Rd 410 4 Form PDF Details

The RD 410-4 form, formally known as the Application for Rural Assistance (Nonfarm Tract), serves as a vital tool for those seeking to navigate the complexities of obtaining a rural home loan. Approved by the Office of Management and Budget (OMB No. 0575-0172), this comprehensive document is tailored for completion by applicants with the guidance of lenders, ensuring that the process is as smooth and straightforward as possible. It caters to various applicants by allowing them to apply either as "Applicant #1" or "Applicant #2", addressing the unique financial situations of individuals or couples. The form meticulously covers areas such as the type of mortgage and terms of loan, extensive property information, applicant details including employment and monthly income, as well as a detailed breakdown of assets and liabilities. Its thorough design is intended to assess applicants’ financial readiness and qualifications for rural assistance under programs like the Rural Housing Service, part of the USDA, among others. Additionally, by requiring information on the intended use of the property and the source of down payments, the form plays a crucial role in presenting a clear picture of the applicant’s financial landscape. Importantly, it obliges honesty and accuracy in the application process, highlighting potential civil and criminal liabilities for misrepresentations, underpinning the form’s significance in ensuring responsible lending and borrowing practices.

QuestionAnswer
Form NameRd 410 4 Form
Form Length10 pages
Fillable?No
Fillable fields0
Avg. time to fill out2 min 30 sec
Other namesuniform residential loan application 1003 fillable, usda loan application form, rd 410 4, usda application pdf

Form Preview Example

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

Mortgage

 

V.A.

 

Conventional

 

 

Other:

Agency Case Number

 

Lender Account Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Applied for:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FHA

 

USDA/Rural Housing Service

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Amount

 

 

 

Interest Rate

No. of Months

Amortization

 

 

Fixed Rate

 

Other (Explain):

$

 

 

 

%

 

 

Type:

 

 

GPM

 

ARM (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

 

 

 

 

Purchase

 

 

 

Construction

 

 

 

Other (Explain):

 

 

 

 

 

 

Property will be:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Refinance

 

 

 

Construction-Permanent

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Fee Simple

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Source of Down Payment, Settlement Charges and/or Subordinate Financing (Explain)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Leasehold

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Show expiration date)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ill. 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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

mm/dd/yy

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

mm/dd/yy

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Married

 

Unmarried (Include single

Dependents (Not listed by Applicant #2)

 

 

Married

 

Unmarried (Include single

Dependents (Not listed by Applicant #1)

 

 

 

Separated

divorced, widowed)

No.

Ages

 

 

 

 

 

 

Separated

divorced, widowed)

No

 

 

Ages

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Present Address (Street, City State, ZIP)

 

 

Own

 

 

Rent

 

No. Yrs.

Present Address (Street, City, State, ZIP)

 

 

Own

 

 

 

 

Rent

 

 

 

 

 

No. Yrs.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mailing Address if different from Present Address

Mailing Address if different from Present Address

If residing at present address for less than two years, complete the following:

Former Address (Street, City State, ZIP)

 

Own

 

Rent

 

No. Yrs.

 

 

 

 

 

 

 

 

 

 

 

 

 

Former Address (Street, City, State, ZIP)

 

Own

 

Rent

 

No. Yrs.

 

 

 

 

 

 

 

Freddie Mac Form 65

Page 1 of 10

Fannie Mae Form 1003

According to the Paperwork Reduction Act 1995, an agency may not conduct or sponsor, and a person is not 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 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.

IV. EMPLOYMENT INFORMATION

 

Applicant #1

 

 

 

 

Applicant #2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name & Address of Employer

 

 

Self-Employed

Yrs./Mos. on the job

Name & Address of Employer

 

 

Self-Employed

Yrs./Mos. on the 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 (Inct. 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

Combined

Present

Proposed

Monthly Housing Expense

 

 

 

 

 

 

 

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

 

 

 

Homeowner Assn. Dues

 

 

see the notice in "describe

 

 

 

 

 

 

 

 

 

 

 

Other

 

 

other income," below

 

 

 

 

 

 

 

 

 

 

 

Total

$

$

$

Total

$

$

*Self Employed Applicant may be required to provide additional documentation such as tax returns and financial statements.

A1/A2

Describe Other Income Notice: Alimony, child Support, or separate maintenance income need not be revealed if the

Applicant #1, (A 1) or Applicant #2 (A2) does not choose to have it considered for repaying this loan.

