Fillable Rural Development Thank you for your interest in (USDA)

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Rural Development Thank you for your interest in (USDA)

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Rural Development
U.S. DEPART
MENT OF AGRICULTURE
Rural Development
USDA is an equal opportunity provider, employer and lender.
If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form (PDF), found online at
http://www.ascr.usda.gov/complaint_filing_cust.html, or at any USDA office, or call (866) 632-9992 to request the form. You may also write a letter containing all of
the information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Director, Office of Adjudication,
1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, by fax (202) 690-7442 or email at program.intake@usda.gov.
Dear Applicant:
Thank you for your interest in our Single Family Housing (SFH) Direct Home Loan program through
Rural Development (RD).
Prior to submitting your application, you can complete an online eligibility assessment to determine if
you are a good candidate for our SFH Direct Home Loan program. The link for the self-assessment is:
https://eligibility.sc.egov.usda.gov/eligibility/welcomeAction.do?pageAction=assessmentType
Enclosed is the application package to apply for the SFH Direct Home Loan program through Rural
Development.
The application package includes the following:
• Transmitting Single Family Housing Direct Applications via eForms and eForms Quick Reference
Guide (for your information)
• Attachment 3-D, Applicant Information Sheet (for your records)
• Attachment 3-J, Checklist of Items to Accompany the Uniform Residential Loan Application
(fully complete and return all applicable items on this checklist)
• Form RD 410-4, Uniform Residential Loan Application (fully complete highlighted sections and
return)
• (2) Form RD 3550-1, Authorization to Release Information (each applicant to sign/date
separate forms)
• Form RD 3550-4, Employment and Asset Certification (fully complete highlighted sections and
return)
• Attachment 3-H, Credit Score Disclosure and Notice to Home Loan Applicant (for your records)
• Exhibit 4-4, Indicators of Unacceptable Credit Guidelines (for your records)
To apply, complete all the applicable items in the attached 3-J Checklist of Items to Accompany the
Uniform Residential Loan Application and submit the package using one of the options below:
Option 1: Contact a loan application packager at the following website:
https://www.rd.usda.gov/sites/default/files/RD-SFH-IntermediaryMap.pdf
Option 2: Apply online via eForms. For instructions, see: “Transmitting Single Family Housing
Direct Applications via eForms” and “eForms Quick Reference Guide”.
Option 3: Return to a local Rural Development office:
Email to:
Mail to:
Go to https://offices.sc.egov.usda.gov/locator/app to locate a Rural Development Service Center.
KSDirect@ks.usda.gov
KSDirect@ks.usda.gov
IMPORTANT: If any item, information and/or signature is missing, your application is considered
incomplete and you will be contacted and asked to provide the missing pieces.
To qualify for the SFH Direct Home Loan program, your household’s adjusted annual income must be
within our established income limit based on household size and location. The income limits can be
found online at: https://www.rd.usda.gov/sites/default/files/RD-DirectLimitMap.pdf.
During your loan approval process, you will be instructed to watch the Agency’s online applicant
orientation video: https://www.youtube.com/watch?v=XxobzC24FfU&feature=youtu.be.
For more information, go to HB-1-3550, Direct Single Family Housing Loans and Grants – Field Office
Handbook: https://www.rd.usda.gov/resources/directives/handbooks.
All properties financed must be in an eligible rural area. Visit the property eligibility website to view
eligible rural areas: https://eligibility.sc.egov.usda.gov/eligibility/welcomeAction.do.
Final determination of eligibility is made by Rural Development upon receipt of a complete application.
Thank you for choosing Rural Development, if you have questions or concerns please feel free to
contact your local Rural Development office.
HOMEOWNERSHIP EDUCATION
Please be advised that Rural Development has a homeownership education requirement for first-time
homebuyers. You are expected to successfully complete this training prior to entering into a sales
contract to purchase or construct a home, since the training prepares you for shopping, buying,
financing, and owning a home.
During the time of the COVID-19 pandemic, classroom and one-on-one counseling being offered by
local providers is very limited or restricted. An alternative option to meet the homeownership
education requirement during the COVID-19 pandemic is to complete one of the three nationally
approved online homeownership education courses:
eHome America - http://ehomeamerica.org/usda (cost $75),
Framework - http://www.frameworkhomeownership.org/ (cost $75), and
Utah State University - https://extensioncourses.usu.edu/product-category/homebuyer-
education/ (cost $60 for the applicant and $5 for a co-applicant).
Upon completion of the course, you must provide documentation that you have successfully
completed the course by submitting a certificate of completion or letter from the certified provider.
There is generally an out-of-pocket fee for the training, which can be reimbursed should the loan
request be approved and closed. Please be advised if you do not close on your loan, you are
responsible for the homeownership education fee.
(Important - homeownership education is required for first-time homebuyers.)
Rev: April 8, 2020
TRANSMITTING SINGLE FAMILY HOUSING DIRECT APPLICATIONS
VIA EFORMS
Rural Development in _______________________________ accepts Single Family Housing
Direct (SFHD) Section 502 and 504 applications thru electronic submission using the eForms
site. The eForms site allows applicants and individuals working on behalf of the applicant to
search for and complete forms to apply for the SFHD programs. With the eForms site, users can
electronically submit all the items listed on Attachment 3-J for the Section 502 program (with the
exception of the credit report fee) or on Attachment 12-E for the Section 504 program.
The eForms user guide, training, and handout can be found on the Single Family Housing Direct
Home Loans website (under To Apply), Single Family Housing Repair Loans & Grants website
(under To Apply), and on the Direct Loan Application Packagers website. As outlined in the
materials, eForms is beneficial to both the submitter and to the Agency.
• For the submitter, eForms provides a convenient and secured way to submit a loan
application package.
• For the Agency, eForms streamlines the application process and reduces paper
consumption (which is good for the environment). In addition, applications that are
"accepted" in eForms automatically upload into the Agency’s origination system so they
can be "parsed" for further processing.
To start the process, please follow the steps on the attached eForms Quick Reference Guide.
If you have questions, our state eForms point of contact, _______________________________,
can be reached at _______________________________________________________________
_____________________________________________________________________________.
Kansas
Megan Herrman
(Information for submitting your application via eForms - option 2.)
Rev. April 2020
EFORMS QUICK REFERENCE GUIDE
Step 1: Obtain a USDA eAuthentication account with a verified identity.
o Click on https://www.eauth.usda.gov/eauth/b/usda/registration.
o Select “Customer” and click continue. Enter your email address and click submit.
o You will receive a notice that an email has been sent to complete the registration process.
o Log into your email account and locate the email with a subject line of “eAuth – Confirm Email”. The
email will be from donotreply.icam@ocia.usda.gov. Check your junk/spam folder if you do not see the
email in your inbox.
o In the email, click “Continue Registration”, enter the requested information (be sure to enter the
information exactly how it shows on your government issued ID), and select a password for your
eAuthentication account. Once the password is accepted, click submit.
o At the top of the page, click “Manage Account”.
o From the dropdown menu click “Update Account”.
o If you are not logged in to your eAuthentication account, you
will be directed to the log in screen. Enter your User ID
(email) and password.
o Scroll to and click “Verify My Identity” (as seen here).
o On the Verify Identity screen, select “Verify my identity online (recommended)” and click continue.
o Read the disclaimer and terms of service and click “I Agree”.
o Finish completing the additional information based on your government issued photo ID and click
continue.
o Answer five identity verification questions. If all five questions are answered correctly, the next screen
will state you have successfully completed the online identity verification process. If online verification
is unsuccessful, you can retry the identity verification process or you can submit your application
through another acceptable means.
