Guaranty Loan Status report

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OMB NO.:2105-0555
DOT F2305-1
EXPIRATION DATE: MM/DD/YYYY

Guaranty Loan Status Report

Lender:

Date Submitted:

Address:
Contact Telephone:

Contact:

Borrower's Name

Contact Fax:

Address, City, State, Zip

Internal
Loan Number

Outstanding
Balance

Month Ending:

Advances in
Period

Date
of Advance

Principal
Paid

Interest
Paid

Date of
Payment

Note Status

Changes
(Y/N)

Details

Summary of Contracts Guaranteed:

Summary of Contracts Guaranteed:

Summary of Contracts Guaranteed:

Summary of Contracts Guaranteed:

Summary of Contracts Guaranteed:

Summary of Contracts Guaranteed:

Rev. 5/12

OPI: Office of Small and Disadvantaged
Business Utilization
PRIVACY ACT STATEMENT

The Privacy Act requires that we provide you with the following information regarding our use of your Personally Identifiable Information. The information on this form is solicited under the
authority of Title 49 U.S.C. 332(b)(3)(4)(5) which authorizes DOT OSDBU to assist Disadvantage Business Enterprises and Small and Disadvantaged Businesses in acquiring access to
working capital and to debt financing, in order to obtain transportation related contracts funded by DOT. STLP loans are provided through lenders that serve as STLP Participating Lenders
(PL). The PLs enter into a Cooperative Agreement with DOT’s OSDBU. The STLP is subject to budgeting and accounting requirements of the Federal Credit Reform Act of 1990 (FCRA).
The PL must carry out processes to activate, monitor, service and close out STLP loans. To fulfill the requirements of FCRA, the PL submits reports and the forms to OSDBU. Provisions of
the requested information are voluntary; however it is a requirement of the Cooperative Agreement.
PAPERWORK REDUCTION ACT PUBLIC BURDEN STATEMENT

A Federal agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a current valid OMB control number. The OMB Control
No. for this information collection is 2105-0555. The information requested on this form is being collected and disseminated by the U.S. Department of Transportation, Office of the Secretary
as a courtesy to the public. Public reporting for this collection of information is estimated to be 60 minutes per response, including time for reviewing instructions, and completing and
reviewing the collection of information. All responses to this collection of information are mandatory. Send comments regarding the burden estimate or any other aspect of the collection of
information, including suggestions for reducing this burden, to: Information Collection Clearance Officer, Office of the Secretary, Office of Small and Disadvantaged Business Utilization,
Financial Assistance Division, 1200 New Jersey Ave., S.E., 5th Floor, W56-448, Washington, DC 20590.