FSA2211INS_xx-xx-20V01 proposal 2

FSA-2211

Date of Modification: proposal 2

APPLICATION FOR GUARANTEE
INSTRUCTIONS FOR PREPARATION
Purpose:
Lenders use this form to apply for an FSA loan guarantee.
Loan applicants should not submit this form to FSA. This form is submitted to FSA by lenders
after the lender has recorded the required information.

Handbook Reference:
2-FLP

Number of Copies:
Original copy.

Lenders submit the original of the completed
form in hard copy, scanned via email or
facsimile to the appropriate USDA servicing
office.

Signatures Required:

Applicant, Co-Applicant, Co-Signer, Entity Member, and Lender.

Distribution of Copies:

Original to FSA servicing office. (Documents sent via email or facsimile are considered originals)

Automation-Related Transactions: GLS

Lenders who have established electronic access credentials with USDA eforms may electronically
transmit this form to the USDA servicing office. The application will be processed; however, the
original, signed copy (hard, scanned/emailed or facsimile) of the form must be submitted to the
local servicing office before FSA can issue a loan guarantee. Features for transmitting the form
electronically are available to those customers with access credentials only. If you would like to
establish online access credentials with USDA, follow the instructions provided at the USDA
eForms web site. If lenders haven’t established electronic access credentials with USDA, they can
also submit the application via email or facsimile.

All loan applicants must complete Part A and Parts D through F. Entity
applicants must complete Part B. Individual applicants must complete Part C.
Co-applicants, co-signers, and entity members must complete Parts O and P.
Ethnicity, race, gender, and veteran status information is voluntary. Additional
pages for Parts O and P may be attached for additional co-applicants, entity
members or co-signers.
Lenders must complete Parts G through M.

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FSA-2211

Date of Modification: proposal 2

NOTE: Any questions answered “NO” may require additional information.
Lenders should contact the local FSA Office for more direction.
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Instruction

PART A – Type of Operation (Loan Applicant)
1
Type of Operation

Check the appropriate box for the type of operation. Entity applicants complete Part B.
Individual applicants complete Part C.

PART B – Entity Applicant Information (Loan Applicant)
1
Entity Name

Enter the entity’s name.

2
Entity Address

Enter the entity’s business mailing address. Include the physical address if different from
mailing address.

3
Number of Entity Members

Enter the number of individuals and/or embedded entities who have an ownership interest in
the entity. All members must complete Parts O and P. (Refer to 2-FLP, paragraph 111 (d) for
embedded entity information)
Enter the entity’s tax ID number.

4
Entity Tax ID Number
5
Entity Headquarters County

Enter the county where the entity’s headquarters is located.

6
Entity Telephone Number

Enter the telephone number (Including Area Code) for the entity.

7
Entity Telephone Type

Check the telephone type (Home, Cell, Work) for the entity.

PART C – Individual Applicant Information (Loan Applicant)
1
Applicant’s Full Legal
Name
2
Applicant’s Address

Enter the applicant’s complete legal name.

3
Applicant’s Birthdate

Enter applicant’s date of birth (MM-DD-YYYY).

4
Applicant’s 9 Digit Social
Security or Tax ID Number
5
Residence or Headquarters

Enter applicant’s 9-digit social security number or tax ID number.

Enter applicant’s complete mailing address, including physical address if different from
mailing address.

Enter county the applicant resides and the county where the headquarters office is located if
different from each other.

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Date of Modification: proposal 2

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6
Applicant’s Telephone
Number

Enter applicant’s home or business telephone number, including area code.

7
Applicant Telephone Type

Check the telephone type (Home, Cell, Work) for the applicant.

8
Marital Status

For individual applicants, check the box that most closely corresponds to current marital
status.

9
Citizenship Status

Check appropriate box. If not a U.S. citizen, applicant will be asked to provide I-551 and/ or
other proper documentation of immigration status as found under PRWORA (8 U.S.C. 1641)

PART D – Other Information (Loan Applicant)
Note: To be considered a Socially Disadvantaged Applicant, the majority interest must be held by eligible individual(s)
1
Other Business Names
2A
Ethnicity
2B
Race

If the individual applicant or entity applicant has conducted business under any other name,
answer “YES”. If not, answer “NO”.
If “YES”, enter the other name(s) the applicant has used.
Check the appropriate box indicating individual applicant or entity applicant ethnicity.
Check the appropriate box or boxes indicating individual applicant or entity applicant race.

2C
Gender

Check the appropriate box indicating individual applicant or entity applicant gender.

2D
Veteran Status

Check the appropriate box indicating individual applicant or entity applicant veteran status.

PART E – Eligibility Information (Loan Applicant)
1
Description of Operation

Describe the applicant’s operation or proposed operation including the commodity(s) that is or
will be produced.

