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Protected B when complete
If you farm in Manitoba, New Brunswick, Newfoundland and Labrador, Nova Scotia, or the 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 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:
British Columbia Ministry of Agriculture
200-1500 Hardy Street
Kelowna, BC V1Y 8H2
Toll free fax: 1-877-605-8467
Please identify the information you are sending by checking the applicable box(es) below:
- 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:
Number of pages/attachments including this page: ___
- Participant Identification Number (PIN):
- Telephone number:
- Fax number:
2. Adjustment details
Indicate the details of your requested adjustment below. 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. Please ensure you indicate the year(s) you are adjusting.
Note: If you would prefer to show your adjustments using a page from the Statement A rather than filling in part 2 of this form, attach the page(s) from the Statement A to this form.
|Section on the form||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 information on this form, including your Social Insurance Number (SIN) and Participant Identification Number (PIN) is collected under the authority of Section 4 of the Farm Income Protection Act (FIPA) and will be used exclusively for the purposes 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 farm income and special assistance programs and
- for purposes of audit, analysis, and evaluation of the AgriStability and AgriInvest and other farm income and special assistance 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 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 farm programs.
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 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 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.
You have the right to access the personal information held by federal departments and to request changes to incorrect personal information. For more information about your rights regarding the Privacy Act contact the Access to Information and Privacy Directorate at the Canada Revenue Agency at ATIP-AIPRP@cra-arc.gc.ca or the AAFC Access to Information and Privacy Coordinator at email@example.com and reference CRA PPU 005, CRA PPU 025 and/or AAFC PPU 183.
In addition, by submitting this form for benefits under the AgriStability and AgriInvest programs, you:
- certify that the information provided is complete and correct
- 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
- 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
- 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
- understand that interest will be charged on overpayments and
- 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 who are being combined with your information
- 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
- 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
- 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
- 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