Monthly Amount

Freddie Mac Form 65

Page 2 of 10

Fannie Mae Form 1003

VI. 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

Cash or Market

Liabilities and Pledged Assets. List the creditor's name, address and account number for all outstanding debts,

Description

Value

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

 

 

 

Cash deposit toward purchase held by:

 

 

$

 

upon refinancing of the subject property.

Monthly Payment &

 

 

 

 

 

 

LIABILITIES

 

Unpaid

 

 

 

 

Months Left to Pay

 

 

 

 

 

 

Balance

 

 

 

Name and Address of Company

$ Payment/Months

$

 

 

 

 

 

 

 

 

List checking and saving accounts below

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name and Address of Bank, S&L, or Credit Union

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Acct. No.

 

 

 

 

 

 

 

Name and Address of Company

$ Payment/Months

$

 

 

 

 

 

Acct. No.

$

 

 

 

 

 

 

 

 

 

 

 

 

 

Name and Address of Bank, S&L, or Credit Union

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Acct. No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name and Address of Company

$ Payment/Months

$

 

 

 

 

 

 

 

 

Acct. No.

$

 

 

 

 

 

 

 

 

 

 

 

 

 

Name and Address of Bank, S&L, or Credit Union

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Acct. No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name and Address of Company

$ Payment/Months

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Acct. No.

$

 

 

 

 

 

 

Name and Address of Bank, S&L, or Credit Union

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Acct. No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name and Address of Company

$ Payment/Months

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Acct. No.

$

 

 

 

 

 

 

Stocks & Bonds (Company name/number &

$

 

 

 

 

 

 

description)

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

Acct. No.

 

 

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

Name and Address of Company

$ Payment/Months

 

$

 

 

 

 

Life insurance net cash value

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Face amount: $

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Subtotal Liquid Assets

$

 

 

 

 

 

 

Real estate owned (Enter market value

$

 

 

 

 

 

 

from schedule of real estate owned)

 

 

Acct. No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vested interest in retirement fund

$

 

Name and Address of Company

$ Payment/Months

 

$

 

 

 

 

Net worth of business(es) owned

$

 

 

 

 

 

 

(Attach financial statement)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Automobiles owned (Make and year)

$

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

Acct. No.

 

 

 

 

 

 

 

 

 

 

 

 

$

 

Alimony/Child Support/Separate Maintenance

$

 

 

 

 

Payments Owed to:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other Assets (Itemize)

$

 

 

 

 

 

 

 

Job Related Expense (Child care, union dues, etc.)

$

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

Total Monthly Payments

$

 

 

 

 

 

 

 

Total Assets a.

$

 

Net Worth

$

Total Liabilities b.

 

$

 

 

 

(a minus b)

 

 

 

 

Freddie Mac Form 65

Page 3 of 10

Fannie Mae Form 1003

VI. ASSETS AND LIABILITIES (cont.)

Schedule of Real Estate Owned (If additional properties are owned, use continuation sheet.)

Properly Address (Enter S if sold, PS if pending sale

or R if rental being held for income)

Type of Property

Present

Market Value

Amount of

Mortgage & Liens

Gross

Rental Income

Mortgage Payments

Insurance

Maintenance

Taxes & Misc.

Net

Rental Income

$

$

$

$

$

$

Totals

$

$

$

$

$

$

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

$

If you answer ''Yes'' to any questions a through i, please use

Applicant #1 Applicant #2

b. Alterations, improvements, repairs

 

continuation sheet for explanation.

 

 

Yes No

 

Yes No

 

 

 

 

 

c. Land (If acquired separately)

 

a. Are there any outstanding judgments against you?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

d. Refinance (incl. debts to be paid off)

 

b. Have you been declared bankrupt within the past 7 years?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

c. Have you had property foreclosed upon or given title or deed in

 

 

 

 

 

 

 

 

 

 

 

e. Estimated prepaid items

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

f. Estimated closing costs

 

lieu thereof in the last 7 years?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

g, PMI, MIP, Funding Fee

 

d. Are you a party to a lawsuit?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

h. Discount (If Borrower will pay)

 

e Have you directly or indirectly been obligated on any loan which resulted in foreclosure,

 

 

 

 

 

 

 

 

 

 

 

 

i. Total Costs (Add items a through h)

 

transfer of title in lieu of foreclosure, or judgment? (This would include such loans as home mortgage loans.

j. Subordinate financing

 

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

k. Borrower's closing costs paid by Seller

 

Lender, FHA or V.A. case number, if any, and reasons for the action.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I. Other Credits (Explain)

 

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?