2
Operator of a Family Farm

Check “YES” if the applicant is or will be the operator of a family size farm. If not, check
“NO”.

3
Number of Years

Enter number of years individual applicant or entity applicant has operated a farm. If applicant
is an entity, number of years farming for each entity member must be input.

4
Acres Owned

Enter total number of acres individual applicant or entity applicant currently owns.

5
Acres Rented

Enter total number of acres individual applicant or entity applicant currently rents.

6
Debt Forgiveness

Check “YES” if you (including all members if an entity) have NOT caused the Agency any
loss. If you have, check “NO”.

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7
Delinquent Debt to the U.S.
Government

Check “YES” if you (including all members if an entity) do NOT have any delinquent debt
owed to the US Government. If you have delinquent debt owed to the US Government, check
“NO”.

8
Outstanding Recorded
Judgments
9
Citizen of the US

Debt to the U.S. Government includes but is not limited to education loans, obligations to the
Commodity Credit Corporation, Natural Resources Conservation Service, Veterans
Administration, FSA, Rural Housing Service or Federal Crop Insurance Corporation/Risk
Management Agency.
Check “YES” if you (including all members if an entity) do NOT have any outstanding
judgements obtained by the U.S. in Federal Court. If you do have recorded judgements, check
“NO”.
Check “YES” if you or the members holding majority interest in the entity are citizens of the
U.S., a U.S. non-citizen national, or a qualified alien under applicable Federal immigration
laws. If not, check “NO”.

10
Legal Capacity

Check “YES” if you (including all members if an entity) have the legal capacity to incur debt.
If not, check “NO”.

11
Controlled Substances

Check “YES” if you (including all members if an entity) have NOT been convicted of
planting, cultivating, growing, producing, harvesting, storing, trafficking, or possessing a
controlled substance within the last 5 crop years. If you have been convicted, check “NO”.

12
Employee or Related to an
Employee

Check “YES” if you (including all members if an entity) are NOT an employee, related to an
employee, or an associate of an employee of the lender or Farm Service Agency. If you are,
check “NO”.

13
Sufficient Credit

Check “YES” if you (including all members if an entity) are UNABLE to get credit without a
guarantee. If you are able to, check “NO”.

14
False Statements

Check “YES” if you (including all members if an entity) have NOT given FSA false or
misleading documents or statements in the past. If you have, check “NO”.

PART F - Loan Applicant Certifications (Loan Applicant)
Certification/
Acknowledgment

Please read the statements in this section carefully before signing.

1A
Signature of Applicant

Enter the signature of the applicant.

1B
Capacity

Check “Self” if you are signing for yourself. Check “Entity Representative” if you are signing
on behalf of an entity. Check both boxes if applicable.

1C
Date

Enter the date (MM-DD-YYYY) the applicant signed the form.

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FSA-2211

Date of Modification: proposal 2

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Instruction

PART G - Type of Assistance Requested (All Lender Types)
1
Request Number

Enter number of requests for each guarantee request submitted on FSA-2211. For example: If
form FSA-2211 is submitted for Guaranteed FO assistance only, this item should be
completed to show “1 of 1” and Parts G, H, and I would be completed only once.
If form FSA-2211 is submitted for Guaranteed FO assistance, Guaranteed OL assistance, and
Guaranteed OL-Line of Credit assistance, only Parts G, H, and I must be completed for each
guarantee requested. The separate request section should be completed to show “1 of 3", “2 of
3", and “3 of 3”.

2
Loan Type

Check the appropriate box for the type of loan the applicant is requesting.

3
EZ Guarantee

Check “YES” if the guarantee request is submitted under the EZ Guarantee program. Check
“NO” if the guarantee request is NOT submitted as an EZ Guarantee.

4
Loan Amount or LOC
Ceiling

Enter the amount of the loan request or Line-of-Credit (LOC) ceiling.

5
Interest Rate

Enter the rate of interest the loan applicant will be charged and check the appropriate box if
the rate is “Fixed” or “Variable”.
Note: If the interest rate is variable or fixed for less than five years, check Variable.
If the interest rate is fixed for five or more years, check Fixed.

6
Requested Guarantee
Percentage

Check “Maximum” box if requesting that FSA consider the maximum guarantee percentage
allowable or choose “Other” and enter the requested guarantee percentage if a guarantee
percentage less than the maximum is desired.

7
Repayment Period

Enter the repayment period (years) for the loan requested.

8
Principal Repayment Terms

Enter the principal repayment terms for the loan requested, including estimated installment;
even, uneven, balloon; and frequency of installment.

9
Interest Repayment Terms

Enter the interest repayment terms for the loan requested, including estimated installment;
even, uneven, balloon; and frequency of installment.

