Fill - Free fillable 502 PreQual- Pkg PDF form

Revised 11/13/2017

RuralDevelopment

502 Pre‐Qualification

ThankyouforyourinterestintheRuralDevelopmenthomeloan/grantprogram.Thefirststepinthehome

loan/grantapplicationprocessistoobtainapre‐qualificationreview.Enclosedisthe“HomeLoanPre‐Qualification

Worksheet‐VA”andthe“FormRD3550‐1AuthorizationtoReleaseInformation”.Pleasecompleteandmakesure

bothformsarelegibleandsigned.Eachindividual(18orover)residinginthehouseholdmustcompleteandsigna

separate“FormRD3550‐1AuthorizationtoReleaseInformation”.Iftherearemorethantwoindividualsover18

residinginthehousehold,pleasemakeadditionalcopiesfortheseindividualstocomplete.

Oncetherequestedformsarereceived,theinformationwillbeverifiedtodetermineyoureligibilityforloan/grant

pre‐qualification.Pleasenotethatpre‐authorizationsarenotbindingandshouldnotbeconsideredanapprovalor

rejection.

Inaddition,onewillneedtocompleteahomebuyereducationclassuponloanapproval.Theseclassesareavailable

in‐personandonline.Formoreinformation,pleasecontactVHDA800‐227‐8432orvisittheirwebsiteat

http://www.vhda.com/Homebuyers/HomeownershipEdu/Pages/HomeownershipEdu.aspx.

Pleasee‐mail,mailorfaxtherequested502Pre‐Qualificationinformationto:

Welookforwardtoreviewingyoursubmittedmaterialandprocessingyourpre‐qualification.

Ifyoushouldhavefurtherquestions,pleasecontactourofficeat276‐889‐4650ext.102.Ifhearingimpaired,the

TTDnumberis800‐287‐1753.

The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age

(provided the applicant has the capacity to enter into a binding contract); because all or part of the applicant’s income derives from any public assistance program; or because the applicant

has in good faith exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with this law concerning this creditor is the Federal Trade

Commission. If a person believes he or she was denied assistance in violation of this law, they should contact the Federal Trade Commission, Washington, DC 20580.

The Fair Housing Act prohibits discrimination in real estate related transactions or in the terms of conditions of such a transaction because of race, color, religion, sex, disability, familial

status, or national origin. The federal agency that is responsible for enforcing this law is the U.S. Department of Housing and Urban Development. If a person believes that they have been

discriminated against in violation of this law, they should contact the U. S. Department of Housing and Urban Development, Washington, DC 20410 or call (800) 669-9777.

eb:

http://www.rurdev.usda.gov

Committed to the future of rural

communities.

USDA is an equal opportunity provider, employer and lender.

To file a complaint

of discrimination, write USDA, Assistant Secretary for Civil Rights, 1400 Independence Avenue, S.W., Stop 9410 Washington, DC

20250-9410 or call toll-free

(866) 632-9992 (English) or (800) 877-8339 (TDD) or (866) 377-8642 (English Fed-relay) or (800) 845-6136 (Spanish Fed-relay).

Indicators of Unacceptable Credit

Little or no credit history. The lack of credit history on the credit report may be mitigated if the applicant can

document a willingness to pay recurring debts through other acceptable means such as third party verifications or

canceled checks. Due to impartiality issues, third party verifications from relatives of household members are not

permissible.

Payments on any installment account where the amount of the delinquency exceeded one installment for more than

30 days within the last 12 months.

Payments on any revolving account which was delinquent for more than 30 days on two or more occasions within the

last 12 months.

A foreclosure that has been completed within the last 36 months.

An outstanding Internal Revenue Service (IRS) tax lien or any other outstanding tax liens with no satisfactory

arrangement for payment.

Two

more rent or mortgage payments paid 30 or more days late within the last 2 years. If the applicant has

experienced no other credit problems in the past 2 years, only 1 year of rent history will be evaluated. This

requirement may be waived if the program loan will reduce shelter costs significantly and contribute to improved

repayment ability.

Outstanding collection accounts with a record of irregular payments with no satisfactory arrangements for

repayment, or collection accounts that were paid in full within the last 6 months, unless the applicant had been

making regular payments previously.

Non-Agency debts written off within the last 36 months, unless the debt was paid in full at least 12 months ago.

Agency debts that were debt settled within the past 36 months, or are being considered for debt settlement.

