CCC-941 U.S. Department of Agriculture - (07-19-26) Commodity Credit Corporation Average Adjusted Gross Income (AGI) Certification and Consent to Disclosure of Tax Information - Instructions and Privacy Act Statement

Sep 19, 2026

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CCC-941 is an AGI certification and consent form for commodity and conservation program payment eligibility. Part A certifies the applicant’s average adjusted gross income for the program year, based on a three-taxable-year calculation period. Part B authorizes the IRS to review specified tax return information and disclose results to USDA to determine whether eligibility requirements are met, including disclosures if returns cannot be located. It also includes signature and date fields plus a Privacy Act Statement describing legal authorities and intended uses of information.

LanguageEnglish

CategoryForms

FormatPDF

Pages4

Reading Time2 min

AccessFree to download

Instructions

Part A – Certification of Average Adjusted Gross Income

Part B – Consent to Disclosure of Tax Information

Signature and Date

Privacy Act Statement

OMBApproval No.: 0560-0297 OMB Expiration Date: 10/31/2027 | CCC-941 U.S. DEPARTMENT OF AGRICULTURE
(07-19-26) Commodity Credit Corporation
AVERAGE ADJUSTED GROSS INCOME (AGI) CERTIFICATION AND CONSENT TO DISCLOSURE OF TAX INFORMATION | | | 1. Return completed form to: | | | --- | --- | --- | --- | --- | | INSTRUCTIONS: Please return completed form to FSA at the above address in box 1. In box 2, use the name and address recorded on the most recently filed tax return or IRS change of address notification. | | | | | | 2. Name and Address of Individual or Legal Entity (Including Zip Code) | | 3. Taxpayer Identification Number (TIN) (Social Security
Number for Individual; or Employer Identification Number for Legal Entity) | | | | PART A – CERTIFICATION OF AVERAGE ADJUSTED GROSS INCOME | | | | | | 4. The program year for payment eligibility | | | | | | A. 20 Enter the year for which program benefits are requested. The period for calculation of the average AGI will be of the three ~~ ~~ taxable years preceding the most immediately preceding complete taxable year for which benefits are requested. For example, the 3-year period for the calculation of the average AGI for 2026 would be the taxable years of 2022, 2023 and 2024. | | | | | | 5. I certify that the average adjusted gross income of the individual or legal entity in Item 2 (for the year included in Item 4) was: | | | | | | A. Less than (or equal to) $900,000 More than $900,000
PART B – CONSENT TO DISCLOSURE OF TAX INFORMATION | | | | | | Pursuant to 26 U.S.C. §6103, I hereby authorize the Internal Revenue Service (IRS) to review the following items of “return information”(as defined in 26 U.S.C. §6103(b)(2)) from the returns (as specified below) of the individual or legal entity identified in Item 2 for the taxable years indicated in Item 4:
Form 1040 and 1040NR filers: farm income or loss; adjusted gross income Form 1120, 1120A, 1120C filers: charitable contributions, Form 1041 filers: farm income or loss, charitable contributions, income taxable income
distribution deductions, exemptions, adjusted total income; total income Form 1120S filers:
Form 1065 filers: guaranteed payments to partners, ordinary business Form 990T: unrelated business taxable income income
I understand the IRS will review these items of return information in order to perform calculations, the results of which I authorize to be disclosed to officers and employees of the United States Department of Agriculture (USDA) for use in determining the individual’s or legal entity’s eligibility for specified payments for various commodity and conservation programs. The calculations performed by the IRS use a methodology prescribed by the USDA. In addition, I am aware that the USDA may use the information received for compliance purposes related to this eligibility determination, including referrals to the Department of Justice.
Specifically, the IRS will disclose to the USDA the individual’s or legal entity’s name and TIN, and inform the USDA if, pursuant to its calculations, the average Adjusted Gross Income (AGI) is above or below eligibility requirements as prescribed by the Agricultural Act of 2014 or Agriculture Improvement Act of 2018. The IRS will also disclose to the USDA the type of return from which the information used for the calculations was obtained.
If the IRS is unable to locate a return that matches the taxpayer identity information provided above, or if IRS records indicate that the specified return has not been filed, for any of the taxable years indicated, the IRS may disclose that it was unable to locate a return, or that a return was not filed, for those years, whichever is applicable.
I understand the Internal Revenue Code §6103(c), limits disclosure and use of return information provided pursuant to a taxpayer’s consent and holds the recipient subject to penalties, brought by private right of action, for any unauthoriz

FAQs

What does CCC-941 certify in Part A?

Part A certifies the applicant’s average adjusted gross income (AGI) for the program year, using a three-taxable-year calculation period.

What does Part B authorize the IRS to do?

Part B authorizes the IRS to review specified items from the applicant’s tax returns for the indicated taxable years and disclose the calculation results to USDA for eligibility determinations.

What happens if the IRS cannot locate or verify a matching return?

If the IRS cannot locate a matching return or records indicate it was not filed for any indicated taxable year, the IRS may disclose that status to USDA.

How does the form address privacy and lawful use of information?

The form includes a Privacy Act Statement identifying the legal authorities for requesting information and explaining that the information will be used to determine eligibility under the referenced programs and regulations.

Sep 19, 2026

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