Note: For LOC, enter the number of years the loan will be outstanding, not the
number of years of advances.

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Date of Modification: proposal 2

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Instruction

PART H – Funds Purpose (All Lender Types)
1
Funds Purpose

Enter purpose for which loan funds obtained under FSA guarantee will be used.
Example 1: OL/LOC Request for Guarantee
Annual operating costs for cash grain operations
Annual family living costs
Example 2: OL to refinance ‘authorized’ farming debts
Carry-over operating losses
Machinery and Equipment debts

2
Funds Amount

Enter the amount of money to be used for each purpose.
Example 1: OL/LOC Request for Guarantee
Annual operating costs for cash grain operations
Annual family living costs

$30,000
$18,000

Example 2: OL Request for Guarantee
Carry-over operating losses
Machinery and Equipment debts

$92,000
$88,000

PART I - Proposed Security (All Lender Types)
1-5
Proposed Security

Enter specific security information for each field.
Example 1:
OL/LOC Request for Guarantee
1.
Item Description
Crops
Machinery

2.
Lien
Position

3.
Est. Value

4.
Amount of Prior
Lien

5.
Collateral Value

1st
2nd

$96,000
$82,000

$0
$50,000

$96,000
$32,000

2.
Lien
Position

3.
Est. Value

4.
Amount of Prior
Lien

5.
Collateral Value

1st
2nd

$280,000
$82,000

$65,000
$50,000

$215,000
$32,000

Example 2:
OL Request for Guarantee
1.
Item Description
Machinery/Equipment
RE
6
Totals

Enter totals of column from Items 3, 4 and 5.

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Date of Modification: proposal 2

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Instruction

PART J – Interest Assistance Documentation (Applicable Only for Interest Assistance Applications)
1
Net Cash Flow without
Interest Assistance
2
Net Cash Flow with Interest
Assistance

Enter information from the applicant’s cash flow budget. This item should be completed for
all requests for assistance
Complete Item 2 only if Item 1 is negative and the lender is requesting interest assistance. If
applicant has multiple guaranteed loans, lender is to indicate on which loans interest assistance
is requested.

PART K – EZ Guarantee Documentation (Applicable Only for EZ Guarantee Applications)
1
Applicant shows the ability
to repay…

2
Applicant has Acceptable
Credit History

Check “YES”, if your analysis shows the applicant shows the ability to repay this loan. If not,
check “NO”.
Repayment can be demonstrated by such things as:

•
•
•
•

Scorecard analysis score of _______
Historical debt coverage ratio of _____
Pro forma debt coverage ratio of ______
Or other repayment capacity indicator calculated

Also include how this compares to your minimum underwriting standard or acceptable level
of risk.
Check “YES” if applicant, including all members of the entity, have acceptable credit history.
If not, check “NO”.

PART L - Environmental Information (All Lender Types)

Lenders shall carefully consider questions 1 through 8 and respond with the appropriate answers for the farm
operation proposed for guarantee. If the lender has questions regarding these issues, the FSA Farm Loan Manager at
the local USDA Service Center should be contacted for assistance.
Lenders must complete a site visit to the operation and conduct environmental reviews as applicable.
1
HEL/WL Compliance

Check “YES” if compliance on the AD-1026 has been certified and is on file. Otherwise
check “NO”.

2
Land Use

Check “YES” if proceeds from this request or project will NOT accommodate any shift in
land use, ground disturbance, clearing of woody vegetation or stumps, or for drilling of a well.
Otherwise check “NO”.

3
Floodplains

Check “YES” if the property on which farming activities are taking place is NOT located near
or within a floodplain. Otherwise check “NO”.

4
Historical and
Archaeological Sites

Check “YES” if property on which farming activities take place is NOT known to be of
historical significance or contain any known archaeological sites. Otherwise check “NO”.

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Hazardous Substances
6
Endangered Species
7
Environmental Compliance
8
State Water Quality
Standards

Date of Modification: proposal 2
Instruction
Check “YES” if property on which the farming activities take place is NOT known to be
contaminated with hazardous substances or waste and does NOT contain underground storage
tanks. Otherwise check “NO”.
Check “YES” if there are NO known endangered species or habitats that will be disturbed by
the operation. Otherwise check “NO”.
Check “YES” if there are NO pending or active lawsuits regarding environmental compliance
against the operator or property and there are NO environmental liens or judgements filed
against the property as a result of not complying with Federal or State environmental laws.
Otherwise check “NO”.
Check “YES” if this is NOT a livestock operation. Check “NO” if this is a livestock operation
and include number of animals and type of livestock.

PART M - Lender Information and Certification (All Lender Types) - Read the certification statement.
1
Lender Status

Check box that represents current lender status.