Step 2: Using Internet Explorer, login to the eForms site with your User ID (email) and password.
https://forms.sc.egov.usda.gov/eForms/welcomeAction.do?Home
Step 3: Click “Browse Forms” from the menu options on the left.
Step 4: At the Form Number search option, enter “410-4”. Click search.
Step 5: Click the “RD 410-4” to open the form.
Step 6: Complete the “RD 410-4” and click submit.
Do not use punctuation in the “RD 410-4” form (e.g. enter “Road” instead of “Rd.”).
Note: Rural Development staff will not accept an
application unless it is complete (including all
applicable items listed on the Attachment 3-J or
Attachment 12-E). If any documents are determined
missing or incomplete during the review, the package
will be returned to the user with explanation. A 410-4
application submitted via the eForms site is considered
signed (a wet signature is not required).
(Information for submitting your application via eForms - option 2.)
Rev. April 2020
Step 7: Select the following state/county/RD Office combination:
Step 8: Attach documents required in the Attachment 3-J for Section 502 or Attachment 12-E for Section 504.
Click add.
Browse to locate the documents on your computer, select the document, enter a brief description, and click add.
Repeat until all documents are added. To save time, combine all documents into a single PDF on your
computer and add that single PDF.
Step 9: Click submit.
Be sure to retain your User ID and password. If the loan closes, this information can be used to
make the mortgage payment online.
Kansas / Ellis / Hays 17026
(Information for submitting your application via eForms - option 2.)
HB-1-3
550
Attachment 3-D
Page
1 of 5
ATTACHMENT 3-D
RURAL DEVELOPMENT
RURAL HOUSING SERVICE
“Applicant Information Sheet” - Single Family Housing
The Rural Housing Service (RHS) provides loans in rural areas to eligible low- and very
low-income applicants. The loan may be to purchase existing housing, purchase and repair
existing housing, purchase a building site and construct a dwelling, or purchase new housing.
Rural areas typically include open country and places with a population of 10,000 or less and,
under certain conditions, towns and cities between 10,000 and 35,000 population.
For detailed information on income limits and eligible areas, visit:
http://eligibility.sc.egov.usda.gov/eligibility/welcomeAction.do
The property must be in good repair or placed in good repair with loan funds. For an
existing property, a whole house inspection performed by a qualified inspector is needed. The
buyer and seller should discuss who will cover the cost of the whole house inspection and
address this item in the purchase agreement.
All who apply get equal consideration without regard to race, color, national origin,
religion, sex, gender identity, s
exual orientation, disability, age, marital status, family/parental
status, income derived from a public assistance program, political beliefs, or reprisal or
retaliation for prior civil rights activity.
To apply, complete all the applicable items in the attached checklist of items to
accompany the uniform r
esidential loan application and submit the package using one of the
options below:
x Through your loan application packager.
x Apply online after registering to obtain a USDA eAuthentication identification and
password. http://forms.sc.egov.usda.gov/eForms/welcomeAction.do?Home
x Return to the Rural Development office using the address(es) below. If an email
address is listed below, password protect the email to protect personal identifiable
information.
(01-23-03)
SPECIAL PN
Revised (12-12-19) PN 532
Email to KSDirect@ks.usda.gov
or
Mail to an address listed on the cover page
(Be sure to read these frequently asked questions.)
HB-1-3550
Attachment 3-D
Page 2 of 5
Please contact your loan application packager (if present) or the above Rural Development office if
you have questions regarding what needs to be in your application package or if would like
assistance in completing a form. To determine if you qualify, review these frequently asked
questions:
“CAN I ASSESS MY ELIGIBILITY PRIOR TO APPLYING?”
Using the Single Family Housing Direct Eligibility Assessment tool, potential applicants may
enter information online to determine if the Section 502 Direct Loan Program is a good fit for
them prior to applying. The tool will provide a preliminary eligibility determination after a
potential applicant enters information on their general household composition, monthly income,
monthly debts, property location, estimated property taxes, and estimated hazard insurance.
To access the tool, visit http://eligibility.sc.egov.usda.gov/eligibility/welcomeAction.do and click
on the Single Family Housing Direct tab.
Potential applicants are welcome to submit a complete application for an official determination
by Rural Development regardless of the eligibility assessment results. Upon receipt of a
complete application, Rural Development will determine the applicant’s eligibility using verified
information and the applicant’s maximum loan amount based on their repayment ability and the
area loan limit for the county in which the property is located.
“DOES IT MATTER HOW MANY OTHER BILLS I HAVE TO PAY?”
RHS will look at your monthly obligations and how much you currently owe to others. We’ll
want to know if paying back the proposed loan on top of your other payments will be difficult for
you.
“WHAT IF I THINK MY INCOME IS TOO LOW?”
Having enough income to repay your loan is an important part of getting a loan; however, the
RHS loan may be subsidized. A subsidized loan is based on the applicant repaying a percentage
of their income toward the housing payment, taxes, and insurance. The percentage is generally
24 percent of the applicant’s household income.
“WHAT CAN I DO IF MY INCOME IS TOO LOW?”
Consider applying with a co-applicant if there is another member of your household willing and
able to be a note signer. RHS will then look at your combined income and credit when
determining repayment ability. You may also consider a cosigner. A cosigner is an individual
who will not reside in the dwelling, but who is willing to be responsible for the debt. You may
also consider applying for down payment assistance programs in your area which provide
affordable housing products. Many areas have Housing Finance Agencies, Housing Authorities,
or Nonprofit Agencies which administer these programs. Funding from these sources can be
combined with Rural Development loan funds.
(Be sure to read these frequently asked questions.)
HB-1-3550
Attachment 3-D
Page 3 of 5
“HOW CAN I DETERMINE IF MY INCOME IS ADEQUATE TO REPAY A LOAN?”
The amount of your proposed monthly house payment, real estate taxes, insurance, and other
credit debts cannot exceed 41 percent of your gross monthly income. If you have questions
regarding how this determination is made, you may contact the local Rural Development Office
shown on the front cover.
“CAN I GET A LOAN IF I’M UNEMPLOYED?”
A steady source of income is very important to getting a loan. An applicant must show sufficient
resources to repay the housing loan. Not having a job or a stable source of income may have an
impact on the Agency’s decision. Experience has shown that applicants with stable jobs and
income sources are more likely to repay the loan.
“WILL YOU FIND OUT ABOUT OTHER CREDIT I’VE HAD?”
Yes. Your credit report provides information on your payment history including any difficulty
you have had repaying other loans or credit cards. That information will be used to determine if
you can repay the loan. If you are unsure what your credit history contains, you can obtain a free
credit report by calling 1-877-322-8228 or logging into http://www.annualcreditreport.com. By
law, individuals are entitled to receive one free credit file disclosure every 12 months from each
of the nationwide consumer credit reporting companies – Equifax, Experian and TransUnion.
This free report cannot replace the credit report that the Agency will obtain to determine
eligibility.
