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This form is available electronically. 

CCC-1045UP-2

(04-19-19) 

U.S. DEPARTMENT OF AGRICULTURE 

Commodity Credit Corporation 

MONTHLY CONSUMPTION/APPLICATION FOR PAYMENT REPORT

FOR UPLAND COTTON 

1. AGREEMENT NO.

2. DATE PREPARED (MM-DD-YYYY)

NOTE: The primary authority for requesting and safeguarding the information described on this form is the Food, Conservation, and Energy Act of 

2008 (Pub. L. 110-246 and any amendments to such act as may follow). The information requested is necessary for participation in the 

Upland Cotton Economic Adjustment Assistance Program. Furnishing the requested information is voluntary. Failure to furnish the 

requested information will result in a determination of ineligibility for certain program benefits and other financial assistance administered by 

USDA. The information collected as a result of this form may be released to USDA employees, USDA contractors, or authorized USDA 

cooperators who are bound to safeguard the information under Section 1619 of the Food, Conservation and Energy Act, the Privacy Act of

1974, the E-Government Act of 2002, and related authorities. This information collection is exempted from the Paperwork Reduction Act, as 

it is required for administration of the Food, Conservation, and Energy Act of 2008 (see Pub. L. 110-246, Title I, Subtitle F – Administration). 

The provisions of criminal, civil, and privacy statutes may be applicable to the information provided. RETURN THIS COMPLETED FORM 

TO eaap.els@usda.gov or WAREHOUSE AND COMMODITY MANAGEMENT DIVISION, Beacon Facility, PO BOX 419205, STOP 

9148, KANSAS CITY, MISSOURI 64141-6205. 

3. COMPANY NAME AND ADDRESS (Include Zip Code) 4. MONTHLY CONSUMPTION DATES (MM-DD-YYYY)

(a) 

Beginning Date 

through 

(b) 

Ending Date 

5A. CONTACT PERSON 5B. TELEPHONE NO. (Include Area Code) 

PART A INVENTORY (BALES) 

6. 

TYPE OF COTTON 

7. 

COMPUTATIONS 

8. 

BALED LINT 

9. 

BALED LOOSE 

10. 

SEMI-PROCESSED 

MOTES 

11. 

REGINNED MOTES 

A. BEGINNING INVENTORY

B. ACQUIRED BALES + 

C. RESOLD & OTHER (ADJ) + OR -

D. CONSUMED BALES -

E. ENDING INVENTORY = 

PART B PAYMENT 

12. 

TYPE OF COTTON 

13. 

NET POUNDS 

14. 

PAYMENT RATE 

15. 

PAYMENT AMOUNT 

A. BALED LINT $.03 

B. BALED LOOSE $.03 

C. SEMI-PROCESSED MOTES $.03 

D. REGINNED MOTES $.03 

16. TOTAL PAYMENT:

PART C CERTIFICATION 

“I hereby certify that this form and all supporting documents (when required) are being submitted in accordance with the terms of the 

Upland Cotton Domestic User Agreement and regulations at 7 CFR Part 1427 and that the cotton covered by this Application has not 

previously earned a payment under the Upland Cotton Economic Adjustment Assistance Program (7 CFR Part 1427) and is eligible 

for a payment. I also certify that all funds received from CCC will be used in accordance with section 1207 (c)(3) of the Food, 

Conservation, and Energy Act of 2008.” 

17A. SIGNATURE OF AUTHORIZED REPRESENTATIVE 17B. TITLE OF AUTHORIZED REPRESENTATIVE 17C. DATE SIGNED 

(MM-DD-YYYY) 

In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in 

or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, gender identity (including gender expression), sexual orientation, disability, age, 

marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded 

by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident. 

Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the responsible 

Agency or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in 

languages other than English. 

To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at http://www.ascr.usda.gov/complaint_filing_cust.html and at any USDA 

office or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or 

letter to USDA by: (1) mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) 

email: program.intake@usda.gov. USDA is an equal opportunity provider, employer, and lender.