Delinquency on a federal debt.

A court-created or court-affirmed obligation or judgment caused by nonpayment that is currently outstanding or

has been outstanding within the last 12 months, except:

◊ A bankruptcy in which:

♦ Debts were discharged more than 36 months prior to the date of application; or

♦ Where one successfully completed a bankruptcy debt restructuring plan and has demonstrated a

willingness to meet obligations when due for the 12 months prior to the date of application.

◊ A judgment satisfied more than 12 months before the date of application.

An applicant with an outstanding judgment obtained by the United States in a Federal court, other than the

United States Tax Court, is not eligible for a Section 502 loan. This requirement is statutory and cannot be

waived.

Do you have any outstanding judgments against you or judgments that have not been paid off for one (1) year?

Yes ___ No ___

Have you been foreclosed on in the last three (3) years

? Yes ___ No ___

Have you filed bankruptcy in the last three (3) years

? Yes ___ No ___

If yes, please

complete the following: Chapter filed:

3 ___ 7 ___ 13 ___

Date discharged

___________

Do you have any outstanding collection accounts? Yes ___ No ___

Have you been more than thirty (30) days late on any payments in the past two (2) years? Yes ___ No ___

If you answered “yes” to any of the above questions, we recommend you contact a credit counselor. Dial 211 or visit

www.virgin

ia211.org for information on counselors in your area.

Date Received _____________

Date Entered into UNIFI _____________

Home Loan Pre-Qualification Worksheet – VA

Complete this page and sign the attached release.

Send to the applicable servicing office serving the county where the home is located.

USDA is an equal opportunity provider and employer. To file a complaint of discrimination, write USDA, Office of Assistant Secretary for Civil Rights, Office of Adjudication, 1400

Independence Ave, SW, Washington, DC 20250-9410 or call (866)632-9992 (Toll-free Customer Service), (800)877-8339 (Local or Federal Relay), (866)377-8642 (Relay voice users).

• The purpose of this request is Home Purchase or Home Repair | County _____________________

• I am currently a homeowner living with relative renting $ ___________ (month)

• Have you ever had a loan or grant from USDA Rural Development or FmHA? Yes No

plicant Co-Applicant

(if applicable)

Name

E-mail

Social Security #

SS#

DOB

Current Street Address

Street

City, State, Zip

C/S/Z

Phone(s): Home

Preferred

Home

Preferred

Cell

or preferred

Cell

or preferred

Work

or preferred

Work

or preferred

List All Members of Your Household NOTE: Everyone living in the household and one’s income must be included.

Wage Income Other Income (Monthly Amt)

Name

Relation to

you

Age

Sex

Hourly

Rate

Hrs/

Self-Employment *Will need last 2

years Fed’l Tax Return w/Schedule C

Enter amounts from Line # 12 on

1040 of both years

Chld

Support

Soc Sec/

SSI/VA

Pensio

AFDC

Food Stamps

Self

Tax Year _____

Amount _____

Tax Year _____

Amount _____

Tax Year _____

Amount _____

Tax Year _____

Amount _____

Tax Year _____

Amount _____

Tax Year _____

Amount _____

Tax Year _____

Amount _____

Tax Year _____

Amount _____

Tax Year _____

Amount _____

Tax Year _____

Amount _____

ist All Household Debts

Car/truck paid to

Payment/month

Balance owed

Credit card paid to

Payment/month

Balance owed

Student loan paid to

Payment/month

Balance owed

Other loan paid to

Payment/month

Balance owed

I pay Alimony and/or Child Support:

If yes, amount owed/month

I pay Child Care Expenses: Yes

(school age child)

Weekly $____________ for _______ weeks during school year.

Weekly $____________ for ______ weeks during the summer.

Household Assets

Bank Name (Checking)

Account Balance

Bank Name (Savings)

Account Balance

Other Asset

Present Value

Do you have any liquid assets in excess of $5,000.00? Yes No

Thank you for your interest in a USDA home loan. A team member will contact you shortly.

This PRE-QUALIFICATION is for INFORMATION ONLY and DOES NOT constituate an application for assistance.

Do you have any liquid assets in excess of

$5,000.00?

USDA is an equal opportunity provider and employer. To file a complaint of discrimination, write USDA, Office of Assistant Secretary for Civil Rights, Office of Adjudication, 1400 Independence

Ave, SW, Washington, DC 20250-9410 or call (866)632-9992 (Toll-free Customer Service), (800)877-8339 (Local or Federal Relay), (866)377-8642 (Relay voice users).

