2020 AgriStability Interim Payment Application Form

By submitting this Interim Application, you agree to meet all participation requirements of the AgriStability program for the 2020 program year. This application allows you to estimate your income and production for the 2020 program year. The Administration can then issue a payment based on a percentage of your estimated program year benefits. If your final 2020 payment differs for any reason from the 2020 Interim Payment, any overpayments must be repaid by you, and any underpayments will be paid to you.

Participant identification

Name (individual or entity):

Participant Identification Number (PIN):

• 1a) Are you a new participant? If the answer is "Yes", complete Schedule 1 (sections a, b, c) and Schedule 2. Yes/No

• 1b) Since your last application have you:

  • Changed your address or telephone number? If "Yes", provide the new information on Schedule 1, section a. Yes/No
  • Changed your contact person information? If "Yes", complete Schedule 1, section b. Yes/No
  • Changed your business structure? If "Yes", complete Schedule 1, sections c and d. Yes/No

Other information

• 2a) Did you complete a production cycle on at least one of the commodities you produced? Yes/No

  If "No", was at least half of your farm's total production not completed due to disaster circumstances? Yes/No

• 2b) Are you, or anyone who helped you complete your form, a current or former federal public office holder or employee of Agriculture and Agri-Food Canada? Yes/No

• 2c) Did you produce commodities that were, or could have been, insured under AgriInsurance (crop or production insurance)? Yes/No

  Are the majority (more than half) of your insurable crop acres insured at 70% or higher? Yes/No

• 2d) Have you submitted a complete 2019 AgriStability form? If "No", complete Schedule 2. Yes/No

Farming operation

• 3a) Fiscal period from Year/Month/Day to Year/Month/Day

• 3b) Is this farming operation part of a Whole Farm? If yes, please provide PINs for all operations. Yes/No

  PIN:
  PIN:

Partnership information (if applicable)

3c) Enter a Participant Identification Number (PIN) for each of your partners. Enter the first and last names for individual partners. Enter the corporation’s name for corporate partners. Your partnership’s total shares must equal 100%.

• Your % share of the partnership:

Confidential information and participant consent

The information on this form is collected under the authority of Section 4 of the Farm Income Protection Act (FIPA) and will be used for the purposes of administering your participation in the AgriStability program; determining your eligibility for benefits; verifying the information submitted; issuing tax receipts; administering benefits under other farm income and special assistance programs; and for the purposes of audit, analysis and evaluation of the AgriStability and other farm income and special assistance programs by the Administration, AAFC, the provincial/territorial governments or third parties engaged for that purpose.

The Privacy Act protects information you give on this form which is kept in personal information bank number AAFC PPU 183.

By submitting this application form, you:

• certify that the information you provided on this form is complete and accurate. You understand that it is a criminal offense to make a false statement in application for program benefits and any declarations made are subject to audit.
• certify that you have completed at least six months of farming activity and a production cycle in the program year, or could not for reasons beyond your control
• understand and agree that as a condition of receiving an Interim payment, you must participate in AgriStability and submit a complete 2020 AgriStability form by the deadline to be entitled to any AgriStability benefits
• understand that any Interim payment of AgriStability program funds will be deducted in the calculation of your final AgriStability program payment
• agree to repay any overpayment amount received as an Interim payment if the amount exceeds your final 2020 AgriStability program payment. You understand that interest will be charged on overpayments.
• understand any amount you owe to the Crown will be subtracted from an Interim payment
• understand and agree that the person you identified as your contact person may receive information relating to your form from the Administration and may instruct the Administration to modify the information on your form
• consent to the use and disclosure of the information contained in this form to officials from Agriculture and Agri-Food Canada and the provincial/territorial department responsible for agriculture to administer your application for AgriStability, and for the purposes of audit, analysis and evaluation of the AgriStability program
• consent to the use of any information you submitted to the AgriStability or AgriInsurance (production or crop insurance) agencies to administer this application
• understand and agree that the information you submitted may be combined with information of other participants to determine your Interim payment
• consent to the disclosure of information pertaining to you and your financial affairs to the other participants being combined with your information

Program year farming activity

• 4a) Program year payments
  For each of the following, provide the amounts you have received or expect to receive for the 2020 program year:

  • AgriInsurance (production or crop insurance) payments: $
  • Private insurance payments for allowable commodities (include Western livestock price insurance program (WLPIP)): $
  • Other program payments (see the Interim Guide for a list of program payment): $

• 4b) Allowable expenses
  If you had no significant change to the expenses listed, check the “no significant change” box.
  If you had a significant change to the expenses listed, provide the total amount of the expense (not just the amount of the increase or decrease).

  Expenses

  Expense categories	No significant change	Total expected expense amount
  Seed purchases
  Feed purchases
  Fertilizers and soil supplements
  Pesticides and chemical treatments
  Machinery (gasoline, diesel fuel, oil)
  Arm's length salaries

• 4c) Did your productive capacity decrease during the program year due to disaster?

  • For Crops Yes/No
  • For Livestock Yes/No

• 4d) Crop Production

  Code	Crop description	Acres	Unseedable acres	Production expected (tonnes)	Production intended for sale (tonnes)	Price per tonne $
  						$
  						$
  						$
  						$
  						$
  						$
  17	Summerfallow acres
  18	Pasture acres
  19	Wasteland acres

• 4e) Livestock Production

  Livestock - Cattle/Hogs - Production

  Code	Productive animals	2020 Productive capacity	2020 Production	Average wean weight
  8004	Cow/Calf	Number of cows that calved	Number of calves born
  8004	Cow/Calf	Number of cows that calved	Number of calf feed days	N/A
  8751	Hogs, farrowing	Number of sows that farrowed	Number of animals born
  8760	Hogs, farrow to finish	Number of sows that farrowed	Number of animals born	N/A
  N/A = not available

  Livestock - Cattle/Hogs - Feeder

  Code	Feeder livestock	2020 Productive capacity	2020 Production
  8066	Feeder cattle, fed up to 900 lbs	Number of animals fed	Number of animal feed days
  8068	Feeder cattle, fed over 900 lbs	Number of animals fed	Number of animal feed days
  8762	Hogs, nursery, up to 50 lbs	Number of animals fed	Number of animal feed days
  8761	Hogs, feeders, fed over 50 lbs	Number of animals fed	Number of animal feed days

  Custom Fed Livestock

  Code	Custom fed livestock	2020 Productive capacity
  8133	Cattle	Number of animal feed days
  8749	Hogs	Number of animal feed days

  Supply Managed Commodities

  Code	Supply managed commodities	2020 Productive capacity	2020 Production	Estimated price $
  7650	Chickens, broilers	Kilograms of quota	Kilograms produced	$
  7862	Turkey, broilers	Kilograms of quota	Kilograms produced	$
  7663	Chicken, layers, broiler eggs for hatching	Number of producing hens	Dozens of eggs produced	$
  7664	Chicken, layers, eggs for consumption	Number of producing hens	Dozens of eggs produced	$

  Other Production

  Code	Other Production: specify	2020 Productive capacity	2020 Production	Estimated price $
  				$
  				$
  				$
  				$