2023 AgriStability Interim Payment Application Form

This HTML document is not an application form. Its purpose is to display the information as found on the form for viewing purposes only. If you wish to submit an application form, please use the PDF version.

PDF forms

If you have problems opening a PDF form in your Internet browser, you need to:

  • Use your computer. The forms may not open on mobile devices (iPads, tablets, mobile phones).
  • Make sure you have Adobe Reader 11 (or higher) already installed on your computer. If not, download Adobe Reader 11 or higher for free. Adobe has help for solving common issues.
  • You must save the file on your computer in a place you can remember.
  • Open the file on your computer using Adobe Reader 11 or higher.
  • If you can't open the form with Adobe Reader 11 or higher, contact the program.
How to download and open a PDF form
  • Microsoft Windows Operating System computers using "Internet Explorer" or "Microsoft Edge" as your browser
    1. Right-click on the link you want to save
    2. Select "Save target as" or "Save link as"
    3. Choose the location on your computer where you would like to save the file
    4. Select "Save"
    5. Open Adobe Reader 11 or higher
    6. Select "File"
    7. Select "Open"
    8. Go to the location where you saved the file
    9. Select the PDF file
    10. Select "Open"
  • Microsoft Windows Operating System or Apple computers using "Chrome" or Firefox" as your browser
    1. Right-click on the link you want to save
    2. When the option menu appears, choose "Download link file" or "Download link file as"
    3. Choose the location on your computer where you would like to save the file. Your computer will start the download once you have selected a location.
    4. Open Adobe Reader 11 or higher
    5. Go to the location where you saved the file
    6. Select the PDF file
    7. Select "Open"

2023 AgriStability Interim Payment Application (PDF Version, 174 KB)

If you cannot access the PDF version or require printed copies of this publication, please contact us at 1-866-367-8506.

Participant identification

Name (individual or entity):

Participant identification number (PIN):

  • 1a) Are you a new participant? If the answer is "Yes", complete Schedule 1 (sections a, b, c) and Schedule 2. Yes/No
  • 1b) Since your last application have you:

    • Changed your address or telephone number? If "Yes", provide the new information on Schedule 1, section a. Yes/No
    • Changed your contact person information? If "Yes", complete Schedule 1, section b. Yes/No
    • Changed your business structure? If "Yes", complete Schedule 1, sections c and d. Yes/No

Other information

  • 2a) Did you complete a production cycle on at least one of the commodities you produced? Yes/No

    If "No", was at least half of your farm's total production not completed due to disaster circumstances? Yes/No

  • 2b) Are you, or anyone who helped you complete your form, a current or former federal public office holder or employee of Agriculture and Agri-Food Canada? Yes/No
  • 2c) Did you produce commodities that were, or could have been, insured under AgriInsurance (crop or production insurance)? Yes/No

    Are the majority (more than half) of your insurable crop acres insured at 70% or higher? Yes/No

  • 2d) Have you submitted a complete 2022 AgriStability form? If "No", complete Schedule 2. Yes/No

Farming operation

  • 3a) Fiscal period from Year/Month/Day to Year/Month/Day

  • 3b) Is this farming operation part of a Whole Farm? If yes, please provide PINs for all operations. Yes/No

    PIN:
    PIN:

Partnership information (if applicable)

3c) Enter the Participant identification number (PIN) for each of your partners. Enter the first and last names for individual partners. Enter the corporation's name for corporate partners. Your partnership's total shares must equal 100%.

  • Your % share of the partnership:
Partnerships
AgriStability PIN Individual's first name Individual's last name Corporation name % share
        %
        %
        %

Confidential information and participant consent

The information on this form is collected under the authority the Farm Income Protection Act and will be used for the purposes of administering your participation in the AgriStability program; determining your eligibility for benefits; verifying the information submitted; issuing tax receipts; administering benefits under other farm income and special assistance programs; and for the purposes of audit, analysis and evaluation of the AgriStability and other farm income and special assistance programs by the Administration, AAFC, the provincial/territorial governments or third parties engaged for that purpose.

The Privacy Act protects information you give on this form which is kept in personal information bank number AAFC PPU 183.

