RD 1980-21 Request for SFH Loan Guarantee

Close

Save
UNITED STATES DEPARTMENT OF AGRICULTURE
RURAL DEVELOPMENT
RURAL HOUSING SERVICE

Form RD 1980-21
(Rev. 02-13)

Form Approved
OMB No. 0575-0078

REQUEST FOR SINGLE FAMILY HOUSING LOAN GUARANTEE
Approved Lender:

Approved Lender Tax ID No.:

Contact:

Approved Lender E-Mail:

Phone Number:

Fax Number:

Third Party Originator (TPO):

TPO Tax ID No:

USDA Application Number:

Lender Loan Reference Number:

Please issue a Conditional Commitment for Single Family Housing Loan Guarantee in the following case:
Applicant Information (Please complete, circle, or mark as appropriate)

Co-Applicant Information (Please complete, circle, or mark as appropriate)

Name:

Name:

Date of Birth:
SSN:
U.S. Citizen:
Yes
No
Permanent Resident/Qualified Alien:
Yes

SSN:
Date of Birth:
Yes
U.S. Citizen:
No
Permanent Resident/Qualified Alien:
Yes

No

Veteran:
Gender:

Yes
Yes

Veteran:
Gender:
Ethnicity:

No
Yes
Disabled:
F First Time Homebuyer
M

No

Yes
Yes

No
No

Ethnicity.:

Hispanic or Latino

(Check only One Box)

(Check as many boxes as applicable)

Race:

Black or African American

Asian

American Indian or Alaska Native
Black or African American

Native Hawaiian or Other Pacific Islander
Married

Not Hispanic or Latino

(Check as many boxes as applicable)

Asian

American Indian or Alaska Native

Marital Status:

No
No

Hispanic or Latino

(Check only One

Box)

Not Hispanic or Latino

Race:

Yes
Disabled:
No
F First Time Homebuyer
M

Native Hawaiian or Other Pacific Islander

White

Separated

Unmarried

Marital Status:

Married

Separated

White
Unmarried

does not have a relationship with any current
The applicant
has
Rural Development employee. Explain.

The co-applicant
has
does not have a relationship with any
current Rural Development employee. Explain.

Applicant's Credit Score:

Co-Applicant's Credit Score:

No Score

No Score

ANY ADDITIONAL APPLICANTS MUST BE FULLY DOCUMENTED ON A SEPARATE FORM.
Property Address:
County:

City, State, Zip Code:
Is this a Refinance Loan?

No

Yes

Guaranteed Loan
If Yes, refinanced loan is an RD Single Family Housing
Number of dependants under Age 18 or Full-time Students:

1. Number of persons in the household:
2a. The current annual income for the household is: $
TOTAL DEBT ratio:
3. PITI ratio:
4. We propose to loan $
5. The interest rate is based on the

Direct Loan

2b. The current adjusted income for the household is: $
% per annum with payments (P&I) of $

for 30 years at
Fannie Mae on

/

/

per month.

(required).

/

/

The interest rate is locked in until
.
The interest rate will float until loan closing (documentation of lock date will be required w/ loan closing report).
NOTE: If the interest rate increases at loan closing, the loan must be re-underwritten and this document must be recertified.
6. The applicant understands that Rural Development approval of guarantee is required and is subject to the availability of funds.
7. The applicant is unable to secure the necessary conventional credit without a Rural Development guarantee upon reasonable rates, terms and
conditions in which the applicant could reasonably be expected to fulfill.
8. Loan funds will be used for the following purpose(s):
Purchase / Refinance Amt:

$

Financed Loan Closing Costs:

$

Repairs/Other:

$

Guarantee Fee:

$

Total Request:

$

0.00

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 0575-0078. The time required to complete this information collection is estimated to average 30 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.

Page 1 of 4

Close

Save

Close

Save

Applicant:

Co Applicant:

Certifications
Approved Lender Certification
In order to induce the Agency to issue the requested guarantee, we certify that we have originated and underwritten the loan in
compliance with all Agency loan requirements. This form contains or is supplemented with all information required by 7 C.F.R. §
1980.353(c).

