In today's world, transparency in financial and business transactions has become increasingly important, especially in dealings with government agencies. The Rd 1944 30 form, officially known as the Identity of Interest (IOI) Disclosure Certificate, plays a crucial role in maintaining this transparency within projects financed or supported by the United States Department of Agriculture (USDA) Rural Development Rural Housing Service. This form serves as a declaration by applicants or borrowers to disclose any financial interests or relationships that might influence their project. It meticulously outlines the conditions under which an Identity of Interest exists, covering aspects from financial ties between the applicant and suppliers to agreements altering management plans not approved by the agency. Completing this document accurately is vital, as it helps ensure that all parties are aware of potential conflicts of interest, thereby preserving the integrity of the project and adhering to legal requirements. The form also contains a section for certification, where the applicant must acknowledge understanding the implications of declaring or not declaring an identity of interest. Furthermore, penalties for falsifying information are clearly described, underscoring the legal responsibilities involved. This careful approach to documenting interests is designed to prevent unethical business practices and foster a level of trust between the USDA, project participants, and the wider community.
| Question | Answer |
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| Form Name | Form Rd 1944 30 |
| Form Length | 4 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 1 min |
| Other names | fillable rd identity of interest form, identity of interest form usda, no identity of interest form usda, usda identity of interest form |
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UNITEDSTATESDEPARTMENTOFAGRICULTURE
RURALDEVELOPMENT
RURALHOUSINGSERVICE
IDENTITYOFINTEREST(IOI)DISCLOSURECERTIFICATE
SECTIONI:TOBECOMPLETEDBYALLAPPLICANTS/BORROWERS
Applicant/BorrowerName:
ProjectName:
Location:(Town,County,State)
CHECKSECTIONIIORIII,ASAPPLICABLE
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SECTIONII.TOBECOMPLETEDONLY |
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SECTIONIII.TOBECOMPLETEDWHEN |
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WHENNOIDENTITYOFINTERESTEXISTS |
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ANIDENTITYOFINTERESTDOESEXIST |
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CertificationofNoIdentity |
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CertificationofIdentity |
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ofInterest |
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ofInterest |
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I, |
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I, |
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(pleaseprint) |
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(pleaseprint) |
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herebycertifythatIhavereadSectionIVofthisDisclosure |
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herebycertifythatIhavereadandunderstandwhatthe |
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CertificateandunderstandwhattheUSDA,Rural |
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Agencyhasdeterminedconstitutesanidentityof |
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Development,RuralHousingService(hereinreferredto |
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interest,asoutlinedinSectionIV,andhereby |
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asAgency)hasdeterminedconstitutesanIdentityofInterest |
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discloseinSectionVthoseentitieswithwhichIhavean |
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andthatNO identityofinterestrelationshipsexistbetweenme |
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identityofinterestrelationship. |
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andANYindividualororganizationdoingbusinesswiththe |
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project. |
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(CompleteSectionVI) |
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(SeeSectionV) |
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SECTIONIV.IDENTITYOFINTERESTSTATEMENT
(1)Whenthereisanyfinancialinterestbetweentheapplicant/borrowerand/ormanagemententityandthesupplyingentity.
(2)Whenoneormoreoftheofficers,directors,stockholdersorpartnersoftheapplicant/borrowerormanagemententity isalsoanofficer,director,stockholder,orpartnerofthesupplyingentity.
(3)Whenanyofficer,director,stockholder,orpartneroftheapplicant/borrowerand/ormanagemententityhasanyfinancial interest whatsoever in the supplying entity.
(4)Whenthesupplyingentityadvancesanyfundstotheapplicant/borrowerand/ormanagemententity.
(5)Whenthesupplyingentityprovidesandpaysonbehalfoftheapplicant/.borrowerandormanagemententitythecostof anymaterialsand/orservicesinconnectionwithobligationsunderthemanagementplan/managementagreement.
(6)Whenthesupplyingentitytakesstockoranyinterestintheapplicant/borrowerand/ormanagemententityaspartofthe considerationtobepaidthem.
(7)Whenthereexistorcomeintobeinganysidedeals,agreements,contractsorunderstandingsenteredintotherebyaltering, amending,orcancellinganyofthemanagementplan/managementagreementdocuments,exceptasapprovedbytheAgency.
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
SECTIONV.TOBECOMPLETEDFOREACHIDENTITYORINTERESTENTITY.(ADDADDITIONALSHEETS IFNECESSARY).EACHIDENTITYOFINTERESTMUSTCOMPLETEANIDENTITYOFINTEREST
Type of Entity: Contractor |
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Subcontractor |
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Architect |
PropertyManagement
Supplier of: Material
Labor
Both
Services
EntityName:
Address:
PhoneNumber:
Trade/Business:
DescriberelationshiptoIOIentity:
Attorney
Type of Entity: Contractor |
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Subcontractor |
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Architect |
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PropertyManagement |
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Supplier of: |
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Material |
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Labor |
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Both |
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Services |
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EntityName:
Address:
PhoneNumber:
Trade/Business:
DescriberelationshiptoIOIentity:
Attorney
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SECTIONVI.TOBECOMPLETEDBYALLAPPLICANTS/BORROWERS
IfurtherunderstandandagreethatifanyofmybusinesspracticeschangeduringthelifeoftheloantoincludeIdentity ofInterestrelationshipsreferredtoabove,IwillfileanamendeddisclosureCertificate.Ialsoagreetoprovideanew disclosureCertificateatanytimerequestedbytheAgency.
ThisCertificationshallbeineffectforaperiodofthreeyears,beginningonthe |
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Iherebycertify,underpenaltyoflaw*,andwithknowledgethatthisinformationmaybeverified,thattheinformationsubmitted istrueandaccurateandthatnootheridentityofinterestrelationshipsexistbetweenmeandanyindividualororganization, doingbusinesswiththeprojectnamedinSectionIofthisCertificate,exceptasdescribedabove.Ifurtherunderstandthatfailure todiscloseanIdentityofInteresttotheAgencywillalsosubjectmetoanyandalladministrativeremediesavailabletothe Agency.SuchremediesmayincludesuspensionanddebarmentfromparticipatinginanyAgencyorFederalprogram.
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*WARNING: Section1001ofTitle18,UnitedStatesCodeprovides.“whoever,inanymatterwithinthejurisdictionofthe executive,legislative,orjudicialbranchoftheGovernmentoftheUnitedStates,knowinglyandwillfully—
(1)falsifies,conceals,orcoversupbyanytrick,scheme,ordeviceamaterialfact;
(2)makesanymateriallyfalse,fictitious,orfraudulentstatementorrepresentation;or
(3)makesorusesanyfalsewritingordocumentknowingthesametocontainanymateriallyfalse, fictitious,orfraudulentstatementorentry;
shallbefinedunderthistitleorimprisonednotmorethan5years,orboth”
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SECTIONVII.GENERALINFORMATIONFORALLAPPLICANTS/BORROWERS
Instructionsforcompletion
Preparedby:Applicant/Borrower
NOTE:Iftheapplicant/borrowerhasanidentityofinterestrelationshipbothasaprincipalinthegeneral partnershipandasanindividual,aDisclosureCertificateforeachwillbeexecuted.
NumberofCopies: |
OriginalandTwo |
SignaturesRequired: |
Applicant/Borrower |
DistributionofCopies: |
OriginaltoBorrowerfile, |
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CopytoBorrower |
NOTE: ATTACHIDENTITYOFINTERESTQUALIFICATIONFORMS.
EachpageandanyattachmentstothisCertificatewillbenumberedandinitialedbytheborrower.
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