AgriInvest - 2024 AgriStability and AgriInvest Additional Information and Adjustment Request

Protected B when complete

If you farm in Manitoba, Newfoundland and Labrador, Nova Scotia, New Brunswick, Northwest Territories or Yukon, use this form to request an adjustment or to submit additional information to the federal administration for AgriStability and AgriInvest. If you farm in British Columbia use this form to request an adjustment or to submit additional information to the British Columbia administration for AgriStability and to the federal Administration for AgriInvest.

Do not use this form to request an adjustment to your income tax return.

• If this adjustment affects your net income, the Administration may require that the adjustment is first accepted by the Canada Revenue Agency (CRA). Requests for adjustments to your tax return should be sent separately to your CRA tax services centre office.

Once complete, fax or send the form and any attachments to the appropriate address listed below:

For the Federal Administration:
AgriStability and AgriInvest Administration
PO Box 3200
Winnipeg MB   R3C 5R7
Toll free fax: 1-877-949-4885

For the British Columbia Administration:
AgriStability Administration
Ministry of Agriculture and Food
200-1500 Hardy Street
Kelowna BC   V1Y 8H2
Toll free fax: 1-877-605-8467

Identify the information you are sending by selecting the applicable box(es) below:

• additional information submitted at the same time as your program forms
• an adjustment to information previously submitted on program forms
• a response to a request from the Administration

Indicate which program year(s) you are requesting the adjustment be made to:

• 2019
• 2020
• 2021
• 2022
• 2023
• 2024

1. Identification

• Name:
• Participant identification number (PIN):
• Telephone number:
• Fax number:

2. Adjustment details

Indicate the details of your requested adjustment. Adjustments to information reported on your AgriStability and AgriInvest program forms must be made within the adjustment timeframe indicated on your original Calculation of Program Benefits (COB) or your AgriInvest Deposit Notice. Ensure you indicate the year(s) you are adjusting.

If you would prefer to show your adjustments using a page from the Statement A Corporation/Co-operative and Special Individual rather than filling in part 2 of this form, attach the page(s) to this form.

Adjustment details

Section on the form	Line code	Description of the item to be adjusted	Previous amount	Revised amount

3. Other details or explanations (attach an extra sheet if required)

Confidential information and participant consent

Agriculture and Agri-Food Canada (AAFC) and the Canada Revenue Agency (CRA) are committed to protecting the privacy of your information. The personal information on this form is collected under Section 4 of the Farm Income Protection Act and will be used exclusively for the purpose of:

• administering your participation in the AgriStability and AgriInvest programs
• determining your eligibility for benefits
• verifying the information submitted
• issuing tax receipts
• administering benefits under other federal (including AAFC) or provincial or territorial programs
• audit, analysis, and evaluation of the AgriStability and AgriInvest programs and other federal or provincial/territorial programs by the Administration, AAFC, the provincial or territorial governments or third parties engaged for that purpose

By completing this form you authorize the Administration, the provincial and territorial governments, administrators of other farm income and special assistance programs, and third parties possessing information relevant to the administration of, and your participation in, the AgriStability and AgriInvest programs to share such information with AAFC.

All applicants except Status Indians and Band farms: by completing this form, you authorize the CRA to share information from this form and any other information not provided by the applicant on their form that CRA has already obtained, with AAFC, and you authorize AAFC, where relevant, to share the information on the form and any additional information that is provided as the application is processed, with the CRA, the Administration, provincial and territorial governments and with the administrators of other federal/provincial/territorial farm programs and with other government departments or agencies as required by law.

Status Indians and Band farms: AAFC agrees that information provided by Status Indians and Band farms to the AgriStability and AgriInvest programs will not be disclosed to CRA by the Administration, unless disclosure is required by law. By completing and submitting this form you authorize the Administration to share information from this form with AAFC, and authorize AAFC, where relevant, to share the information on the form and any additional information that is provided as the application is processed, with provincial or territorial governments and with the administrators of other federal/provincial/territorial farm programs.

If you do not consent to the sharing of information described herein you may be ineligible to participate in the AgriStability or AgriInvest programs or receive benefits or adjustments to benefits under the AgriStability and AgriInvest programs.

Personal information will be handled in accordance with the Privacy Act. You have the right to the protection and correction of, and access to, your personal information.

For personal information under the control of AAFC, these rights may be exercised by contacting the AAFC Access to Information and Privacy Director at aafc.atip-aiprp.aac@agr.gc.ca. You also have the right to file a complaint with the Office of the Privacy Commissioner of Canada concerning AAFC’s handling of your personal information. Details of the collection, use, disclosure, and retention of personal information are described in the Personal Information Bank, the Net Income Stabilization Account (NISA), AAFC PPU 183.

For personal information under the control of the Canada Revenue Agency, these rights may be exercised by contacting the Access to Information and Privacy Directorate at the Canada Revenue Agency at ATIP-AIPRP@cra-arc.gc.ca. Details of the collection, use, disclosure, and retention of personal information are described in the Personal Information Banks CRA PPU 005, CRA PPU 025.

In addition, by submitting this form for benefits under the AgriStability and AgriInvest programs, you:

1. certify that the information provided is complete and correct
2. declare that the structure of this farming operation has not been altered or created for the purpose of manipulating program benefits or avoiding prescribed maximum limits on program payments
3. understand and agree that any interim or targeted advance payment of AgriStability program funds will be deducted in the calculation of a final AgriStability program payment
4. agree that you will repay any amounts paid to you by the AgriStability and AgriInvest programs that are in excess of the amount calculated under the program rules and understand that any amount you owe to the Crown may be subtracted from any payments to be sent to you by the Crown
5. understand that interest will be charged on overpayments
6. understand and agree that the information you submit may be combined with the information of other participants for the purposes of determining AgriStability and AgriInvest benefits, and consent to the disclosure of information pertaining to you or your financial affairs to the other participants whose information is being combined with yours
7. understand and certify that where you have provided information about other individuals or entities you have been authorized by those individuals or entities to provide that information
8. understand and agree that where you have provided information about other individuals or entities, if they request to see the information you have submitted about them, the Administration will give them access to that information
9. consent to third parties, CRA and other government programs disclosing to the Administration, upon its request, any information pertaining to you or your financial affairs which the Administration considers necessary for the purpose of verifying the AgriStability and AgriInvest benefit or the information provided on this form
10. understand that it is a criminal offence to make a false statement in application for program benefits and any declarations made are subject to audit

The business risk management program applicant acknowledges that individuals who are subject to the provisions of the Conflict of Interest Act (S.C. 2006, c.9, s.2), the Conflict of Interest Code for Members of the House of Commons, the Ethics and Conflict of Interest Code for Senators, the Values and Ethics Code for the Public Sector or any other conflicts of interests or values and ethics codes applicable within provincial or territorial governments or specific organizations, shall not derive any direct benefit resulting from this application unless the provision or receipt of such benefit is permitted in such legislation, policy or codes.