Form RD 3550-1 Form Approved

(Rev. 06-06) 0MB No. 0575-0172

United States Department of Agriculture

Rural Development

Rural Housing Service (RHS)

AUTHORIZATION TO RELEASE INFORMATION

TO: (For agency to complete as needed)

RE: (For agency to complete as needed)

Account or Other Identifying Number

(Type or print your name here)

Customer Name

I, and/or adults in my household, have applied for or obtained a loan or grant from the Rural Housing Service

(RHS), part of the Rural Development mission area of the United States Department of Agriculture. As part of this

process or in considering my household for interest credit, payment assistance, or other servicing assistance on such

loan, RHS may verify information contained in my request for assistance and in other documents required in

connection with the request.

I, or another adult in my household, authorize you to provide to RHS for verification purposes the following

applicable information:

x Past and present employment or income records.

x Bank account, stock holdings, and any other asset balances.

x Past and present landlord references.

x Other consumer credit references.

If the request is for a new loan or grant, I further authorize RHS to order a consumer credit report and verify other

credit information.

I understand that under the Right to Financial Privacy Act of 1978, 12 U.S.C. 3401, et seq., RHS is authorized to

access my financial records held by financial institutions in connection with the consideration or administration of

assistance to me. I also understand that financial records involving my loan and loan application will be available to

RHS without further notice or authorization, but will not be disclosed or released by RHS to another Government

agency or department or used for another purpose without my consent except as required or permitted by law.

This authorization is valid for the life of the loan.

The recipient of this form may rely on the Government's representation that the loan is still in existence.

The information RHS obtains is only to be used to process my request for a loan or grant, interest credit, payment

assistance, or other servicing assistance. I acknowledge that I have received a copy of the Notice to Applicant

Regarding Privacy Act Information. I understand that if I have requested interest credit or payment assistance, this

authorization to release information will cover any future requests for such assistance and that I will not be

renotified of the Privacy Act information unless the Privacy Act information has changed concerning use of such

information.

A copy of this authorization may be accepted as an original.

Your prompt reply is appreciated.

Signature (Applicant or adult household member) Date

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless as displays a valid OMB control number. The valid OMB control

number for this information collection is 0575-0172. The time required to complete this information collection is estimated to average 5 minutes per response, including the time for reviewing

instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

RHS Is An Equal Opportunity Lender

SEE ATTACHED PRIVACY ACT NOTICE BELOW

USDA is an equal opportunity provider and employer. To file a complaint of discrimination, write USDA, Office of Assistant Secretary for Civil Rights, Office of Adjudication, 1400 Independence

Ave, SW, Washington, DC 20250-9410 or call (866)632-9992 (Toll-free Customer Service), (800)877-8339 (Local or Federal Relay), (866)377-8642 (Relay voice users).

(Use this page for co-applicant and other adults over 18 living in the household, if applicable)

Form RD 3550-1 Form Approved

(Rev. 06-06) 0MB No. 0575-0172

United States Department of Agriculture

Rural Development

Rural Housing Service (RHS)

AUTHORIZATION TO RELEASE INFORMATION

TO: (For agency to complete as needed)

RE: (For agency to complete as needed)

Account or Other Identifying Number

(Type or print your name here)

Customer Name

I, and/or adults in my household, have applied for or obtained a loan or grant from the Rural Housing Service

(RHS), part of the Rural Development mission area of the United States Department of Agriculture. As part of this

process or in considering my household for interest credit, payment assistance, or other servicing assistance on such

loan, RHS may verify information contained in my request for assistance and in other documents required in

connection with the request.

I, or another adult in my household, authorize you to provide to RHS for verification purposes the following

applicable information:

x Past and present employment or income records.

x Bank account, stock holdings, and any other asset balances.

x Past and present landlord references.

x Other consumer credit references.

If the request is for a new loan or grant, I further authorize RHS to order a consumer credit report and verify other

credit information.

I understand that under the Right to Financial Privacy Act of 1978, 12 U.S.C. 3401, et seq., RHS is authorized to

access my financial records held by financial institutions in connection with the consideration or administration of

assistance to me. I also understand that financial records involving my loan and loan application will be available to

RHS without further notice or authorization, but will not be disclosed or released by RHS to another Government

agency or department or used for another purpose without my consent except as required or permitted by law.