Lender's Authorized Representative Signature / Title

Date

Name of Authorized Representative

Title/Company

Applicant(s) Acknowledgments and Certifications
CERTIFICATION. As the applicant, I certify to the best of my knowledge and belief; (1 ) I am not presently debarred, suspended,
declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency; (2) I have not within a
three year period preceding this proposal been convicted or had a civil judgment rendered against me for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, state, or local) transaction or
contract under a public transaction; or commission of embezzlement, theft, forgery, bribery, falsification, or destruction of records,
making false statement, or receiving stolen property; (3) I do not have an outstanding judgment lien on any property for a debt in favor
of the United States which was obtained in any Federal court other than the United States Tax Court; and (4) I am not delinquent on
any outstanding debt to the Federal Government (excluding any Federal Tax debt).
I AM (WE ARE) unable to provide the housing I (we) need on my (our) own account, and I am (we are) unable to secure the credit
necessary for this purpose from other sources upon terms and conditions which I (we) can reasonably fulfill. I (we) certify that the
statements made by me (us) in this application are true, complete and correct to the best of my (our) knowledge and belief and are
made in good faith to obtain a loan.
I (we) acknowledge this loan will be subject to payment of an annual fee by the Lender. The Lender may pass this fee on to me (us). I
(we) understand that the annual fee for the first year is calculated when the loan is closed based upon the loan amount. Thereafter, the
annual fee is calculated every 12 months based upon the average scheduled amortized unpaid principal balance. Billing for the annual
fee will begin 12 months from the closing of the loan.
Warning:

Section 1001 of Title 18, United States Code provides: ''Whoever, in any matter within the jurisdiction of any Department or
Agency of the United States knowingly and willfully falsifies, conceals or covers up by any trick, scheme, or device a material
fact, or makes any false, fictitious or fraudulent statements or representations, or makes or uses any false writing or
document knowing the same to contain any false, fictitious or fraudulent statement or entry, shall be fined under this title or
imprisoned not more than five years, or both.''

Each of the undersigned hereby acknowledges having read page three and four of this document as it relates to information regarding
the PRIVACY ACT and a NOTIFICATION TO APPLICANT ON USE OF FINANCIAL INFORMATION FROM FINANCIAL INSTITUTION.