(01-23-03) SPECIAL PN
Revised (12-12-19) PN 532
(Be sure to read these frequently asked questions.)
HB-1-3550
Attachment 3-D
Page 4 of 5
“HOW LONG WILL IT BE BEFORE I CAN MOVE INTO MY NEW HOME?”
Typically, applicant eligibility, loan approval, and loan closing may be accomplished within
approximately 120 days of filing a complete application. However, depending on the availability
of Government funding, this time-frame may be extended. The applicant is periodically advised
regarding the status of their application when there is lack of funding.
When there is lack of funding, applications will be processed based on the following priorities:
1) subsequent loans to correct health and safety hazards, 2) loans to purchase homes owned by
RHS and loans to transfer and assume properties owned by RHS borrowers, 3) hardships as
defined by RHS, 4) loans that bring in additional resources as defined by RHS, and 5)
applications that do not qualify for priorities 1 - 4. Within each priority category, veteran’s
preference will be given to applicants who were discharged or released (except for a
dishonorable discharge) from the U.S. active forces (regardless of the position held –
administrative support, combat, mechanics, medical, transportation, etc.) and who actively
served during eligible periods.
“HOW MUCH MONEY WILL I NEED FOR A DOWNPAYMENT?”
A down payment is generally not required. Loans may be made for up to 100 percent of the
market (appraised) value. Simply put, this means if the sales price of the property is equal to or
less than the appraised value, no down payment is needed.
“DOES THIS MEAN I WON’T NEED ANY CASH TO GET A LOAN?”
Generally, the applicant will need some cash available. There are costs associated with the credit
report, appraisal report, escrow, and other related closing costs. The credit report fee is always
paid by the applicant upfront. The first year’s hazard insurance premium and whole house
inspection report fee are paid prior to closing unless included in the loan amount. Costs pertaining
to the appraisal, escrow, and loan closing may be included in the loan amount. You may also
negotiate with the seller to contribute a percentage toward closing costs. Any agreement with the
seller should be entered into prior to signing and documented in the purchase agreement or sales
contract.
“DOES THE APPLICANT HAVE OTHER RESPONSIBILITIES?”
Yes. Rural Development staff are available to assist the applicant from the application to loan
closing. The applicant is responsible for providing requested information timely. The
information may be requested by Rural Development staff, a loan application packager, a real
estate agent, or a closing agent. Failure to provide information timely results in delayed
decisions and other actions.
(Be sure to read these frequently asked questions.)
HB-1-3550
Attachment 3-D
Page 5 of 5
“ARE THERE OTHER ELIGIBILITY REQUIREMENTS?”
Yes. The applicant must:
1. Be without decent, safe, and sanitary housing.
2. Be unable to obtain a loan from other resources on terms and conditions that they can
reasonably be expected to meet.
3. Possess the legal capacity to incur the loan obligation.
4. Be a U.S. citizen, a U.S. noncitizen national, or a qualified alien and provide
acceptable evidence of qualified alien status.
“WHAT ARE THE TERMS OF THE LOAN?”
The maximum repayment period is 33 years and, under certain conditions, 38 years. The maximum
repayment period for manufactured homes is 30 years.
“WHERE MAY HOUSES BE LOCATED?”
Houses must be located in a rural area, on desirable sites with an adequate supply of safe
drinking water and suitable arrangements for sewage disposal. Streets must have an all-weather
surface and be maintained by a public body or a homeowner’s association.
“WHAT ABOUT THE SIZE AND FEATURES OF THE HOME AND SITE?”
While cost and features vary in different areas of the country, the home and site must be
modest. A modest home generally has between 400 and 2,000 square feet living area, above
grade. A modest site generally cannot be subdivided under local zoning laws, does not include
land or structures that will be used principally for income-producing purposes, complies with
local zoning requirements, and does not have an in-ground swimming pool (unless the seller
agrees to remove/fill it before closing). Under certain conditions, an exception to these
standards may be granted on a case by case basis. The value of a dwelling may not exceed the
area loan limit for the area in which the applicant is requesting financing.
WHO IS RESPONSIBLE FOR INSPECTING THE HOME?
The applicant/borrower is responsible for hiring a qualified inspector to conduct a whole house
inspection on an existing property and for making inspections necessary to protect their interests.
While a Rural Development staff member or designee may inspect a property during and/or
following construction or repair, these inspections do not create or imply a warranty or guarantee
on the condition of the property.
“WHERE MAY I APPLY?”
Applications are made at the local Rural Development office or through an application packager
serving the area where the house will be located. To locate your nearest Rural Development
office, please visit: https://offices.sc.egov.usda.gov/locator/app?state=us&agency=rd
(01-23-03) SPECIAL PN
Revised (12-12-19) PN 532
(Be sure to read these frequently asked questions.)
HB-1-3550
Attachment 3-J
Page 1 of 3
ATTACHMENT 3-J
CHECKLIST OF ITEMS TO ACCOMPANY THE
UNIFORM RESIDENTIAL LOAN APPLICATION
You, as the applicant, need to simultaneously submit the applicable items below when applying
for a loan. Copies of the verification documents should be submitted. If any item, information,
and/or signature is missing, you will be contacted and asked to provide the missing pieces. If the
missing pieces are not provided within 15 days of the request, your incomplete application
will be withdrawn from consideration. To avoid any delay or withdrawal, verify that your loan
application is fully complete prior to submission.
This checklist with the applicable and included items checked.
Form RD 410-4, Uniform Residential Loan Application: You must complete all sections (be
sure to provide all applicable information, details, and data) and sign/date pages 5 and 8.
https://forms.sc.egov.usda.gov//efcommon/eFileServices/eForms/RD410-4.PDF
Verification of identity: You must provide a copy of your Government-issued picture
identification (ID) along with evidence of age. Standard verifications are a driver’s license or a
passport. Contact us if you do not have these standard verifications to discuss possible
alternatives.
Verification of taxpayer ID number: You must provide verification of your full taxpayer ID
number (i.e. no numbers are hidden or suppressed) using evidence such as your pay stubs or tax
returns. A copy of your social security card is only needed if you do not have any other evidence
of your full taxpayer ID number.
$25 credit report fee (non-refundable): You must provide a check or money order that is signed,
dated, and made payable to USDA Rural Development. If the applicant and co-applicant
currently reside at separate addresses, the fee is $25 each. Remove any credit freeze at the time
of application submission and keep it lifted until such time as the Agency pulls a credit report.
(01-23-03) SPECIAL PN
Revised (12-12-19) PN 532
Notice to Customers Making Payment by Check: If applicants send the Agency a check, it will be
converted into an Electronic Funds Transfer (EFT). This means the Agency will copy the check and
use the account information on it to electronically debit the applicant’s account for the amount of the
check. The debit from the applicant’s account will usually occur within 24 hours and will be shown
on the applicant’s regular account statement. Applicants will not receive their original check back.
The Agency will destroy the original check but will keep an image of it. If the EFT cannot be
processed for technical reasons, applicants authorize the Agency to process a paper copy of the
image in place of the original check. If the EFT cannot be completed because of insufficient funds,
the Agency may try to make the transfer up to two additional times and the Agency will charge a
one-time fee of $15, which will also be collected by EFT.
(Fully complete and return all applicable items on this checklist.)
