Instructions for RD0400-0004

Assurance Agreement

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.

Instructions for RD0400-0004

Assurance Agreement

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.

Please do not attempt to complete this form. It is provided on this web site for information purposes only.