RD 1944-62 Request for Verification of Deposit

UNITED STATES DEPARTMENT OF AGRICULTURE
RURAL HOUSING SERVICE

Form RD 1944-62
(Rev. 07-06)

Form Approved
OMB No. 0575-0172

REQUEST FOR VERIFICATION OF DEPOSIT
INSTRUCTIONS:
APPLICANT - Complete items 1, sign item 9 and return to the Rural Housing Service (RHS) Field Office address noted in block 2.
PACKAGER OR LENDER - Complete items 1 through 8. Have applicant complete item 9. Forward directly to depository named in block 1
DEPOSITORY - Please complete items 10 through 18 and return DIRECTLY to address noted in block 2.
This form is to be transmitted directly to the lender and is not to be transmitted through the applicant or any other party.
Part I – Request
1. To (Name and address of depository)

2. From (Name and address of lender or RHS Office)

I certify that this verification has been sent directly to the bank or depository and has not passed through the hands of the applicant or any other party.
This also certifies that the U.S. Department of Agriculture, acting through RHS, has complied with the applicable provisions of Title XI, the Right to Financial Privacy Act
of 1978, Public Law 95-630, in seeking financial information regarding the below named applicant.
3. Signature of Lender/Packager/RHS

4. Title

5. Date

6. Lender’s No. (Optional)

7. Information To Be Verified
Type of Account

Account in Name of

Account Number

Balance
$
$
$

To Depository: I have applied for financial assistance from the United States Department of Agriculture and stated in my financial statement that the balance on deposit with
you is as shown above. You are authorized to verify this information and to supply the lender identified above with the information requested in items 10 through 13. Your
response is solely a matter of courtesy for which no responsibility is attached to your institution or any of your officers.
8. Name and Address of Applicant

9. Signature of Applicant

T Part II – Verification of Depository
O 10. Deposit Accounts of Applicants
B
E
C
O
M
P
L
E
T
E
D
B
Y

Type of Account

Account Number

Current Balance

Average Balance For
Previous Two Months

$

$

$

$

$

$

Date Opened

11. Loans Outstanding To Applicants

Loan Number

Date of Loan

Original Amount

Current Balance

Installments
(Monthly/Quarterly)

$

$

$

per

$

$

$

per

$

$

$

per

Secured By

Number of Late
Payments
(Last 12 Months)

12. Please include any additional information which may e of assistance in determination of credit worthiness. (Please include information on loans paid-in-full in
Item 11 above.)
13. If the names on the accounts differ from those listed in Item 7, please supply the names on accounts as reflected by your records.

D
E
P Part III – Authorized Signature - Federal statutes provide severe civil and criminal penalties for any person who knowingly makes false or fraudulent
O statements or representations to a government agency or officer with the intention of influencing any action by such agency or officer.
S
15. Title (Please print or type)
16. Date
I 14. Signature of Depository Representative
T
O
18. Phone No.
R 17. Please print or type name signed in item 14
T
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.

SEE ATTACHED PRIVACY ACT NOTICE

NOTICE TOAPPLICANT REGARDINGPRIVACYACT 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.

NOTICE TOAPPLICANT REGARDINGPRIVACYACT 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 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)).