 

 

 

 

 

 

 

 

 

 

 

m. Loan amount

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Exclude PMI, MIP Funding Fee financed)

 

k Are you a permanent resident alien?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

n. PMI, MIP, Funding Fee financed

 

l. Do you intend to occupy the property as your primary residence?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If ''Yes," complete question m. below.

 

 

 

 

 

 

 

 

 

 

 

o. Loan amount (Add m & n)

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

 

 

 

 

 

 

 

 

 

 

p. Cash from/to Borrower

 

(SH), or investment property (IP)?

 

 

 

 

 

 

 

 

 

 

 

 

(2) How did you hold title to the home-solely by yourself (S), jointly with your

 

 

 

 

 

 

 

 

 

 

 

(Subtract j, k, l, & o from i)

 

 

 

 

 

 

 

 

 

 

 

 

 

spouse (SP), or jointly with another person (0)?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Freddie Mac Form 65

Page 4 of 10

Fannie Mae Form 1003

 

IX. ACKNOWLEDGMENT AND AGREEMENT

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.

Applicant's Signature

X

Date

Applicant's Signature

X

Date

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.)

 

 

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

Ethnicity:

 

 

 

 

 

 

 

Hispanic or Latino

 

 

Not Hispanic or Latino

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Race

 

American Indian or

 

 

 

Asian

 

 

Black or

Race

 

American Indian or

 

 

Asian

 

 

Black or

 

 

 

 

 

 

Alaska Native

 

 

 

 

 

African American

 

 

Alaska Native

 

 

 

 

African American

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Native Hawaiian or

 

 

 

White

 

 

 

 

 

 

Native Hawaiian or

 

 

White

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other Pacific Islander

 

 

 

 

 

 

 

 

 

 

 

Other Pacific Islander

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sex:

 

 

 

 

 

Female

 

 

 

Male

 

 

 

 

Sex:

 

 

 

 

 

 

 

Female

 

 

Male

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

To be Completed by Interviewer

Interviewer's Name (Print or type)

 

 

 

 

 

 

 

Name and Address of Interviewer's Employer

 

 

 

This application was taken by:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

face-to-face interview

Interviewer's Signature

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

by mail

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

by telephone

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Interviewer's Phone Number (Incl. Area Code)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Internet

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Continuation For/Residential Loan Application

Use if you need more space to complete the Residential Loan Application Mark A1 for Applicant #1 or A2 for Applicant #2

Applicant #1 (Al)

Applicant #2 (A2)

Agency Account Number:

Lender Account Number:

Freddie Mac Form 65

Page 5 of 10

Fannie Mae Form 1003

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?

 

 

 

 

No

 

 

 

 

 

 

 

Yes

 

 

 

 

 

 

 

 

 

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:

Name

Age

Are you a

Do you want to be con-

 

full time

sidered for an adjustment

 

student?

from household income

 

because of a disabling

 

y/n

 

condition? y/n

 

 

 

 

 

Annual

Wage

Income

Source of Wage Income (employer)

Annual

Source of Non-Wage

Non-Wage

Income (social security,

Income

alimony, child support,

 

separate maintenance,

 

etc.)

 

 

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 $

 

 

 

 

 

10. Name, Address and Telephone No. of Child care Provider(s).

11. Characteristics of Present Housing

Does the Dwelling:

Yes

 

No

Lack complete plumbing

 

 

 

 

 

 

Lack adequate heating

 

 

 

Yes No

Physically deteriorated or structurally unsound Overcrowded (More than 2 persons per room)

12. Name, Address and Telephone Number of Present Landlord.

If residing at present address for less than two years, complete the following:

Name, Address and Telephone Number of Previous Landlord(s).

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

 

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. It 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, 14th 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. It you believe you have been discriminated against for any of these reason 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 DEPART- MENT 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.

DateSignature of Applicant

 

 

X

 

 

 

Date

Signature of Applicant

X

17. Date

Signature of Loan Approval Official

Determination of Eligibility

Eligible

 

Not Eligible

 

Racial Data Provided by

Applicant RHS

18.

Application received on

 

 

.

 

Application completed on

 

 

. .

19.

Credit Report Fee

 

 

 

 

 

 

Date Received:

 

Amount Received: $

 

Initial:

 

 

 

 

Page 8 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 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 address, 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.

Page 9 of 10

Form RD 410-4

NOTICE TO APPLICANT REGARDING PRIVACY ACT INFORMATION- CONTINUED

14Referral 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)).

Page 10 of 10

Form RD 410-4

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