FSA-2261 Report on Collection Activities on Liquidated Accounts

This form is available electronically.

Form Approved - OMB No. 0560-0155
U.S. DEPARTMENT OF AGRICULTURE
Farm Service Agency

FSA-2261
(Proposal 1)

REPORT OF COLLECTION ACTIVITIES ON LIQUIDATION ACCOUNTS
INSTRUCTIONS TO LENDER: Complete Part B, and submit this form to the FSA Office in Item 2 by November 30 each year.

PART A - TO BE COMPLETED BY FSA LOAN SERVICING OFFICIAL
1. Lender's Name and Mailing Address

2. Name and Address of County FSA Office Loan Service Official

3. Borrower Name (Last, First, Middle Initial)

4. Borrower Case Number

5. Total unpaid loan balance as of date of loss claim (guaranteed and unguaranteed portion)

NOTE: The dollar amount must agree with the amount on the RD-449-30.

$

6. Percentage of loan guaranteed by Farm Service Agency

%

PART B - TO BE COMPLETED BY LENDER
7. Total Collected in Most Recently Completed Fiscal Year (October 1 - September 30)

$

8. Total Amount Remitted to Farm Service Agency by Lender.

NOTE: Do not include proceeds remitted prior to the payment of the final loss claim.

$

9. Describe briefly the collection efforts made during the past fiscal year:

10A. Signature of Authorized Lender's Representative

NOTE:

10B. Title of Authorized Lender's Representative

10C. Date (MM-DD-YYYY)

The following statements are made in accordance with the Privacy Act of 1974 (5 USC 552a): the Farm Service Agency (FSA) is authorized by the Consolidated Farm and
Rural Development Act, as amended (7 USC 1921 et seq.), and the regulations promulgated thereunder, to solicit the information requested on this form. The information
requested is necessary for FSA to determine eligibility for payment, service the guaranteed loan, and conduct statistical analyses. Supplied information may be furnished to
other Department of Agriculture agencies, the Department of the Treasury, the Department of Justice or other law enforcement agencies, the Department of Defense, the
Department of Housing and Urban Development, the Department of Labor, the United States Postal Service, or other Federal, State, or local agencies as required or permitted
by law. In addition, information may be referred to interested parties under the Freedom of Information Act (FOIA), to financial consultants, advisors, lending institutions,
packagers, agents, and private or commercial credit sources, to collection or servicing contractors, to credit reporting agencies, to private attorneys under contract with FSA or
the Department of Justice, to business firms in the trade area that buy chattel or crops or sell them for commission, to Members of Congress or Congressional staff members, or
to courts or adjudicative bodies. Disclosure of the information requested is voluntary. However, failure to disclose the information requested, may result in a delay in the
processing of this form or its rejection.
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 0560-0155. The time required to complete this information collection is
estimated to average 20 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. RETURN THIS COMPLETED FORM TO YOUR LOCAL FSA OFFICE.

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its program and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status,
parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individuals income is derived from any public assistance program. (Not all prohibited bases apply to
all programs.) Persons with disabilities who require alternative means for communication of program information ( Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at (202) 720-2600 (voice
and TDD). To file a complaint of Discrimination, write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW., Washington, DC 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD).
USDA is an equal opportunity provider and employer.