H
B
-1
-3
550
Attachm
ent 3-J
Page 2 of 3
If you have late payments, collections, judgments, or other derogatory items in your credit
history, provide a written explanation for each credit blemish. If you are unsure what your credit
history looks like, obtain a free credit report by calling 1-877-322-8228 or logging into
http://www.annualcreditreport.com. By law, you are entitled to receive one free credit file
disclosure every 12 months from each of the nationwide consumer credit reporting companies –
Equifax, Experian and TransUnion. This free report cannot replace the credit report that the
Agency will obtain to determine eligibility.
Form RD 3550-1, Authorization to Release Information: Each adult member of the household
must sign/date a separate release form.
http://forms.sc.egov.usda.gov/efcommon/eFileServices/eForms/RD3550-1.PDF
Form RD 3550-4, Employment and Asset Certification: You must check the appropriate blocks,
account for the household members’ employment and nonretirement assets as instructed, and
sign/date the certification.
http://forms.sc.egov.usda.gov/efcommon/eFileServices/eForms/RD3550-4.PDF
Your last two signed Federal Income Tax Returns with all applicable tax return schedules. Also
provide:
All W-2s, 1099s, and other forms attached to the returns.
If filed electronically, include a copy of the signature page with the Self-Select PIN,
confirmation that the return was accepted, or evidence that it was filed by an authorized
E-File provider.
Last four consecutive weeks of pay stubs for all employed adult household members.
If you have an employment history of less than two years or employment gaps in excess
of 30 days within the last two years, you should provide a letter of explanation.
Recent benefit statements for regular unearned income for all household members who
receive:
Social Security/Supplemental Security Income
Public assistance
Retirement income
Other
Last 12-month payment history of alimony and/or child support received by all adult
household members as provided by the court appointed entity responsible for handling
payments. If this is not available, provide a copy of the separation agreement or divorce decree.
While you can choose to have this income excluded from your repayment income, it must be
reported to determine if your household’s adjusted income is within the program’s income limit.
____________________________________________________________________________________________
(Fully complete and return all applicable items on this checklist.)
HB-1-3550
Attachment 3-J
Page 3 of 3
Two most recent brokerage or bank statements for all household members (excluding tax
advantaged plans for education, health/medical, and retirement). If you are obtaining this
information online, provide the statements as opposed to providing the online transaction
histories.
For a household member who is a full-time student and 18 years of age or older, a copy of their
school transcript.
Written evidence of child care expenses for dependents 12 years of age or younger.
If you are 62 years of age or older, are disabled, or have a disabled household member, provide
evidence of unreimbursed annual medical expenses if you wish to be considered for a deduction
to household income.
List your personal email address(es) below if you authorize the Agency to contact you via
email. The Agency password protects emails containing personal identifiable information.
____________________________________ ____________________________________
____________________________________ ____________________________________
While you are strongly discouraged from identifying a property or entering into a purchase
agreement until you receive a Certificate of Eligibility from Rural Development, enter the
county you are interested in purchasing a home in below.
____________________________________
If you have already entered into a purchase agreement (which again is strongly discouraged),
provide a copy of the agreement.
Applicants who are first-time homebuyers are strongly encouraged to complete a homeowner
education training as early in the application process as possible since the training covers the
following important topics: preparing for homeownership (readiness to go from rental to
homeownership), budgeting (pre- and post-purchase), credit counseling, shopping for a home,
obtaining a mortgage, loan closing, and life as a homeowner. There is generally an out-of-
pocket fee for the training, which can be reimbursed should the loan request be approved and
closed. Attached is a list of Agency-approved education providers. You will be expected to
successfully complete this training prior to entering into a contract to purchase or construct a
home for maximum benefit.
(01-23-03) SPECIAL PN
Revised (12-12-19) PN 532
(Fully complete and return all applicable items on this checklist.)
Mortgage
Applied for:
Agency Case Number Lender Account Number
Fixed Rate Other (Explaln):
GPM ARM (Type):
Purchase Construction Other (Explain):
Refinance Construction-Permanent
Fee Simple
Leasehold
(Show expiration date)
Separated Separated
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of
information unless it 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 1- 1/2 hours 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.
Mailing Address if different from Present Address
Mailing Address if different from Present Address
Present Address (Street, City, State, ZIP) Own Rent ______ No. Yrs. Present Address (Street, City, State, ZIP) Own Rent ______ No. Yrs.
Former Address (Street, City, State, ZIP) Own Rent ______ No. Yrs. Former Address (Street, City, State, ZIP) Own Rent ______ No. Yrs.
mm/dd/yy mm/dd/yy
Form RD 410-4 Form Approved
(Rev. 10-06) Position 3 OMB No. 0575-0172
APPLICATION FOR RURAL ASSISTANCE (NONFARM TRACT)
Uniform Residential Loan Application
This application is designed to be completed by the applicant with the lender’s assistance. Applicants should complete this form as “Applicant #1 “ or “Applicant #2”, as applicable.
All Applicants must provide information (and the appropriate box checked) when the income or assets of a person other than the “Applicant “ (including the Applicant’s
spouse) will be used as a basis for loan qualification or the income or assets of the Applicant’s spouse will not be used as a basis for loan qualification, but his or her liabilities
must be considered because the Applicant resides in a community property state, the security property is located in a community property state, or the Applicant is relying on other
property located in a community property state as a basis for repayment of the loan.
I. TYPE OF MORTGAGE AND TERMS OF LOAN
V.A. Conventional Other:
FHA USDA/Rural Housing Service
Amount Interest Rate No. of Months Amortization
Type:
$ %
II. PROPERTY INFORMATION AND PURPOSE OF LOAN
Subject Property Address (Street, City, State, ZIP) No. of Units
Legal Description of Subject Property (Attach description if necessary) Year Built
Purpose of Loan Property will be:
Primary Secondary
Residence Residence Investment
Complete this line if construction or construction-permanent loan.
Year Lot Original Cost Amount Existing Liens (a) Present Value of Lot (b) Cost of Improvements Total (a + b)
Acquired
$ $ $ $ $
Complete this line if this is a refinance loan. Purpose of Refinance Describe Improvements
Year Original Cost Amount Existing Liens Made To be made
Acquired
$ $ Cost: $
Title will be held in what Name(s) Manner in which Title will be held Estate will be held in:
Source of Down Payment, Settlement Charges and/or Subordinate Financing (Explain)
III. APPLICANT INFORMATION
Applicant #1 Applicant #2
Name (Include Jr. or Sr. if applicable) Name (Include Jr. or Sr. if applicable)
Social Security Number Home Phone (Incl. Area Code) DOB Yrs. School Social Security Number Home Phone (Incl. Area Code) DOB Yrs. School
Married Unmarried (Include single, Dependents (Not listed by Applicant #2) Married Unmarried (Include single, Dependents (Not listed by Applicant #1)
divorced, widowed) No. Ages divorced, widowed) No. Ages
Freddie Mac Form 65
Page 1 of 10 Fannie Mae Form 1003
If residing at present address for less than two years, complete the following:
0.00
(Fully complete highlighted sections.)