2A - G
Lender Certifies

Item G - All lenders enter the effective date of FSA-2201, Lender’s Agreement.

3A - B
Lending Institution Name,
Address & Telephone
Number
4A
Lender Tax ID Number

Enter the Lender’s name, complete mailing address and phone number (Include Area Code).

4B
Regulatory Agency

Enter the lender’s primary oversight agency (e.g., FDIC, OCC, FCA).

5
Email Address

Enter lender representative’s email address.

6A
Name of Lender's
Representative
6B
Title of Lender
Representative
7A
Signature of Authorized
Lender Representative

Enter the name of official authorized to execute official binding documents on the lender’s
behalf.

7B
Date

Enter the Lender’s 9 Digit Tax ID Number.

Enter the title of official authorized to execute official binding documents on the lender’s
behalf.
Enter the signature of the individual whose name appears in Item 4A. The lender should
promptly submit the completed application to FSA for consideration.
If you are mailing, emailing or faxing this form, print the form and manually enter your
signature. If this form is approved for electronic transmission and 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
Enter the date the official authorized to execute official binding documents on the lender's
behalf signed this form.

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FSA-2211

Date of Modification: proposal 2

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Instruction

PART N - FSA USE ONLY
1A
Date Received
1B
Date Completed

Insert date application is received.
Insert date application is determined complete.

PART O – Co-Applicant / Entity Member / Co-Signer Information (If Applicable)
1A
Co-Applicant’s, Entity
Member’s, or Co-Signer’s
Name
1B
Co-Applicant’s, Entity
Member’s, or Co-Signer’s
ID Number

Enter the co-applicant’s, entity member’s, or co-signer’s complete legal name.

1C
Co-Applicant’s, Entity
Member’s, or Co-Signer’s
Birthdate

Enter co-applicant’s, entity member’s, or co-signer’s date of birth
(MM-DD-YYYY).

1D
Co-Applicant’s, Entity
Member’s, or Co-Signer’s
Address

Enter the co-applicant’s, entity member’s, or co-signer’s complete mailing address, including
physical address if different from mailing address.

1E
Residence or Headquarters

Enter county the co-applicant, entity member, or co-signor resides in or the county where the
headquarters office is located if an embedded entity.

1F
Co-Applicant’s, Entity
Member’s, or Co-Signer’s
Telephone No.
1G
Co-Applicant’s, Entity
Member’s, or Co-Signer’s
Telephone Type

Enter co-applicant’s, entity member’s, or co-signer’s home or business telephone number,
including area code.

1H
% Ownership

Enter the percent of the entity that is owned by the member.

1I
Co-Signer Only

Check this box if acting as co-signer only.

1J
Marital Status

Check the box that most closely corresponds to current marital status of the co-applicant or the
entity member, if an individual.

Enter co-applicant’s, entity member’s, or co-signer’s social security number or tax ID
Number.

Check the co-applicant’s, entity member’s, or co-signer’s telephone type (Home, Cell, Work)

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1K
Citizenship Status

Date of Modification: proposal 2
Instruction
Check appropriate box. If not a U.S. citizen, applicant will be asked to provide I-551 and/ or
other proper documentation of immigration status as found under PRWORA (8 U.S.C. 1641)

Items 1L – 1O – Voluntary Information for Monitoring Purposes (Complete as applicable)
1L
Check the appropriate box indicating your ethnicity.
Ethnicity
1M
Check the appropriate box or boxes indicating your race.
Race
1N
Check the appropriate box indicating your gender.
Gender
1O
Check the appropriate box indicating your veteran status.
Veteran Status
Note: If additional Co-Applicants, Entity Members, or Co-Signers; complete Items 2A – 2O. Additional copies of Pages 5
and 6 may be attached if necessary.
PART P – Co-Applicant, Entity Member, and/or Co-Signer Certifications
Certification/
Acknowledgment

Please read the statements in this section carefully before signing.

1A
Signature of Co-Applicant
or Entity Member
1B
Capacity

Enter the signature of the co-applicant or entity member.

1C
Date

Enter the date (MM-DD-YYYY) the co-applicant or entity member signed the form.

Check “Self” if you are signing for yourself. Check “Entity Representative” if you are signing
on behalf of an entity. Check both boxes if applicable.

Note: If additional Co-Applicants, Entity Members, or Co-Signers complete Items 2A – 2C in the same manner.
Additional copies of Pages 5 and 6 may be attached if necessary.
PART Q – Supporting Information for SEL/CLP lenders (For SEL/CLP Lenders Completing Non-EZ Guaranteed Loans)
1
Please attach the
following

Attach the appropriate items as indicated for SEL or CLP lenders.

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