Print Applicant's Name

Applicant's Signature

Date

Print Co-Applicant's Name

Co-Applicant's Signature

Date

Page 2 of 4

Close

Save

Close

Save

NOTICE TO APPLICANT REGARDING PRIVACY ACT INFORMATION
The information requested on this form is authorized to be collected by the Rural Housing Service (RHS), Rural Business Cooperative Services (RBS),
Rural Utilities Service (RUS) ("the agency'') by title V of the Housing Act of 1949, as amended (42 U.S.C. 1471 et seq.) or by the Consolidated Farm
and Rural Development Act (7 U.S.C. 1921 et seq.), or by other laws administered by RHS, RBS or RUS.
Disclosure of information requested is voluntary. However, failure to disclose certain items of information requested, including your Social Security
Number or Federal Identification Number, may result in a delay in the processing of an application or its rejection. Information provided may be used
outside of the agency for the following purposes:
1. When a record on its face, or in conjunction with other records, indicates a violation or potential violation of law, whether civil, criminal or regulatory
in nature, and whether arising by general statute or particular program statute, or by regulation, rule, or order issued pursuant thereto, disclosure may
be made to the appropriate agency, whether federal, foreign, state, local, or tribal, or other public authority responsible for enforcing, investigating or
prosecuting such violation or charged with enforcing or implementing the statute, or rule, regulation, or order issued pursuant thereto, if the information
disclosed is relevant to any enforcement, regulatory, investigative, or prosecute responsibility of the receiving entity.
2. A record from this system of records may be disclosed to a Member of Congress or to a Congressional staff member in response to an inquiry of
the Congressional office made at the written request of the constituent about whom the record is maintained.
3. Rural Development will provide information from this system to the U.S. Department of Treasury and to other Federal agencies maintaining debt
servicing centers, in connection with overdue debts, in order to participate in the Treasury Offset Program as required by the Debt Collection
Improvement Act , Pub. L. 104-134, Section 31001.
4. Disclosure of the name, home address, and information concerning default on loan repayment when the default involves a security interest in tribal
allotted or trust land. Pursuant to Cranston-Gonzales National Affordable Housing Act of 1990 (42 U.S.C. 2701 et seq.), liquidation may be pursued
only after offering to transfer the account to an eligible tribal member, the tribe, or the Indian Housing Authority serving the tribe(s).
5. Referral of names, home addresses, social security numbers, and financial information to a collection or servicing contractor, financial institution,
or a local, state, or federal agency, when Rural Development determines such referral is appropriate for servicing or collecting the borrower's account
or has provided for in contracts with servicing or collection agencies.
6. It shall be a routine use of the records in this system of records to disclose them in a proceeding before a court or adjudicative body, when: (a) the
agency or any component thereof; or (b) any employee of the agency in his or her official capacity, or (c) any employee of the agency in his or her
individual capacity where the agency has agreed to represent the employee; or (d) the United States is a party to litigation or has an interest in such
litigation, and by careful review, the agency determines that the records are both relevant and necessary to the litigation, provided; however, that in
each case, the agency determines that disclosure of the records is a use of the information contained in the records that is compatible with the
purpose for which the agency collected the records.
7. Referral of name, home address, and financial information for selected borrowers to financial consultants, advisors, lending institutions, packagers,
agents, and private or commercial credit sources, when the agency determines such referral is appropriate to encourage the borrower to refinance their
RHS indebtedness as required by title V of the Housing Act of 1949, as amended (42 U.S.C. 147 1) or to assist the borrower on the sale of the
property.
8. Referral of legally enforceable debts to the Department of the Treasury, Internal Revenue Service (IRS), to be offset against any tax refund that
may become due the debtor for the tax year in which the referral is made, in accordance with the IRS regulations and under the authority contained in
31 U.S.C. 3720A.
9. Referral of information regarding indebtedness to the Defense Manpower Data Center, Department of Defense, and the United States Postal
Service for the purpose of conducting computer matching programs to identify and locate individuals receiving Federal salary or benefit payments and
who are delinquent in their repayment of debts owed to the U.S. Government under certain programs administered by the agency in order to collect
debt under the provisions of the Debt Collection Act of 1982 (5 U.S.C. 5514) by voluntary repayment, administrative or salary offset procedures, or by
collection agencies.
10. Referral of names, home addresses, and financial information to lending institutions when Rural Development determines the individual may be
financially capable of qualifying for credit with or without a guarantee.
11. Disclosure of names, home addresses, social security numbers, and financial information to lending institutions that have a lien against the same
property as the agency for the purpose of the collection of the debt by Rural Development or the other lender. These loans can be under the direct and
guaranteed loan programs.
12. Referral to private attorneys under contract with either the agency or with the Department of Justice for the purpose of foreclosure and possession
actions and collection of past due accounts in connection with the agency.
13. It shall be a routine use of the records in this system of records to disclose them to the Department of Justice when: (a) the agency or any
component thereof; or (b) any employee of the agency in his or her official capacity where the Department of Justice has agreed to represent the
employee; or (c) the United States Government, is a party to litigation or has an interest in such litigation, and by careful review, the agency determines
that the records are both relevant and necessary to the litigation and the use of such records by the Department of Justice is therefore deemed by the
agency to be for a purpose that is compatible with the purpose for which the agency collected the records.
14. Referral of names, home addresses, social security numbers, and financial information to the Department of Housing and Urban Development
(HUD) as a record of location utilized by Federal agencies for an automatic credit prescreening system.
15. Referral of names, home addresses, social security numbers, and financial information to the Department of Labor, state wage information
collection agencies, and other federal, state, and local agencies, as well as those responsible for verifying information furnished to qualify for federal
benefits, to conduct wage and benefit matching through manual or automated means, for the purpose of determining compliance with federal
regulations and appropriate servicing actions against those not entitled to program benefits, including possible recovery of improper benefits.
16. Referral of names, home addresses, and financial information to financial consultants, advisors, or underwriters, when Rural Development
determines such referral is appropriate for developing packaging and marketing strategies involving the sale of Rural Development loan assets.
17. Rural Development, in accordance with 31 U.S. C. 3711 (e)(5), will provide to consumer reporting agencies or commercial reporting agencies
information from this system indicating that an individual is responsible for a claim that is current.
18. Referral of names, home and work addresses, home telephone numbers, social security numbers, and financial information to escrow agents
(which also could include attorneys and title companies) selected by applicant or borrower for the purpose of closing the loan.

Page 3 of 4

Close

Save

Close

Save

NOTIFICATION TO APPLICANT ON USE OF FINANCIAL
INFORMATION FROM FINANCIAL INSTITUTION

Pursuant to Title XI, section 1113(h) of Public Law 95-630, your application for a government loan or loan guaranty authorizes the Agency, in connection
with the assistance you seek, to obtain financial information about you contained in financial institutions. No further notice of subsequent access to this
information shall be provided during the term of the loan or loan guaranty.
As a general rule, financial records obtained pursuant to this authority may be used only for the purpose for which they were originally obtained.
However, they may be transferred to another Agency or department if the transfer is to facilitate a lawful proceeding, investigation, examination, or
inspection directed at the financial institution in possession of the records (or another legal entity not a customer). The records may also be transferred
and used (1) by counsel representing a government authority in a civil action arising from a government loan, loan guaranty, or loan insurance
agreement; and (2) by the Government to process, service or foreclose a loan or to collect on an indebtedness to the Government resulting from a
customer's default.
The Agency reserves the right to give notice of a potential civil, criminal, or regulatory violation indicated by the financial records to any other agency or
department of the Government with jurisdiction over that violation. Such agency or department may then seek access to the records in any lawful
manner.

Page 4 of 4

Close

Save