Form 5-4749 BIA Interest Subsidy Report

BIA Form 5-4749
Revised 4/17/01

OMB Control No. 1076-0020
Expires: 12/31/06

Bureau of Indian Affairs
Interest Subsidy Report
(Using this form is optional, but it complies with 25 CFR § 103.23.)

Lender: __________________________________
Address: __________________________________
__________________________________
__________________________________
Borrower:
__________________________________
Address: __________________________________
__________________________________
__________________________________

1.
2.

3.
4.

This Interest Subsidy Report (“Report”) covers the period from _____________, 20__ to _____________,
20__ (“Reporting Period”).
The Lender may include summaries for multiple loans and/or Borrowers in a single Report, as long as the
information concerning each loan and each Borrower is complete and attached to this Report as a separate
Calculation Page. See, Exhibit A, attached. Blank Exhibits A may be reproduced by the Lender as necessary
to attach to this Report.
The Lender also must attach a printout or duplicate of its loan payment history for each loan on which interest
subsidy is to be paid, identifying the Lender’s loan number, the Borrower, and the date and amount of all loan
balance activity for the reporting period.
By submitting this Report, the official signing for the Lender below represents that he or she (a) has been given
due authority from the Lender to submit this Report on its behalf, (b) has made diligent inquiry into the truth
and accuracy of the information contained in this Report, and (c) believes this Report is an appropriate claim for
the payment of interest subsidy under the provisions of the Loan Guaranty, Insurance and Interest Subsidy
Program, 25 U.S.C. §§ 1481 et seq., 1511 et seq., and 25 CFR Part 103.
Lender:_____________________________
ABA No.:___________________________

By:_________________________________
Its:_________________________________
Date of this Report:______________, 20 __.

BIA Form 5-4749
Revised 4/17/01

OMB Control No. 1076-0020
Expires: 12/31/06

Exhibit A
Calculation Page
Lender:___________________________________________________
Reporting Period: _____________, 20____ to _____________, 20____
… Loan Guaranty Certificate No.: ___________________________
… Loan Insurance Agreement No.: ___________________________
Date of Loan:_______________, 20___.
Date of BIA insurance approval:_______________, 20___.
Original Loan Principal Amount:
$__________________________
(Exclusive of amounts potentially added pursuant to 25 CFR §§ 103.8, 103.34, or 103.36.)
Lender’s Internal Loan Number:
___________________________
1.
2.
3.
4.

5.

6.
7.

List the total accrued interest paid on the Loan during the Reporting Period:
$____________
In Box A below, list the Treasury/BIA interest rate established for the Loan. Please use decimals; e.g., 5.5% =
.055.
In Box B below, list the Lender’s interest rate for the Reporting Period. Again, please use decimals; e.g., 8.75%
= .0875. If there is an adjustable interest rate which changed during the Reporting Period, fill out more than one
row and indicate the portion of the Reporting Period during which the specified interest rate was in effect.
Subtract the Treasury interest rate (Box A) from the Lender’s interest rate (Box B), then divide the result by the
Lender’s interest rate. Put the quotient in Box C. This number is the Subsidy Factor. Using the example above,
if the Treasury/BIA interest rate is 5.5% and the Lender’s interest rate is 8.75%, the Subsidy Factor is (.0875.055)/.0875 = .37142.
In Box D, please list the amount of accrued interest paid on the Loan during each segment of the Reporting
Period for which there was a different Lender’s interest rate (Box B). When totaled, the amount(s) listed in
Box(es) D should equal the total accrued interest figure entered in item 1, above. (Note that if the Loan has a
fixed rate of interest, or if it has an adjustable rate of interest that did not change during the Reporting Period,
the Lender should fill out only one row of Boxes below.)
Multiply the Subsidy Factor(s) (Box C) by the corresponding amount(s) of interest paid (Box D), and enter the
product(s) in Box E.
If there is more than one row filled out below, total the amounts from Box E in the space provided.
A
Treasury
Interest Rate
for BIA

B
Lender’s Interest Rate
(and dates applicable, if less than
entire Reporting Period)

D
Accrued Interest
Paid on Loan

C
Subsidy
Factor
(B-A)/B

E
Subsidy Due from
BIA

_____________________
(from __/__/__ to __/__/__)

$

$

_____________________
(from __/__/__ to __/__/__)

$

$

_____________________
(from __/__/__ to __/__/__)

$

$

TOTAL:

$________________