FSA-2251 Lenders Guaranteed Loan Payment to USDA

This form is available electronically.

FSA-2251

U.S. DEPARTMENT OF AGRICULTURE
Farm Service Agency

(08-18-08)

OMB Control No. 0560-0155
OMB Expiration Date: 07/31/2020
Position 2

LENDER’S GUARANTEED LOAN PAYMENT TO USDA
Transaction 4035

INSTRUCTIONS: Complete all items.
1. FSA ACCOUNT NUMBER
STATE CODE

COUNTY CODE

2. LENDER’S ID NUMBER
FSA ID NUMBER

3. FSA LOAN NUMBER

4. FSA ASSIGNED BRANCH NUMBER

5. BORROWER’S NAME

6. LENDER’S NAME

7. RECEIVABLE NUMBER (Assigned by Finance Office)

8A. DATE INTEREST PAID
THROUGH TO FSA

9. AMOUNT OF PRINCIPAL PAYMENT

10. AMOUNT OF INTEREST PAYMENT

$

8B. DATE PRINCIPAL PAID

(Completed by Finance Office)

$

11. TOTAL REMITTANCE (Item 9 + Item 10)

12. DATE OF DEPOSIT (To be completed by Finance Office)

$
(To Be Completed By Finance Office)
14. SERVICING FEE CODE (Insert appropriate code in box below)

13. PAYMENT CODE (Insert appropriate code in box below)

01 = REGULAR PAYMENT

01 = ACCRUED INTEREST

02 = DEFERRED PAYMENT
15. AUTHORIZED LENDER’S SIGNATURE

02 = SERVICING FEE
16. TITLE

17. DATE

Note: 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, (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 financial assistance, service your loan, and conduct statistical analyses. Supplied information maybe
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
certain items of information requested, including your Social Security Number or Federal Tax Identification Number, 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 2 hours 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.
In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees,
and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, gender identity
(including gender expression), sexual orientation, disability, age, marital status, family/parental status, income derived from a public assistance program, political beliefs, or
reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing
deadlines vary by program or incident.
Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should
contact the responsible Agency or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339.
Additionally, program information may be made available in languages other than English.
To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at
http://www.ascr.usda.gov/complaint_filing_cust.html and at any USDA office or write a letter addressed to USDA and provide in the letter all of the information requested in
the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture Office of
the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: [email protected].
USDA is an equal opportunity provider, employer, and lender.