IV. EMPLOYMENT INFORMATION
Applicant #1 Applicant #2
Name & Address of Employer Self-Employed Yrs./Mos. on this job Name & Address of Employer Self-Employed Yrs./Mos. on this job
Yrs./Mos. employed in this Yrs./Mos. employed in this
line of work/profession line of work/profession
Position/Title/Type of Business Business Phone (Incl. Area Code) Position/Title/Type of Business Business Phone (Incl. Area Code)
If employed in current position for less than two years or if currently employed in more than one position, complete the following:
Name & Address of Employer Self-Employed Dates (From ›To) Name & Address of Employer Self-Employed Dates (From ›To)
Monthly Income Monthly Income
$ $
Position/Title/Type of Business Business Phone (Incl. Area Code) Position/Title/Type of Business Business Phone (Incl. Area Code)
Name & Address of Employer Self-Employed Dates (From ›To) Name & Address of Employer Self-Employed Dates (From ›To)
Monthly Income Monthly Income
$ $
Position/Title/Type of Business Business Phone (Incl. Area Code) Position/Title/Type of Business Business Phone (Incl. Area Code)
V. MONTHLY INCOME AND COMBINED HOUSING EXPENSE INFORMATION
Gross Monthly Income Applicant #1 Applicant #2 Total Present Proposed
Base Empl. Income* $ $ $ Rent $
Overtime First Mortgage (P&I) $
Bonuses Other Financing (P&I)
Commissions Hazard Insurance
Dividends/Interest Real Estate Taxes
Net Rental Income Mortgage Insurance
Other
(Before completing
see the notice in “describe
other income,” below
Total $$$Total $$
*Self Employed Applicant may be required to provide additional documentation such as tax returns and financial statements.
Describe Other Income Notice: Alimony, child Support, or separate maintenance income need not be revealed if the
A1/A2 Applicant #1, (A 1) or Applicant #2 (A2) does not choose to have it considered for repaying this loan. Monthly Amount
Homeowner Assn. Dues
Other
Combined
Monthly Housing Expense
Freddie Mac Form 65 Page 2 of 10 Fannie Mae Form 1003
(Fully complete highlighted sections.)
Vl. ASSETS AND LIABILITIES
This Statement and any applicable supporting schedules may be completed jointly by both married and unmarried Applicants if their assets and liabilities are sufficiently joined so
that the Statement can be meaningfully and fairly presented on a combined basis; otherwise separate Statements and Schedules are required. If the Applicant #2 section was
completed about a spouse, this Statement and supporting schedules must be completed about that spouse also.
Completed Jointly Not Jointly
ASSETS
Description
Cash or Market
Value
Cash deposit toward purchase held by: $
List checking and saving accounts below
Name and Address of Bank, S&L, or Credit Union
Acct. No. $
Name and Address of Bank, S&L, or Credit Union
Acct. No. $
Name and Address of Bank, S&L, or Credit Union
Acct. No. $
Name and Address of Bank, S&L, or Credit Union
Acct. No. $
Stocks & Bonds (Company name/number $
& description)
Life insurance net cash value $
Face amount: $
Subtotal Liquid Assets $
Real estate owned (Enter market value $
from schedule of real estate owned)
Vested interest in retirement fund $
Net worth of business(es) owned $
(Attach financial statement)
Automobiles owned (Make and year) $
Other Assets (Itemize) $
Total Assets a. $
Liabilities and Pledged Assets. List the creditor’s name, address and account number for all outstanding debts,
including automobile loans, revolving charge accounts, real estate loans, alimony, child support, stock pledges,
etc. Use continuation sheet, if necessary. Indicate by (*) those liabilities which will be satisfied upon sale of real
estate owned or upon refinancing of the subject property.
LIABILITIES
Name and Address of Company $ Payment/Months $
Acct. No.
Name and Address of Company $ Payment/Months $
Acct. No.
Name and Address of Company $ Payment/Months $
Acct. No.
Name and Address of Company $ Payment/Months $
Acct. No.
Name and Address of Company $ Payment/Months $
Acct. No.
Name and Address of Company $ Payment/Months $
Acct. No.
Name and Address of Company $ Payment/Months $
Acct. No.
Alimony/Child Support/Separate Maintenance $
Payments Owed to:
Job Related Expense (Child care, union dues, etc.) $
Total Monthly Payments $
Net Worth
(a minus b)
Freddie Mac Form 65 Page 3 of 10 Fannie Mae Form 1003
$ Total Liabilities b. $
Monthly Payment &
Months Left to Pay
Unpaid
Balance
(Fully complete highlighted sections.)
Vl. ASSETS AND LIABILITIES (cont.)
Schedule of Real Estate Owned (If additional properties are owned, use continuation sheet.)
Insurance
Property Address (Enter S if sold, PS if pending sale Type of Present Amount of Gross Mortgage Maintenance Net
or R if rental being held for income) Property Market Value Mortgage & Liens Rental Income Payments Taxes & Misc. Rental Income
$ $ $ $$$
$ $ $ $$$
List any additional names under which credit has previously been received and indicate appropriate creditor name(s) and account number(s):
Alternative Name Creditor Name Account Number
VII. DETAILS OF TRANSACTION VIII. DECLARATIONS
a. Purchase price $
b. Alterations, improvements, repairs
c. Land (If acquired separately)
d. Refinance (Incl. debts to be paid off)
e. Estimated prepaid items
f. Estimated closing costs
9, PMI, MIP, Funding Fee
h. Discount (If Borrower will pay)
i. Total Costs (Add items a through h)
j. Subordinate financing
k. Borrower’s closing costs paid by Seller
l. Other Credits (Explain)
m. Loan amount
(Exclude PMI, MIP, Funding Fee financed)
n. PMI, MIP, Funding Fee financed
o. Loan amount (Add m & n)
p. Cash from/to Borrower
(Subtract j, k, l, & o from i)
If you answer “Yes” to any questions a through i, please use Applicant #1 Applicant #2
continuation sheet for explanation.
Yes No Yes No
a. Are there any outstanding judgments against you?
b. Have you been declared bankrupt within the past 7 years?
c. Have you had property foreclosed upon or given title or deed in
lieu thereof in the last 7 years?
d. Are you a party to a lawsuit?
e. Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer
of title in lieu of foreclosure, or judgment?
(This would include such loans as home mortgage loans, SBA loans,
home improvement loans, educational loans, manufactured (mobile) home loans, any mortgage, financial obligation, bond, or
loan guarantee. If “Yes, “ provide details, including date, name, and address of Lender, FHA or V.A. case number, if any, and
reasons for the action.)
f. Are you presently delinquent or in default on any Federal debt or any other loan
mortgage, financial obligation, bond, or loan guarantee? If “Yes,” give details as
described in question e. above.
g. Are you obligated to pay alimony, child support, or separate
maintenance?
h. Is any part of the down payment borrowed?
i. Are you a co-maker or endorser on a note?
j. Are you a U.S. citizen?
k. Are you a permanent resident alien?
l. Do you intend to occupy the property as your primary residence?
If “Yes,” complete question m. below.
m. Have you had ownership interest in a property in the last 3 years?
(1 ) What type of property did you own-principal residence (PR), second home (SH),
or investment property (IP)?
(2) How did you hold title to the home-solely by yourself (S), jointly with your
spouse (SP), or jointly with another person (0)?
Freddie Mac Form 65 Page 4 of 10 Fannie Mae Form 1003
Totals
⇓
(Fully complete highlighted sections.)
