The local Rural Development (RD) servicing office completes this form.RD uses this form to inform an applicant
of their responsibility to abide by the Civil Rights Act of 1964.Applicants will be asked to sign this
form indicating they have been notified to comply with the law.
Submit the original of the completed form in hard copy or facsimile to the
appropriate Rural Development servicing office.
Features for transmitting the form electronically are
available to those customers with access credentials only. If you would
like to establish online access credentials with USDA, follow the instructions
provided at the USDA eForms web site.
Please do not attempt to complete this form.It is provided on this web site for
information purposes only.