1	This Interest Subsidy Report (“Report”) covers the period from _____________, 20__ to  _____________, 20__ (“Reporting Period”). 
2	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. 
3	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. 
4	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 Guarantee, 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 __. 

Paperwork Reduction Act Notice:  This form is covered by the Paperwork Reduction Act.  It is used to calculate and document the amount of interest subsidy for which the Federal government may reimburse respondent.  The information is provided by respondents to obtain or retain a benefit.  In compliance with the Paperwork Reduction Act of 1995, as amended, the collection has been reviewed by the Office of Management and Budget and assigned a number and an expiration date.  The number and expiration date are at the top right corner of the form.  An agency may not sponsor or conduct, and a person is not required to respond to, a request for information collection unless it displays a currently valid OMB Control Number. The public reporting burden is estimated to average 2 hours per respondent.  This includes the time needed to understand the requirements, gather the information, complete the form, and submit it to the Department.  Comments regarding the burden or other aspects of the form may be directed to the Indian Affairs Information Collection Clearance Officer, Office of Regulatory Affairs – Indian Affairs, 1849 C Street, NW, MS-4141, Washington, DC 20240.  

Privacy Act Statement (5 U.S.C. 552(a)):  The authority for collecting this information is 25 U.S.C. 1511.  The information will be used to administer the Loan Guarantee, Insurance and Interest Subsidy Program, 25 U.S.C. 1481 et seq.  Disclosures of this information may be made to track and record payments and unpaid balances and provide information on payments made for paying interest subsidy, credits obtained, service loans made, and premiums paid by Lenders, and for the other routine uses described by system of record notice, BIA-13, Loan Management and Accounting System.

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

Lender: __________________________________ Address: __________________________________ 
Borrower:__________________________________ Address:__________________________________ 
 
Exhibit A Calculation Page 
Lender:___________________________________________________ Reporting Period: _____________, 20____ to _____________, 20____ 
 Loan Guarantee Certificate No.: ___________________________ 
 Loan Insurance Agreement No.: ___________________________ 
Date of Loan:_______________, 20___. 
Date of BIA insurance approval:_______________, 20___. 

1	List the total accrued interest paid on the Loan during the Reporting Period: $____________ 
2	In Box A below, list the Treasury/IFA interest rate established for the Loan.  Please use decimals; e.g., 5.5% = .055. 
3	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. 
4	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/IFA interest rate is 5.5% and the Lender’s interest rate is 8.75%, the Subsidy Factor is (.0875.055)/.0875 = .37142. 
5	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.) 
6	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. 
7	If there is more than one row filled out below, total the amounts from Box E in the space provided. 

A
Treasury Indian Financing Act Rate	B
Lender’s Interest Rate (and dates applicable, if less than entire Reporting Period)	C
Subsidy Factor (B-A)/B	D
Accrued Interest Paid on Loan	E
Subsidy Due from DOI	
	
________________

(from__/__/__ to __/__/__)
		$	$	
	________________

(from__/__/__ to __/__/__)
		$	$	
	________________

(from__/__/__ to __/__/__)
		$	$	

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: ___________________________ 

TOTAL: $________________