This authorization is valid for the life of the loan.

The recipient of this form may rely on the Government's representation that the loan is still in existence.

The information RHS obtains is only to be used to process my request for a loan or grant, interest credit, payment

assistance, or other servicing assistance. I acknowledge that I have received a copy of the Notice to Applicant

Regarding Privacy Act Information. I understand that if I have requested interest credit or payment assistance, this

authorization to release information will cover any future requests for such assistance and that I will not be

renotified of the Privacy Act information unless the Privacy Act information has changed concerning use of such

information.

A copy of this authorization may be accepted as an original.

Your prompt reply is appreciated.

Signature (Applicant or adult household member) Date

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless as displays a valid OMB control number. The valid OMB control

number for this information collection is 0575-0172. The time required to complete this information collection is estimated to average 5 minutes per response, including the time for reviewing

instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

RHS Is An Equal Opportunity Lender

SEE ATTACHED PRIVACY ACT NOTICE BELOW

USDA is an equal opportunity provider and employer. To file a complaint of discrimination, write USDA, Office of Assistant Secretary for Civil Rights, Office of Adjudication, 1400 Independence

Ave, SW, Washington, DC 20250-9410 or call (866)632-9992 (Toll-free Customer Service), (800)877-8339 (Local or Federal Relay), (866)377-8642 (Relay voice users).

NOTICE TO APPLICANT REGARDING PRIVACY ACT INFORMATION

The information requested on this form is authorized to be collected by the Rural Housing Service (RHS), Rural Business-

Cooperative Services (RBS), Rural Utilities Service (RUS) or the Farm Service Agency (FSA) (''the agency'') by title V of the

Housing Act of 1949, as amended (42 U.S.C. 1471 et seq.) or by the Consolidated Farm and Rural Development Act (7 U.S.C.

1921 et seq.), or by other laws administered by RHS, RBS, RUS or FSA.

Disclosure of information requested is voluntary. However, failure to disclose certain items of information requested, including

your Social Security Number or Federal Identification Number, may result in a delay in the processing of an application or its

rejection. Information provided may be used outside of the agency for the following purposes:

1. When a record on its face, or in conjunction with other records, indicates a violation or potential violation of law, whether

civil, criminal or regulatory in nature, and whether arising by general statute or particular program statute, or by regulation,

rule, or order issued pursuant thereto, disclosure may be made to the appropriate agency, whether Federal, foreign, State,

local, or tribal, or other public authority responsible for enforcing, investigating or prosecuting such violation or charged

with enforcing or implementing the statute, or rule, regulation, or order issued pursuant thereto, if the information disclosed

is relevant to any enforcement, regulatory, investigative, or prosecutive responsibility of the receiving entity.

2. A record from this system of records may be disclosed to a Member of Congress or to a Congressional staff member in

response to an inquiry of the Congressional office made at the written request of the constituent about whom the record is

maintained.

3. Rural Development will provide information from this system to the U.S. Department of the Treasury and to other Federal

agencies maintaining debt servicing centers, in connection with overdue debts, in order to participate in the Treasury Offset

Program as required by the Debt Collection Improvement Act, Pub. L. 104-134, Section 31001.

4. Disclosure of the name, home address, and information concerning default on loan repayment when the default involves a

security interest in tribal allotted or trust land. Pursuant to the Cranston-Gonzales National Affordable Housing Act of 1990

(42 U.S.C. 12701 et seq.), liquidation may be pursued only after offering to transfer the account to an eligible tribal member,

the tribe, or the Indian Housing Authority serving the tribe(s).

5. Referral of names, home addresses, social security numbers, and financial information to a collection or servicing

contractor, financial institution, or a local, State, or Federal agency, when Rural Development determines such referral is

appropriate for servicing or collecting the borrower's account or as provided for in contracts with servicing or collection

agencies.

6. It shall be a routine use of the records in this system of records to disclose them in a proceeding before a court or

adjudicative body, when: (a) the agency or any component thereof; or (b) any employee of the agency in his or her official

capacity; or (c) any employee of the agency in his or her individual capacity where the agency has agreed to represent the

employee, or (d) the United States is a party to litigation or has an interest in such litigation, and by careful review, the

agency determines that the records are both relevant and necessary to the litigation, provided; however, that in each case, the

agency determines that disclosure of the records is a use of the information contained in the records that is compatible with

the purpose for which the agency collected the records.

