FSA-2254A Guaranteed Loan Report of Loss - Report Types 1, 2, 5, 6

This form is available electronically.

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

FSA-2254A

U.S. DEPARTMENT OF AGRICULTURE
Farm Service Agency

(02-23-12)

GUARANTEED LOAN REPORT OF LOSS – REPORT TYPES 1, 2, 5, 6, and 7
(Supplemental Form to FSA-2254)

NOTE:

The following statement is made in accordance with the Privacy Act of 1974 (5 U.S.C. 552a - as amended). The authority for requesting the information identified on this
form is the Consolidated Farm and Rural Development Act, as amended (7 U.S.C. 1921 et. seq.). The information will be used to determine eligibility and feasibility for
loans and loan guarantees, and servicing of loans and loan guarantees. The information collected on this form may be disclosed to other Federal, State, and local
government agencies, Tribal agencies, and nongovernmental entities that have been authorized access to the information by statute or regulation and/or as described in
the applicable Routine Uses identified in the System of Records Notice for USDA/FSA-14, Applicant/Borrower. Providing the requested information is voluntary.
However, failure to furnish the requested information may result in a denial for loans and loan guarantees, and servicing of loans and loan guarantees. The provisions of
criminal and civil fraud, privacy, and other statues may be applicable to the information provided.
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 105 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 COUNTY FSA OFFICE.

PART A – IDENTIFYING INFORMATION (Complete for Report Types 1, 2, 5, 6, and 7)
1. Borrower’s Name

2. FSA ID Number

3. Agency Loan Number

4. Original Loan Amount

$
5. Original Date of Loan

6. Percent of Guaranteed Portion held by Lender
%

7. Loan Type (Check applicable box):
FO-Farm Ownership

OL-LOC-Operating Loan – Line of Credit

OL–Operating Loan

SW–Soil and Water

EE–Economic Emergency

CL–Conservation Loan

8. Report Type Code (Check applicable box):
01 – Estimated Loss (Liquidation)

06 – Debt Restructure Loss (Write Down without Shared Appreciation)

02 – Final Loss (Liquidation)

07 – Debt Restructure Loss (Write Down with Shared Appreciation)

05 – Loss – Bankruptcy Reorganization

PART B – LOAN INFORMATION
1. Current Interest Rate Information (Complete for Report Types 1, 2, 5, 6, and 7)
A. Guaranteed Rate

B. Guaranteed Rate Type
(Check one):
%

Variable

C. Interest Rate Basis

D. Non-Guaranteed Rate

(Check one):

360 Days

Fixed

365 Days

%

E. Non-Guaranteed Rate
Type (Check one):
Variable

Fixed

2. Lender Liquidation Information (Complete for Report Types 1 and 2). NOTE: (For Item 2C, if requesting an extension of the interest
Accrual Termination 210-day rule, explain the special circumstances in Item 60 on the FSA-2254.)
A. Payment Due Date (For Guaranteed Loan)
B. Liquidation Plan Approval Date

C. Interest Accrual Termination Date

3. Bankruptcy Case Information (Complete for Report Type 5)
A. Filing Date

B. Chapter Number (Check one):
7

D. Bankruptcy Case Number

11

12

C. Plan Confirmation Date
13

E. Effective Date

4. Debt Restructure - Court-Ordered or Negotiated by Lender (Complete for Report Types 5, 6, and 7)
A. New Loan Amount

$

B. Accrued Interest

$

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.

FSA-2254A (02-23-12)
PART C – GUARANTEED LOAN ITEMS (Complete for Report Types 1, 2, 5, 6, and 7)
1. Principal balance (As of date):

Page 2 of 3

2. Accrued Interest owed (As of date):

PART D – PROTECTIVE ADVANCES AND LEGAL EXPENSES (Complete for Report Types 2 and 5)
1. Principal Balance on Protective Advances
A. Real Estate Taxes

$

B. Transportation

$

C. Other (Explain in Item 60 on FSA-2254)

$

D. Total Principal Balance on Protective Advances (Sum of Real Estate Taxes + Transportation + Other)

$

PART E – COLLATERAL (Complete for Report Types 1, 2, and 7)
1. Collateral/Proceeds

A. Real Estate Property
$

(1) Real Estate Property Value
(2) Appraisal Date
(3) Number of Acres

B. Chattel Property
(1) Crops
Appraisal Date:

$

(2) Livestock
Appraisal Date:

$

(3) Equipment
Appraisal Date:

$

C. Total Collateral/Proceeds (Sum of Real Estate Value + Crops + Livestock + Equipment)

$

PART F – LIQUIDATION EXPENSES/PRIOR LIEN (Complete for Report Types 1 and 2) (Continued on Page 3)
1. Liquidation Cost A. Appraisals

$

B. Auctioneer Expenses

$

C. Repairs

$

D. Legal Expenses

$

E. Environmental Cost

$

F. Marketing Expenses

$

G. Other (Explain in Item 60 on FSA-2254)

$
H. Total Liquidation Costs

$

FSA-2254A (02-23-12)

Page 3 of 3

PART F - LIQUIDATION EXPENSES/PRIOR LIEN (Complete for Report Types 1 and 2)
2. Prior Liens

A. Real Estate Debts
(1) Name of Lien Holder:

$

(2) Name of Lien Holder:

$

(3) Name of Lien Holder:

$

(4) Name of Lien Holder:

$
(5) Total Real Estate Debts

$

B. Chattel Property Debts
(1) Crops
(a) Name of Lien Holder:

$

(b) Name of Lien Holder:

$

(c) Name of Lien Holder:

$

(d) Name of Lien Holder:

$
(e) Total Crops Debts

$

(2) Livestock
(a) Name of Lien Holder:

$

(b) Name of Lien Holder:

$

(c) Name of Lien Holder:

$

(d) Name of Lien Holder:

$
(e) Total Livestock Debts

$

(3) Equipment
(a) Name of Lien Holder:

$

(b) Name of Lien Holder:

$

(c) Name of Lien Holder:

$

(d) Name of Lien Holder:

$
(e) Total Equipment Debts

(4) Total Chattel Property Debts (Sum of Total Crop Debt + Total Livestock Debt+ Total Equipment Debt)

C. Total Prior Liens (Sum of Total Real Estate Debt + Total Chattel Debts)

$
$
$

(1) Unpaid Taxes, Ground Rents, and Assessments
(a) Unpaid Taxes

$

(b) Ground Rents

$

(c) Assessments

$

(d) Other (Explain in item 60 on FSA-2254)

$

E. Total Unpaid Taxes, Ground Rents, and Assessments

$

PART G - ADJUSTMENTS
1. Other Deductions (Complete for Report Types 1, 2, 5, 6, and 7)
A. Negligent Servicing

$

B. Unaccounted Collateral Amount

$

C. Other (Explain in Item 60 on FSA-2254)

$
D. Total Other Deductions

$