FSA-2522 Delinquent Borrower Response to Denial of Loan Servicing

Form Approved-OMB No. 0560-XXXX

This form is available electronically.

FSA-2522
(Proposal 3)

U.S. DEPARTMENT OF AGRICULTURE
Farm Service Agency

Position 4

BORROWER RESPONSE TO DENIAL OF PRIMARY LOAN SERVICING
AND INTENT TO ACCELERATE
FOR BORROWERS WHO RECEIVED FORM FSA-2510 OR FSA-2514 AND APPLIED FOR SERVICING
1. FROM BORROWER: (Enter your name)

2. I have received and read your denial of my request to restructure my Farm Service Agency (FSA) Farm Loan Program
(FLP) debt. (Check the appropriate blocks below:)
A. I will pay my FSA account current immediately. (Only applicable if payment delinquency is the reason for your default.
Please contact your local office if you require any further information.)
B. I will pay FSA the full amount of the Current Market Value Buyout (CMV). (The deadline is 90 days from the date you
received form FSA-2521. This only applicable if you were offered (CMV.)
C. I would like to request Reconsideration as described in form FSA-2521. (The deadline is 30 days from the date you
received form FSA-2521.)
D. I would like to request Mediation as described in form FSA-2521. (The deadline is 30 days from the date you received
form FSA-2521.)
E. I would like to request Negotiation of the Appraisal as described in form FSA-2521. (The deadline is 30 days from the
date you received form FSA-2521.)
F. I would like to Appeal as described in form FSA-2521. (The deadline is 30 days from the date you received form
FSA-2521.)

3A. Signature

3B. Date

4A. Signature

4B. Date

5A. Signature

5B. Date

6A. Signature

6B. Date

NOTE: The following statements are made in accordance with the Privacy Act of 1974 (5 U.S.C. 552a): The Farm Service Agency (FSA) is authorized by the Consolidated
Farm and Rural Development Act (7 U.S.C. 1921 et seq.), or other Acts, and the regulations promulgated thereunder, to solicit the information requested on its
application forms. The information requested is necessary for FSA to determine eligibility for credit or other financial assistance, service your loan, and conduct
statistical analyses. Supplied information may be furnished to other Department of Agriculture agencies, the Department of the Treasury, the Department of Justice
or other law enforcement agencies, the Department of Defense, the Department of Housing and Urban Development, the Department of Labor, the United States
Postal Service, or other Federal, State, or local agencies as required or permitted by law. In addition, information may be referred to interested parties under the
Freedom of Information Act (FOIA), to financial consultants, advisors, lending institutions, packagers, agents, and private or commercial credit sources, to collection
or servicing contractors, to credit reporting agencies, to private attorneys under contract with FSA or the Department of Justice, to business firms in the trade area
that buy chattel or crops or sell them for commission, to Members of Congress or Congressional staff members, to courts or adjudicative bodies or to state-certified
or state licensed appraisers. Disclosure of the information requested is voluntary. However, failure to disclose certain items of information requested, including
Social Security Number or Federal Tax Identification Number, may result in a delay in the processing of an application or its rejection.
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 0560-XXXX. The time required to complete this
information collection is estimated to average 60 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. RETURN THIS COMPLETED FORM TO YOUR LOCAL FSA OFFICE.

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where
applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual's
income is derived from any public assistance program. (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 to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, or call (800) 795-3272 (voice) or (202)
720-6382 (TDD). USDA is an equal opportunity provider and employer.