KC-227-A U.S. DEPARTMENT OF AGRICULTURE

(10-25-13) Farm Service Agency

REFINED SUGAR CERTIFICATION REPORT

FOR CCC USE ONLY

3. NAME AND LOCATION OF RECEIVING WAREHOUSE 1. LOAN APPLICATION DATE

2. LOAN NUMBER

4. WAREHOUSE CODE 5. COMMODITY 6. RECEIVED BY 7. CROP YEAR 8. CONTROL NUMBER

CANE TRUCK

RAIL 9. DATE ISSUED 

BEET BARGE 

IN STORE

10.

QUANTITY

A. TOTAL NET POUNDS B. GROSS WEIGHT C. NUMBER OF UNITS D. NUMBER OF UNITS

DAMAGED SHORT OVER

11.

QUALITY

Refined sugar must be dry and free flowing; free of excessive sediment; and free of any objectionable color, flavor, odor, or other 

characteristic which would impair its merchantability or which would impair or prevent its use for normal commercial purposes.

12. CERTIFICATION AND SIGNATURE

I certify that the refined sugar described on this report is refined sugar:

 in which title is vested in CCC, or placed in storage by someone other than CCC and pledged to CCC as security for a CCC loan, and

 which will be safely stored so that refined sugar equivalent to the quantity and quality stated in Item 10 and 11 of this KC-227-A may be 

delivered, upon demand, to the owner of such refined sugar, CCC, or to another person (transferee).

This form must be signed by an authorized individual; i.e., corporate officer, partner or proprietor. A manager cannot sign unless authorized by a 

resolution of the Board of Directors or Power of Attorney furnished by a partner or proprietor.

A. WAREHOUSE OPERATOR=S SIGNATURE B. DATE

PRIVACY ACT AND PUBLIC BURDEN STATEMENTS

The following statement is made in accordance with the Privacy Act of 1974 (5 USC 552a - as amended). The authority for requesting the information identified on this 

form is 7 CFR Part 1423, 7 CFR Part 1435, and the Commodity Credit Corporation Charter Act (15 U.S.C. 714 et seq.). The information will be used to record refined 

sugar received into the warehouse for storage of CCC-interest sugar. The information collected on this form may be disclosed to other Federal, State, Local 

government agencies, Tribal agencies, and nongovernmental entities that have been authorized access to the information by statute or regulation and/or as described 

in applicable Routine Uses identified in the System of Records Notice for USDA/FSA-2, Farm Records File (Automated) and USDA/FSA-14, Applicant/Borrower.

Providing the requested information is voluntary. However, failure to furnish the requested information will result in a determination of ineligibility for program benefits

The authority for collecting the following information is Public Law 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 15 minutes 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 provisions of appropriate criminal and civil fraud, privacy, and other statutes may be applicable to the information provided. RETURN THIS 

COMPLETED FORM TO THE APPROPRIATE FARM SERVICE AGENCY COUNTY OFFICE OR SERVICE CENTER.

NONDISCRIMINATION STATEMENT

The U.S. Department of Agriculture (USDA) prohibits discrimination against its customers, employees, and applicants for employment on the bases of race, color, 

national origin, age, disability, sex, gender identity, religion, reprisal, and where applicable, political beliefs, marital status, familial or parental status, sexual orientation, 

or all or part of an individual's income is derived from any public assistance program, or protected genetic information in employment or in any program or activity 

conducted or funded by the Department. (Not all prohibited bases will apply to all programs and/or employment activities.) 

If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found online at 

http://www.ascr.usda.gov/complaint_filing_cust.html, or at any USDA office, or call (866) 632-9992 to request the form. You may also write a letter containing all of the 

information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Director, Office of Adjudication, 

1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, by fax (202) 690-7442 or e-mail at program.intake@usda.gov. Individuals who are deaf, hard of 

hearing, or have speech disabilities and wish to file either an EEO or program complaint, please contact USDA through the Federal Relay Service at (800) 877-8339 or 

(800) 845-6136 (in Spanish). Persons with disabilities, who wish to file a program complaint, please see information above on how to contact us by mail directly or by 

email. If you require alternative means of communication for program information (e.g., Braille, large print, audiotape, etc.) please contact USDA’s TARGET Center at 

(202) 720-2600 (voice and TDD).