Freddie Mac Form 65 Page 5 of 10 Fannie Mae Form 1003
Each of the undersigned specifically represents to Lender and to Lender’s actual or potential agents, brokers, processors, attorneys, insurers, services,
successors and assigns and agrees and acknowledges that: (1) the information provided in this application is true and correct as of the date set forth opposite
my signature and that any intentional or negligent misrepresentation of this information contained in this application may result in civil liability, including
monetary damages, to any person who may suffer any loss due to reliance upon any misrepresentation that I have made on this application, and/or in
criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of Title 18, United States Code, Sec. 1001, et seq.; (2)
the loan requested pursuant to this application (the “loan”) will be secured by a mortgage or deed of trust on the property described herein; (3) the property
will not be used for any illegal or prohibited purpose or use; (4) all statements made in this application are made for the purpose of obtaining a residential
mortgage loan; (5) the property will be occupied as indicated herein; (6) any owner or servicer of the Loan may verify or reverify any information
contained in the application from any source named in this application, and Lender, its successors or assigns may retain the original and/or an electronic
record of this application, even if the Loan is not approved; (7) the Lender and its agents, brokers, insurers, servicers, successors and assigns may
continuously rely on the information contained in the application, and I am obligated to amend and/or supplement the information provided in this
application if any of the material facts that I have represented herein should change prior to closing of the Loan; (8) in the event that my payments on
the Loan become delinquent, the owner or servicer of the Loan may, in addition to any other rights and remedies that it may have relating to such
delinquency, report my name and account information to one or more consumer credit reporting agencies; (9) ownership of the Loan and/or administration
of the Loan account may be transferred with such notice as may be required by law; (10) neither Lender nor its agents, brokers, insurers, servicers, successors
or assigns has made any representation or warranty, express or implied, to me regarding the property or the condition or value of the property; and (11) my
transmission of this application as an “electronic record” containing my “electronic signature,” as those terms are defined in applicable federal and/or state
laws (excluding audio and video recordings), or my facsimile transmission of this application containing a facsimile of my signature, shall be as effective,
enforceable and valid as if a paper version of this application were delivered containing my original written signature.
IX. ACKNOWLEDGMENT AND AGREEMENT
X. INFORMATION FOR GOVERNMENT MONITORING PURPOSES
The following information is requested by the Federal Government for certain types of loans related to a dwelling in order to monitor
the lender’s compliance with equal credit opportunity, fair housing and home mortgage disclosure laws. You are not required to
furnish this information, but are encouraged to do so. The law provides that a lender may discriminate neither on the basis of this
information, or on whether you choose to furnish it. If you furnish the information, please provide both ethnicity and race. For race,
you may check more than one designation. If you do not furnish ethnicity, race, or sex, under Federal regulations, this lender is
required to note the information on the basis of visual observation or surname. If you do not wish to furnish the information, please
check the box below. (Lender must review the above material to assure that the disclosures satisfy all requirements to which the
lender is subject under applicable state law for the particular type of loan applied for.)
Internet
Ethnicity: Hispanic or Latino Not Hispanic or Latino
Continuation For/Residential Loan Application
Applicant#1 (A1)
Applicant#2 (A2)
Use if you need more space to
complete the Residential Loan
Application Mark A1 for Applicant
#1 or A2 for Applicant #2
Agency Account Number:
Lender Account Number:
Applicant’s Signature Date Applicant’s Signature Date
x x
BORROWER I do not wish to furnish this information
CO-BORROWER I do not wish to furnish this information
Ethnicity: Hispanic or Latino Not Hispanic or Latino
Race American Indian or Asian Black or
Alaska Native African American
Native Hawaiian or White
Other Pacific Islander
Race American Indian or Asian Black or
Alaska Native African American
Native Hawaiian or White
Other Pacific Islander
To be Completed by Interviewer
This application was taken by:
face-to-face interview
by mail
by telephone
Interviewer’s Name (Print or type)
Interviewer’s Signature
Interviewer’s Phone Number (Incl. Area Code)
Date
Name and Address of Interviewer’s Employer
Sex: Female Male
Sex: Female Male
(Each applicant must sign, date and complete highlighted sections.)
Additional Information Required for RHS Assistance
1. Loan Type: Section 502 Section 504 Loan Grant
APPLICANT #1 APPLICANT #2
2. Have you ever obtained a loan/grant from RHS? 3. Have you ever obtained a loan/grant from RHS?
Yes No Yes No
4. Are you a relative to an RHS Employee or Closing agent/attorney? 5. Are you a relative to an RHS Employee or Closing agent/attorney?
Yes No Yes No
If yes, who? _____________________________ If yes, who? _____________________________
Relationship _____________________________ Relationship _____________________________
6. Are you a Veteran? Yes No 7. Are you a Veteran? Yes No
8. Complete for all household members.
To be considered eligible for RHS assistance, all household income, including any income not shown in Section V of this application, must be disclosed below:
9. Child Care (Minors who are 12 years of age or under for whom you have to hire a babysitter or leave at a child care center)
Cost per week $ ________ Cost per month $ ________
11. Characteristics of Present Housing
Does the Dwelling:
Yes
No
Yes
No
Lack complete plumbing
Physically deteriorated or structurally unsound
Lack adequate heating
Overcrowded (More than 2 persons per room)
13. (For Section 504 Grants Only) I certify that as the condition of the grant, I/we will not engage in unlawful manufacture, distribution, dispensing, possession or
use of a controlled substance in conducting any activity with the grant.
14. I am aware RHS does not warrant the condition or value of the property.
Page 6 of 10
Form RD 410-4
Name Age Are you a Do you want to be con- Annual Source of Wage Income Annual Source of Non-Wage
full time sidered for an adjustment Wage (employer) Non-Wage Income (social security,
student? from household income Income Income alimony, child support,
y/n because of a disabling separate maintenance,
condition? y/n etc.)
12. Name, Address and Telephone Number of Present Landlord.
10. Name, Address and Telephone No. of Child care Provider(s).
If residing at present address for less than two years, complete the following:
Name, Address and Telephone Number of Previous Landlord(s)s.
(Fully complete all highlighted sections.)
15. Notices to Applicant
Privacy Act. See attached sheet.
Social Security Number. The Debt Collection Act of 1982, Pub. L. 97-365, and 31 U.S.C. 7701(c) require persons applying for a federally insured or guaranteed loan to furnish his or her
social security number (SSN). Failure to provide your SSN will result in the rejection of your application.
Right to Request Copy of Appraisal. You have the right to a copy of the appraisal report used in connection with your application for credit. If you wish a copy, please write us at the
address of the Rural Development Field Office where you made application. In your written request, you must provide us with the complete name and address used when making
application as well as a current mailing address. We must hear from you no later than 90 days after we notify you about the action taken on your credit application or you withdraw your
application. The creditor, Rural Housing Service, may require you to reimburse the Agency for the cost of the appraisal.
Right to Financial Privacy Act of 1978,12 U.S.C. 3401, et seq. You authorize RHS to have access to financial records held by financial institutions in connection with the consider-
ation or administration of assistance to you. Financial records involving your 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 without your consent except as required or permitted by law.