By submitting this application form, you:

  • certify that the information you provided on this form is complete and accurate and understand that it is a criminal offense to make a false statement in application for program benefits and any declarations made are subject to audit
  • certify that you have completed at least six months of farming activity and a production cycle in the program year, or could not for reasons beyond your control
  • understand and agree that as a condition of receiving an Interim payment, you must participate in AgriStability and submit a complete 2023 AgriStability form by the deadline to be entitled to any AgriStability benefits
  • understand that any Interim payment of AgriStability program funds will be deducted in the calculation of your final AgriStability program payment
  • agree to repay any overpayment amount received as an Interim payment if the amount exceeds your final 2023 AgriStability program payment and understand that interest will be charged on overpayments
  • understand any amount you owe to the Crown will be subtracted from an Interim payment
  • understand and agree that the person you identified as your contact person may receive information relating to your form from the Administration and may instruct the Administration to modify the information on your form
  • consent to the use and disclosure of the information contained in this form to officials from Agriculture and Agri-Food Canada and the provincial/territorial department responsible for agriculture to administer your application for AgriStability, and for the purposes of audit, analysis and evaluation of the AgriStability program
  • consent to the use of any information you submitted to the AgriStability or AgriInsurance (production or crop insurance) agencies to administer this application
  • understand and agree that the information you submitted may be combined with information of other participants to determine your Interim payment
  • consent to the disclosure of information pertaining to you and your financial affairs to the other participants being combined with your information

Program year farming activity

  • 4a) Program year payments
    For each of the following, provide the amounts you have received or expect to receive for the 2023 program year:

    • AgriInsurance (crop or production insurance) payments: $
    • Other program payments (see the Interim Guide for a list of program payments): $
  • 4b) Allowable expenses
    If you had no significant change to the expenses listed, tick the "no significant change" box.
    If you had a significant change to the expenses listed, provide the total amount of the expense (not just the amount of the increase or decrease).

    Expenses
    Expense categories No significant change Total expected expense amount
    Seed purchases    
    Feed purchases    
    Fertilizers and soil supplements    
    Pesticides and chemical treatments    
    Machinery (gasoline, diesel fuel, oil)    
    Arm's length salaries    
  • 4c) Did your productive capacity decrease during the program year due to disaster?

    • For Crops Yes/No
    • For Livestock Yes/No
  • 4d) Crop Production

    Code Crop description Acres Unseedable acres Production expected
    (tonnes)
    Production intended for sale (tonnes) Price per tonne $
                $
                $
                $
                $
                $
                $
    17 Summerfallow acres    
    18 Pasture acres    
    19 Wasteland acres    
     
  • 4e) Livestock Production

    Livestock - Cattle/Hogs - Production
    Code Productive animals 2023 Productive capacity 2023 Production Average wean weight
    8004 Cow/Calf Number of cows that calved Number of calves born  
    8004 Cow/Calf Number of cows that calved Number of calf feed days N/A
    8751 Hogs, farrowing Number of sows that farrowed Number of animals born  
    8760 Hogs, farrow to finish Number of sows that farrowed Number of animals born N/A
    N/A = not applicable
    Livestock - Cattle/Hogs - Feeder
    Code Feeder livestock 2023 Productive capacity 2023 Production
    8066 Feeder cattle, fed up to 900 lbs Number of animals fed Number of animal feed days
    8068 Feeder cattle, fed over 900 lbs Number of animals fed Number of animal feed days
    8762 Hogs, nursery, fed up to 50 lbs Number of animals fed Number of animal feed days
    8761 Hogs, feeders, fed over 50 lbs Number of animals fed Number of animal feed days
    Custom Fed Livestock
    Code Custom fed livestock 2023 Productive capacity
    8133 Cattle Number of animal feed days
    8749 Hogs Number of animal feed days
    Supply Managed Commodities
    Code Supply managed commodities 2023 Productive capacity 2023 Production Estimated price $
    7663 Chickens, breeder, broiler hatching eggs Number of producing hens Dozens of eggs produced $
    7664 Chickens, layers, eggs for consumption Number of producing hens Dozens of eggs produced $
    7650 Chickens, broilers Kilograms of quota Kilograms produced $
    7862 Turkeys, broilers Kilograms of quota Kilograms produced $
    Other Production
    Code Other (specify) 2023 Productive capacity 2023 Production Estimated price $
            $
            $
            $
            $