1
Borrower’s name
and address
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Enter Borrower’s
Name and Address
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2
Borrower’s FSA
Account Number
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Enter Borrower’s
FSA account number. Enter the state and county code and the
borrower’s system generated FSA ID number.
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3
Lender’s Name
and Address
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Enter Lender Name and
Address.
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4
Lender’s ID No.
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Enter the Lender’s
ID number
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5
Lender Status
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Enter the applicable
Lender Status. Example:
MLP
( Program)Micolender
SEL
(Standard Eligible Lender)
CLP
(Certified Lender Program)
PLP
(Preferred Lender Program)
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6
Servicing Office Mail
Code
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Enter the 5-digit mail
code of the FSA servicing office
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7
Effective
Date of Lender’s
Agreement
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Enter the date the
lender’s agreement became effective. Completed only if
Lender’s Status is (Item 5) CLP or PLP.
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8
Expiration
Date of Lender’s
Agreement
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Enter the date the
lender’s agreement expires. Completed only if Lender’s
Status is (Item 5) CLP or PLP.
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9
Lender Loan Number
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Enter the loan number
issued to the loan by the lender.
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10
Amount
of Guarantee Fee Paid
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Enter amount of Guarantee
Fee to be Paid with this report.
Loan
Amount x Fee Percentage x % Guarantee.
If
there is no fee required, Leave Item 10 blank.
Only required if
Item 11 equals 3 (Initial Closing Fee)
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11
Guarantee Fee Purpose
Code
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Select the appropriate
Guarantee Fee Purpose Code.
3
= Initial Closing Fee
5 = Consolidation (No Fee
on Consolidated Loans)
7
= Initial Closing—No Fee
NOTE: If
consolidating loans (Item 11 equals 5), all loans must be
closed. This form will not close and consolidate loans at the
same time.
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12 Amount of Loan-Line of
Credit
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Enter the amount of loan
as follows:
Enter
the full amount of the loan for new loans or ceiling for line of
credit.
NOTE:
THE AMOUNT ENTERED IN THIS Item MUST MATCH THE AMOUNT OBLIGATED
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13
Advance Amount to Date
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Enter amount advanced at
date of loan closing. If the loan is fully advanced, enter
amount of loan. If a line of credit, enter current unpaid
principal balance. If no advances have been made, enter 0.00.
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14
Loan Closing Date
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Enter the closing date.
The date will be the date of loan for new loans.
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15
Loan Maturity Date
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Enter the maturity date
of the loan.
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16
Term
of Interest Assistance Years (if applicable)
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For Farm Loan Program
loans with Interest Assistance only, enter the term or length of
the Interest Assistance Program in years. Must equal 1-5. Leave
blank for all other loans.
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17
Percent
of Loan Guaranteed
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Enter the percent of loan
guarantee as determined by Agency Instructions.
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18
Lender’s
Note Interest Rate and Interest Type (Fixed or Variable)
Guaranteed Portion
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Enter the lender’s
interest rate on the guaranteed portion of the loan prior to any
interest rate reduction interest assistance, or subsidy. Select
the Fixed box for fixed rate loans. Select the Variable box on
variable rate loans.
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19
Lender’s
Note Interest Rate on Nonguaranteed Portion
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Enter the rate that will
be used to compute the interest charged to the borrower on the
non-guaranteed portion of the note prior to any interest rate
reduction interest assistance, or subsidy. Select the Fixed box
for fixed rate loans. Select the Variable box on variable rate
loans.
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20
Interest Assistance
Rate (if applicable)
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Enter 4.0, if applicable,
otherwise leave blank.
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21
Advance Period of
Operating Line of Credit
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For Farm Loan Program
Operating Lines of Credit only, enter the length of the
operating line of credit in years. Must equal 1, 2, 3, 4, or 5.
Leave blank for FO and term OL loans. Final Advance cannot
exceed 5 years from the date of loan closing.
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22
Interest
Basis
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Select the interest
basis. (number of days: 360, 365 or Actual).
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23
Annual
Review Date (if applicable)
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Enter the month and day
(MM/DD) of theFirst Annual Review Date on this loan (FLP
Loans with Interest Assistance Only) For Annual Payment
loans, this should be the First Annual Payment Due Date. For all
other loans, this will be the date established by the lender as
being the last day of the first period of interest assistance
and will be the date in block 23 in the Interest Assistance
Agreement, or FSA-2221. This date must be no more than 12 months
from the closing date of the note. Once established, all future
claims and reviews will be made effective on the anniversary of
this date each year.
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24
Routing Number
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Enter routing number of
the account that guarantee fee should be debited from if not
paying guarantee fee by check.
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25
Account Number
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Enter account number of
the account that guarantee fee should be debited from if not
paying guarantee fee by check.
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26
Account Type
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Enter account type of
account that guarantee fee should be debited from if not paying
guarantee fee by check. Account type must be checking or
savings.
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27 Part B-Lender
Certification
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The lender loan official
will read and certify to these items by signing in item 29.
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28 Part
C-Representations Regarding Felony Convictions and Tax
Delinquent Status for Corporate Lenders (Note: This section only
applies if the lender is a corporation)
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THIS ITEM IS ONLY
APPLICABLE FOR CORPORATE LENDERS.
Corporate
lenders will read these statements and certify to them by
completing Part D.
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29A
Name and Title of
Lender’s Representative
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Enter the name and title
of the lender’s representative that will sign the
certification.
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29B
Signature
of Lender’s Representative
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The authorized
representative of the lender should read the terms of the
certification and sign the form affirming that the conditions
have been met.
If
you are mailing, emailing a scanned copy 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.
THIS FORM WILL BE
RETURNED IF IT IS NOT SIGNED.
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29C
Date
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Enter the date the form
was signed.
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Note
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Lender should ensure that
all applicable listed items are included with this form.
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30
Guaranteed
Loan Number
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Enter the loan number
from the GLS Add Loan Closing Screen or the GLS Loan View
Screen. To be completed by FSA official.
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31
Obligated Loan Number
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Enter the obligation loan
number. Example: 52/01 (The 01 is the obligation loan number).
To be completed by FSA Official.
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32
Branch Number
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Enter the Agency assigned
lender branch number. Verify that this branch number is correct
for the name and address shown in Item 4 using the GLS Lender
List. To be completed by FSA Official.
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33
Date
of
Deposit
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FSA will enter the date
the guaranteed fee was deposited.
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34A
Name
of Agency Official
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Print the name of the
agency official.
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34B
Title
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Print the title of the
agency official.
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34C
Signature
of Agency Official
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Enter the agency
official’s signature.
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34D
Date Approved
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Enter the date signed and
approved by the agency official.
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