Federal collection policies for consumer debts: Delinquencies, defaults, foreclosures and abuses of mortgage loans involving programs of the Federal Government can be costly and
detrimental to your credit, now and in the future. The Federal Government, as mortgage lender in this transaction, its agencies, agents and assigns, are authorized to take any and all of the
following actions in the event loan payments become delinquent on the mortgage loan covered by this application: (1 ) Report your name and account information to a credit bureau; (2) Assess
additional interest and penalty charges for the period of time that payment is not made; (3) Assess charges to cover additional administrative costs incurred by the Government to service
your account; (4) Offset amounts owed to you under other Federal programs; (5) Refer your account to a private attorney, the United States Department of Justice, a collection agency, or
mortgage servicing agency to collect the amount due, and foreclose the mortgage, sell the property, and seek judgment against you for any deficiency; (6) If you are a current or retired Federal
employee, take action to offset your salary, or civil service retirement benefits; (7) Refer your debt to the Internal Revenue Service for offset against any amount owed to you as an income tax
refund; and (8) Report any resulting written-off debt of yours to the Internal Revenue Service as your taxable income. All of these actions can and will be used to recover any debts owed when
it is determined to be in the interest of the lender and/or Federal Government to do so.
Unlawful Discrimination. “The U. S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, gender,
religion, age, disability, political beliefs, sexual orientation, or marital or family status. (Not all prohibited bases apply to all programs.) Persons with disabilities who require
alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at (202) 720-2600 (voice and TDD).
To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, Room 326-W, Whitten Building, 14
th
and Independence Avenue, SW, Washington, DC 20250-9410 or
call (202) 720-5964 (voice and TDD). USDA is an equal opportunity provider and employer.”
The Fair Housing Act prohibits discrimination in real estate-related transactions, or in the terms or conditions of such a transaction, because of race, color, religion, sex, disability,
familial status, or national origin. If you believe you have been discriminated against for any of these reasons, you can write the U. S. Department of Housing and Urban Development,
Washington, D.C. 20410 or call (800) 669-9777.
Certification. As the applicant, I certify to the best of my knowledge and belief; (1 ) I am not presently debarred, suspended, declared ineligible, or voluntarily excluded from covered
transactions by any Federal department or agency; (2) I have not within a three year period preceding this proposal been convicted or had a civil judgment rendered against me for
commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, state, or local) transaction or contract under a public
transaction; or commission of embezzlement, theft, forgery, bribery, falsification, or destruction of records, making false statement, or receiving stolen property; (3) I am not a judgment
debtor on an outstanding judgment in favor of the United States which was obtained in any Federal court other than the United States Tax Court; and (4) I am not delinquent of any
outstanding debt to the Federal Government (including any Federal agency or department).
The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, sex, disability, familial status, national origin,
marital status, age (provided the borrower has the capacity to enter into a binding contract), because all or a 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. If you believe you were denied a loan for this reason, you should contact the Federal Trade
Commission, Washington, DC. 20580.
Page 7 of 10
Form RD 410-4
16. I AM unable to provide the housing I need on my own account, and I am unable to secure the credit necessary for this purpose from other sources upon terms and conditions
which I can reasonably fulfill. I certify that the statements made by me in this application are true, complete to the best of my knowledge and belief and are made in good
faith to obtain a loan.
SECTION 1001 OF TITLE 18, UNITED STATES CODE PROVIDES: “WHOEVER, IN ANY MATTER WITHIN THE JURISDICTION OF ANY DEPARTMENT OR
AGENCY OF THE UNITED STATES KNOWINGLY AND WILLFULLY FALSIFIES, CONCEALS OR COVERS UP BY ANY TRICK, SCHEME, OR DEVICE A
MATERIAL FACT, OR MAKES ANY FALSE, FICTITIOUS OR FRAUDULENT STATEMENTS OR REPRESENTATIONS, OR MAKES OR USES ANY FALSE
WRITING OR DOCUMENT KNOWING THE SAME TO CONTAIN ANY FALSE, FICTITIOUS OR FRAUDULENT STATEMENT OR ENTRY, SHALL BE FINED
UNDER THIS TITLE OR IMPRISONED NOT MORE THAN FIVE YEARS, OR BOTH.”
NOTE TO APPLICANT: IF ANY INFORMATION ON THIS APPLICATION IS FOUND TO BE FALSE OR INCOMPLETE, SUCH FINDING, IN ADDITION TO POSSIBLE
LIABILITY UNDER CIVIL AND CRIMINAL STATUS, MAY BE GROUNDS FOR DENIAL FOR THE REQUESTED CREDIT AND MAY BE A BASIS FOR DEBARMENT
FROM PARTICIPATION IN ALL FEDERAL PROGRAMS UNDER 7 C.F.R. PART 3017.
Form RD 410-4
Page 8 of 10
Date Signature of Applicant
X
Date Signature of Applicant
X
17. Date Signature of Loan Approval Official Determination of Eligibility Racial Data Provided by
______ Eligible ______ Not Eligible ______ Applicant ______ RHS
18. Application received on _____________________________ .
Application complete on _____________________________ .
19. Credit Report Fee
Date Received: ____________________ Amount Received: $ ________________
Initial: ___________________________
(Each applicant must sign and date.)
Page 9 of 10
Form RD 410-4
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.
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 and work 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. 1681a(f) or the Federal Claims Collection Act (31 U.S.C. 3701(a)(3)).
Page 10 of 10
Form RD 410-4
NOTICE TO APPLICANT REGARDING PRIVACY ACT INFORMATION - CONTINUED
Form RD 3550-1
Form Approved
(Rev. 06-06)
0MB No. 0575-0172
United States Department of Agriculture
Rural Development
Rural Housing Service
AUTHORIZATION TO RELEASE INFORMATION
TO:
RE:
Account or Other Identifying Number
Name of Customer
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:
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 conceming use of such information.
A copy of this authorization may be accepted as an original.
Your prompt reply is appreciated.
Date
Signature (Applicant or Adult Household Member)
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
Past and present landlord references
Bank account, stock holdings, and any other asset balances.
Past and present employment or income records.
(Each applicant must sign and date a separate authorization form.)
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 institu-
tion, 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.
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 deter-
mines 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.
NOTICE TO APPLICANT REGARDING PRIVACY ACT INFORMATION- CONTINUED
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)).
Form RD 3550-1
Form Approved
(Rev. 06-06)
0MB No. 0575-0172
United States Department of Agriculture
Rural Development
Rural Housing Service
AUTHORIZATION TO RELEASE INFORMATION
TO:
RE:
Account or Other Identifying Number
Name of Customer
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:
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 conceming use of such information.
A copy of this authorization may be accepted as an original.
Your prompt reply is appreciated.
Date
Signature (Applicant or Adult Household Member)
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
Past and present landlord references
Bank account, stock holdings, and any other asset balances.
Past and present employment or income records.
(Each applicant must sign and date a separate authorization form.)
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 institu-
tion, 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.
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 deter-
mines 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.
NOTICE TO APPLICANT REGARDING PRIVACY ACT INFORMATION- CONTINUED
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)).
Form RD 3550-4 Form Approved
(Rev. 07-19) OMB No. 0575-0172
United States Department of Agriculture
Rural Housing Service
EMPLOYMENT AND ASSET CERTIFICATION
EMPLOYMENT CERTIFICATION
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of
information unless it 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.
