Farm Loan Programs - Direct Loan Making

Farm Loan Programs - Direct Loan Making

FSA2007INS_proposal 1

Farm Loan Programs - Direct Loan Making

OMB: 0560-0237

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FSA-2007 Date of Modification: (proposal 1)



INSTRUCTIONS FOR PREPARATION

COSIGNER APPLICATION AND AGREEMENT

Purpose:

This form is used to obtain and solicit information it deems necessary from a cosigner to support an FSA application.

Handbook Reference:

1-FLP and 3-FLP

Number of Copies:

Original only

Signatures Required:

Original by cosigner

Distribution of Copies:

County Office Case File

Automation-Related Transactions: DLS


Cosigner must complete Parts A, B and C. FSA completes Part D.


PART A – Cosigner

Items 1 – 11 are completed by the cosigner.


Fld Name /
Item No.

Instruction

1

Exact Full Legal Name

Enter the cosigner’s exact full legal name as shown on a state driver’s license or State ID card.

2

Email Address

Enter the cosigner’s email address.

3

Mailing Address

Enter the cosigner’s complete mailing address. Indicate if the mailing address is different from the cosigner’s physical address.

4A

Physical Address

Enter the cosigner’s complete physical address if different from the mailing address.

4B

County of Residence

Enter the county where the cosigner’s residence is located.

5

Contact Numbers

Enter the cosigner’s home, cell, or business telephone number, as applicable. Indicate cosigner’s best contact telephone number by selecting “Primary” in the applicable box.

6

Applicant

Enter the name of the applicant for which the cosigner is agreeing to cosign for.

7

Birth Date

Enter the cosigner’s date of birth.

8

Social Security Number

Enter the cosigner’s social security number (9 digit number).

9

Name and Address of Employer/ Telephone

Enter the name, address and telephone number of the cosigner’s employer, if applicable.

10

Citizenship

Check applicable citizenship status. If non-citizen national, qualified alien, or refugee, as defined by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), 8 U.S.C. 1641, cosigner must provide copies of appropriate documentation of immigration status, including and not limited, to a current I-551, Naturalization Certificate, or I-688B.

11

Race


Check the appropriate box indicating applicant’s race. More than one box may be checked. Providing applicant’s race is voluntary; however, if applying as a socially disadvantaged applicant based on race, this information is required.

12

Veteran Status

Check the appropriate box indicating applicant’s veteran status.

13

Marital Status

Check the appropriate block depending on whether the applicant is unmarried, separated, or married and applying as an individual applicant.

14

Ethnicity


Check the appropriate box indicating applicant’s ethnicity. Providing applicant’s ethnicity is voluntary; however, if applying as a socially disadvantaged applicant based on ethnicity, this information is required.

15

Gender


Check the appropriate box indicating applicant’s gender. Providing applicant’s gender is voluntary; however, if applying as a socially disadvantaged applicant based on gender, this information is required.

16

For FSA Use Only

Check the appropriate box indicating if information collected was provided or observed.

17

Legal Capacity/ Authority

Check the appropriate box to indicate if the cosigner has the legal capacity, age, mental capacity and authority to enter into a legal binding agreement.

PART B – Notifications, Certifications and Acknowledgement for the Cosigner


Items 1 – 12 are completed by the cosigner.

1

Business Under Other Name

Check “YES” if you ever conducted business under any other name; otherwise check “NO.”  If “YES,” provide the names used in Item 8.

2

Previous FSA or FmHA Loans

Check “YES” if you ever obtained a direct or guaranteed farm loan from FSA or the Farmers Home Administration; otherwise check “NO.”

3

Debt Forgiveness

If Item 2 is “YES,” check “YES” if the government ever forgave any debt through write-down, write-off, compromise, adjustment, reduction, charge-off, paying a loss on a guarantee, or bankruptcy.  If “YES,” provide details in Item 8; otherwise check “NO.” 

4

Delinquent on Federal Debt

Check “YES” if you are delinquent on any federal debt (i.e. “Federal Debt” includes but is not limited to education loans, delinquent taxes, obligations to Natural Resources Conservation Service, obligations to FCIC, etc., or have an outstanding Federal judgement).  If “YES,” provide details in Item 8; otherwise check "NO."

5

Pending Litigation

Check “YES” if you are involved in any pending litigation.  If “YES,” provide details in Item 8; otherwise check “NO.”

6

Bankruptcy

Check “YES” if you have ever been in receivership, been discharged, or filed a petition for reorganization in bankruptcy.  If “YES,” provide details in Item 8; otherwise check “NO.” 

7

Employee Relationship

Check “YES” if you are an employee, related to an employee, or closely associated with an employee of the Farm Service Agency. If “YES,” provide details in Item 8; otherwise check “NO.”

8

Additional Answers

Provide explanations to any “YES” responses to Items 1 - 7.  Use additional sheets if necessary.

9 - 12

Statements

Read statements and certifications in Items 9 - 12.

PART C – Certification and Cosigner Signatures


Items 1A and 1B are completed by the cosigner.

1A

Signature

Enter the signature of the cosigner.


1B

Date

Enter the date the cosigner signed.

 

If mailing the form, print the form and manually enter your signature.  This form is approved for electronic transmission.  If you have established credentials with USDA to submit forms electronically, use the buttons provided on the form for transmitting the form to the USDA servicing office.  Electronic submission may only be completed if you are the only person required to sign this form.


PART D – FSA Use Only


Items 1 – 5 are completed by FSA.




Page 5




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