HIGHLY 
ERODIBLE 
Producers use this form to 
request an exemption for highly erodible land conservation provisions under USDA 
programs. 
Submit the original of the completed form in hard copy or facsimile to the appropriate FSA servicing office.
Customers 
who have established electronic access credentials with USDA may electronically 
transmit this form to the USDA servicing office, provided that (1) the 
customer submitting the form is the only person required to sign the 
transaction, or (2) the customer has an approved Power of Attorney (Form 
FSA-211) on file with USDA to sign for other customers for the program and type 
of transaction represented by this form.
Features 
for transmitting the form electronically are available to those customers with 
access credentials only.  If you 
would like to establish online access credentials with 
USDA, follow the instructions provided at the USDA eForms web site.
Producers 
must complete Items 1 through 9B.
 
| Fld. Name/ Item 
      No. | Instruction | 
| 1A State 
      Name | Enter the State name 
      where the farm is located. | 
| 1B | Enter the County name 
      where the farm is located. | 
| 2 Producer Information 
       | Enter the producer’s 
      name, address including Zip code, and telephone number including area 
      code. | 
| 3 Identifica- tion Number | Enter the producer’s 
      social security number or tax ID number. | 
| 4 Farm 
      Number | Enter the Farm Number 
      on which the exemption request is being made. | 
| 5 Crop 
      Year | Enter the crop year 
      for which the exemption request is being made. | 
| 6 Cropland | Enter the number of 
      acres for which the exemption request is being 
    made. | 
| 7 Reason for 
      Request | Enter the reason for 
      the request.  Describe in 
      detail the conservation measures that are required but will not be applied 
      and the reasons they will not be applied. | 
| 8A Producer’s 
      Signature | Enter the producer’s 
      signature. If you are mailing 
      or faxing this form, print the form and manually enter your signature. If 
      this form is approved for electronic transmission and you have established 
      credentials with USDA to submit forms electronically, use the buttons 
      provided on the form for transmitting the form to the USDA servicing 
      office. | 
| 8B Date | Enter the date of 
      producer’s request. | 
| 9A Landlord’s 
      Signature | Landlord’s signature, 
      if applicable. | 
| 9B Date | Date of landlords’ 
      signature. | 
Items 10 – 27 are for FSA's use only.
| File Type | text/html | 
| File Modified | 0000-00-00 | 
| File Created | 0000-00-00 |