Check the appropriate blocks and account for all adult household members by listing their or
your name under the applicable statement:
I hereby certify that the following adult household members are not presently
employed and do not intend to resume employment in the foreseeable future:
I hereby certify that the following adult household members are not presently
employed but are actively seeking employment. I agree to notify RHS
immediately when they become reemployed:
I hereby certify that the following adult household members are currently
employed. I agree to notify RHS should their employment status change:
(Fully complete highlighted sections for all adult household members.)
Household Member Nonretirement Asset(s)
Total (in $)
ASSET CERTIFICATION
I hereby certify that all nonretirement assets of all household members (adults and children) are
listed below. Nonretirement assets include, but are not limited to, savings accounts, stocks, bonds,
Treasury bills, savings certifications, money market funds, investment accounts, equity in real
property, revocable trust funds that are available to the household, lump-sum receipts, and personal
property held as an investment.
The nonretirement asset levels are as follows:
APPLICANT
APPLICANT
APPLICANT
DATE
DATE
DATE
SECTION 1001 OF TITLE 18, UNITED STATES CODE PROVIDES: ''WHOEVER, IN ANY MATTER WITHIN THE
JURISDICTION OF ANY DEPARTMENT OR AGENCY OF THE UNITED STATES KNOWINGLY AND WILL-
FULLY FALSIFIES, CONCEALS OR COVERS UP BY ANY TRICK, SCHEME, OR DEVICE A MATERIAL FACT, OR
MAKES ANY FALSE, FICTITIOUS OR FRAUDULENT STATEMENTS OR REPRESENTATIONS, OR MAKES OR
USES ANY FALSE WRITING OR DOCUMENT KNOWING THE SAME TO CONTAIN ANY FALSE, FICTITIOUS
OR FRAUDULENT STATEMENT OR ENTRY, SHALL BE FINED UNDER THIS TITLE OR IMPRISONED NOT
MORE THAN FIVE YEARS, OR BOTH.''
(Fully complete highlighted sections for all household members and each applicant must sign and date.)
HB-1-3550
ATTACHMENT 3-H
CREDIT SCORE DISCLOSURE
Attachment 3-H
Page 1 of 2
In accordance with the Fair and Accurate Credit Transactions Act of 2003 (FACT Act) and in
connection with your application for a Rural Development Single Family Housing (hereafter
referred to as “the Agency”) home loan, the Agency, upon request, must disclose to you the
score that a credit bureau distributes to users and will be used by the Agency in connection with
your home loan as well as the key factors affecting your credit scores.
While the Agency does not consider credit scores in determining adverse credit decisions, we
may use them to presum
e acceptable credit in lieu of other credit underwriting practices.
Credit scores assist lenders in evaluating your credit history in a more expedient and objective
manner. Your credit scores are found on your tri-merge credit report, a copy of which will be
provided to you upon request. The range of possible scores is from 300 to 850. The Agency
may also obtain and consider other credit scores in making its decision on your application.
In addition to the credit scores, your credit report lists the key factors related to why your
scores were less than th
e maximum possible score. Please keep in mind that the factors are only
indicators of why you received less than the maximum score possible. The listing of these
factors does not by itself indicate that you would not be approved for the loan you have
requested. Rural Development considers many factors in addition to your credit scores in
making a decision on your application. If your application is not approved, you will receive a
separate notice stating the specific reason(s) for that action which may or may not relate to
your credit scores.
The Agency did not calculate your credit scores or develop the scoring models. If you have any
questions ab
out your credit scores or the information in the tri-merge credit report from which
the scores were computed, you can contact the credit bureau at the address listed below.
Equifax Mortgage Solutions
4300 Westown Parkwa
y, Suite 200
West Des Moines, IA 50266
(800) 333-0037
(01-23-03) SPECIAL PN
Revised (12-12-19) PN 532
(Copy for your records.)
HB-1-3550
Attachment 3-H
Page 2 of 2
NOTICE TO HOME LOAN APPLICANT
Pursuant to FACT Act, Section 212.
In connection with your application for a home loan, Rural Development must disclose to you
the score that a credit bureau distributed to the Agency and was used in connection with your
home loan, as well as key factors affecting your tri-merge credit score.
The credit score is a computer-generated summary calculated at the time of the request and
based on the information a credit bureau has on file. The scores are based on data about your
credit histo
ry and payment patterns. Credit scores are important because they are used to
assist the Agency in determining whether you will obtain a loan. Credit scores can change over
time, depending on your conduct, how your credit history and payment patterns change, and
how credit scoring technologies change.
Because the score is based on information in your tri-merge credit history, it is very important
that you review the credit-related informa
tion to make sure it is accurate. Credit records may
vary from one company to another.
If you have any questions, about your score or the credit information that is furnished to you,
contact the credit bureau at the address and telephone number provided with this notice. Th
e
credit bureaus play no part in the decision to take any action on the loan application and are
unable to provide you with specific reasons for the decision on the loan application.
If you have any questions concerning the terms of the loan, contact Rural Development.
THIS DISCLOSURE HAS
BEEN PROVIDED TO THE APPLICANT(S) PURSUANT TO SECTION 212 OF
THE FAIR AND ACCURATE CREDIT TRANSACTIONS ACT OF 2003. I UNDERSTAND THAT I MAY
RECEIVE A COPY OF MY TRI-MERGE CREDIT REPORT BY MAKING A WRITTEN REQUEST TO THE
RURAL DEVELOPMENT OFFICE HANDLING MY LOAN APPLICATION.
(Copy for your records.)
Exhibit 4-4
Indicators of Unacceptable Credit
x 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.
x Payments on any installment account, on a per account basis, where the amount of the delinquency
exceeded one installment for more than 30 days within the last 12 months.
x Payments on any revolving account, on a per account basis, which was delinquent for more than 30 days on
two or more occasions within the last 12 months.
x A foreclosure that has been completed within the last 36 months.
x An outstanding Internal Revenue Service (IRS) tax lien or any other outstanding tax liens with no
satisfactory arrangement for payment.
x Two or 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.
x 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.
x Non-Agency debts written off within the last 36 months, unless the debt was paid in full at least 12 months ago.
x Agency debts that were debt settled within the past 36 months, or are being considered for debt settlement.
x Delinquency on a federal debt.
x 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 an applicant 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.
Note: To be eligible for a Section 502 Direct loan, applicants must demonstrate that they are reasonably able and
willing to repay an Agency loan. An applicant's credit record does not have to be perfect; a few instances of credit
problems can be acceptable if an applicant's overall credit record demonstrates an ability and willingness to repay
obligations. (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 it statutory and cannot be waived.)
Dear Applicant,
This is the end of the Single Family Housing Direct Home Loan application package.
Prior to submitting your application, please check the following items:
1. Check that all highlighted sections on all forms are fully completed.
2. Check that all forms are signed and dated.
3. Make sure all applicable items listed on Attachment 3-J, Checklist of Items to
Accompany the Uniform Residential Application are provided with the application
package.
IMPORTANT: If any item, information and/or signature is missing, your application is
considered incomplete and you will be contacted and asked to provide the missing pieces.
Please forward the entire application package to one of the options listed on the cover page.
Thank you for choosing USDA Rural Development for your home loan.
Respectfully,
USDA Rural Development
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Completed 8 May 2021

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