To the extent that the information requested
herein relates to your individual capacity as opposed to your business
capacity, the following statements are made in accordance with the Privacy
Act of 1974, as amended (5 U.S.C. 552a). The Federal Crop Insurance Act (7
U.S.C. 1501-1524) (Act) and the regulations contained in 7 C.F.R. chapter IV
provides the authority to request the information on this form..
Collection of the social security account number (SSN) or
the employer identification number (EIN) is authorized by section 506 of the
Act and is required as a condition of eligibility for participation in the
Federal crop insurance program. The primary use of the SSN or EIN is to
correctly identify you, and any other person with an interest in you or your
entity of 10 percent or more, as a policyholder within the systems
maintained by the Federal Crop Insurance Corporation (FCIC). Furnishing the
SSN or EIN is voluntary. However, failure to furnish that number will result
in denial of program participation and benefits.
Your policy also specifies other information that must be
provided. The principle purposes of this information are to provide
insurance; reinsurance; determine eligibility; determine the correct parties
to the agreement; determine and collect premiums or other monetary amounts
(including administrative fees and over payments); and pay benefits. The
routine uses of this information include: (1) Referral to the appropriate
agency, whether Federal, State, local or foreign including the Department of
Justice, charged with the responsibility of investigating or prosecuting a
violation of law, or of enforcing or implementing a statute, rule regulation
or order issued pursuant thereto, of any record within this system when
information available indicates a violation or potential violation of law,
whether civil, criminal, or regulatory in nature, and whether arising by
general statute or particular program statute or by rule, regulation or
order issued pursuant thereto; (2) Disclosure to a court, magistrate or
administrative tribunal, or to opposing counsel of any record within the
system that constitutes evidence in that proceeding, or which is sought in
the course of discovery, to the extent that FCIC determines that the records
sought are relevant to the proceeding; (3)
Disclosure to a congressional office in response to any
inquiry from the congressional office made at the request of that
individual; (4) Disclosure to Approved Insurance Providers (AIP),
contractors, cooperators, partners of FCIC, and other Federal agencies for
any purpose relating to the sale, service, and administration of the Federal
crop insurance program and the policies insured under the authority of the
Act; (5) Disclosure to other Federal agencies and contractors, cooperators,
and partners of FCIC for the purpose of conducting research, development,
analyses, and evaluation into all aspects relating to new and existing crop
insurance programs and other risk management tools; (6) Disclosure to
contractors or other Federal agencies to conduct research and analysis to
identify patterns, trends, anomalies, instances and relationships of AIP’s,
agents, loss adjusters and policyholders that may be indicative of fraud,
waste, or abuse; (7) Disclosure to AIPs, contractors, and other applicable
Federal agencies to determine whether information has been accurately
provided to FCIC and the AIPs and to determine compliance with program
requirements; and (8) Disclosure to the Comprehensive Information Management
System (CIMS) authorized under the Farm Security and Rural Investment Act of
2002, Section 10706 (All information disclosed to CIMS may be further
disclosed to any contractor engaged in the development or maintenance of
CIMS, to the Farm Service Agency (FSA) and to AIPs, their insurance agents
and loss adjusters, for information associated with their insured producers
and only with regard to such policies); and (9) To appropriate agencies,
entities, and persons when: (a) USDA suspects or has confirmed that the
security or confidentiality of information in the\ system of records has
been compromised; (b) USDA has determined that as a result of the suspected
or confirmed compromise there is a risk of harm to economic or property
interests, identity theft or fraud, or harm to the security or integrity of
this system or other systems or programs (whether maintained by the
Department or another agency or entity) that rely upon the compromised
information; and (c) the disclosure made to such agencies, entities, and
persons is reasonably necessary to assist in connection with the
Department’s efforts to respond to the suspected or confirmed compromise and
prevent, minimize, or remedy such harm.
Furnishing other information is also voluntary. However,
failure to report the information specified in your policy may result in
rejection of any claim for indemnity, replanting payment, or other benefit;
ineligibility for insurance; a unilateral determination of any monetary
amounts due; or any remedy provided in the policy.