 / CWT. Hundredweight
A.
B.
C.
D.
E.
F.
G.
Authorized Commodity
Crop Year
Unit 1 /
Member Volume
Non-Member Volume
Member Cooperative
Volume
Total Volume
Barley
Bushel
Canola
Cwt.
Corn
Bushel
Cotton:
Bale
Upland
Dry Peas
Tons
ELS
Bale
Flaxseed
Cwt.
Lentils
Cwt.
Mohair
Lbs.
Mustard Seed
Cwt.
Oats
Bushel
Peanuts
Tons
Rapeseed
Cwt.
Rice
Cwt.
Safflower
Cwt.
Small
Chickpeas
Cwt.
Grain Sorghum
Cwt.
Soybeans
Sunflower Seed
Wheat
Wool
Bushel
Cwt.
Bushel
Lbs.
Other
H. TOTALS