7. Referral of names, home addresses, and financial information for selected borrowers to financial consultants, advisors,

lending institutions, packagers, agents and private or commercial credit sources, when Rural Development determines such

referral is appropriate to encourage the borrower to refinance the Rural Development indebtedness as required by title V of

the Housing Act of 1949, as amended (42 U.S.C. 1471), or to assist the borrower in the sale of the property.

8. Referral of legally enforceable debts to the Department of the Treasury, Internal Revenue Service (IRS), to be offset against

any tax refund that may become due the debtor for the tax year in which the referral is made, in accordance with the IRS

regulations at 26 C.F.R. 301.6402-6T, Offset of Past Due Legally Enforceable Debt Against Overpayment, and under the

authority contained in 31 U.S.C. 3720A.

9. Referral of information regarding indebtedness to the Defense Manpower Data Center, Department of Defense, and the

United States Postal Service for the purpose of conducting computer matching programs to identify and locate individuals

receiving Federal salary or benefit payments and who are delinquent in their repayment of debts owed to the U.S.

Government under certain programs administered by Rural Development in order to collect debts under the provisions of the

Debt Collection Act of 1982 (5 U.S.C. 5514) by voluntary repayment, administrative or salary offset procedures, or by

collection agencies.

10. Referral of names, home addresses, and financial information to lending institutions when Rural Development determines

the individual may be financially capable of qualifying for credit with or without a guarantee.

11. Disclosure of names, home addresses, social security numbers, and financial information to lending institutions that have a

lien against the same property as Rural Development for the purpose of the collection of the debt. These loans can be under

the direct and guaranteed loan programs.

USDA is an equal opportunity provider and employer. To file a complaint of discrimination, write USDA, Office of Assistant Secretary for Civil Rights, Office of Adjudication, 1400 Independence

Ave, SW, Washington, DC 20250-9410 or call (866)632-9992 (Toll-free Customer Service), (800)877-8339 (Local or Federal Relay), (866)377-8642 (Relay voice users).

NOTICE TO APPLICANT REGARDING PRIVACY ACT INFORMATION- CONTINUED

12. Referral to private attorneys under contract with either Rural Development or with the Department of Justice for the purpose

of foreclosure and possession actions and collection of past due accounts in connection with Rural Development.

13. It shall be a routine use of the records in this system of records to disclose them to the Department of Justice when: (a) The

agency or any component thereof; or (b) any employee of the agency in his or her official capacity where the Department of

Justice has agreed to represent the employee; or (c) the United States Government, is a party to litigation or has an interest in

such litigation, and by careful review, the agency determines that the records are both relevant and necessary to the litigation

and the use of such records by the Department of Justice is therefore deemed by the agency to be for a purpose that is

compatible with the purpose for which the agency collected the records.

14. Referral of names, home addresses, social security numbers, and financial information to the Department of Housing and

Urban Development (HUD) as a record of location utilized by Federal agencies for an automatic credit prescreening system.

15. Referral of names, home addresses, social security numbers, and financial information to the Department of Labor, State

Wage Information Collection Agencies, and other Federal, State, and local agencies, as well as those responsible for

verifying information furnished to qualify for Federal benefits, to conduct wage and benefit matching through manual and/or

automated means, for the purpose of determining compliance with Federal regulations and appropriate servicing actions

against those not entitled to program benefits, including possible recovery of improper benefits.

16. Referral of names, home addresses, and financial information to financial consultants, advisors, or underwriters, when Rural

Development determines such referral is appropriate for developing packaging and marketing strategies involving the sale of

Rural Development loan assets.

17. Rural Development, in accordance with 31 U.S.C. 3711(e)(5), will provide to consumer reporting agencies or commercial

reporting agencies information from this system indicating that an individual is responsible for a claim that is current.

18. Referral of names, home addresses, home telephone numbers, social security numbers, and financial information to escrow

agents (which also could include attorneys and title companies) selected by the applicant or borrower for the purpose of

closing the loan.

19. Disclosures pursuant to 5 U.S.C. 552a(b)(12): Disclosures may be made from this system to consumer reporting agencies as

defined in the Fair Credit Reporting Act (15 U.S.C. 168a(f) or the Federal Claims Collection Act (31U.S.C. 3701(a)(3)).

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