FSA-2015ins

Farm Loan Programs - Direct Loan Making

FSA-2015ins

OMB: 0560-0237

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Instructions For FSA 2015

VERIFICATION OF DEBTS AND ASSETS

This form is used to verify the debts and assets of applicants applying for FSA assistance.


Submit the original of the completed form in hard copy or facsimile to the appropriate USDA servicing office. Customers who have established electronic access credentials with USDA may electronically transmit this form to the USDA servicing office, provided that the customer submitting the form is the only person required to sign the transaction.


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.


FSA completes Part A.


Financial institutions must complete Parts B, C, and D.


Part A – For FSA use only.


PART B- Verification of Debts


Items 1 – 7 are completed by the Financial Institution.

Fld Name /
Item No.

Instruction

1A

Account Number

Enter the loan or account number.

1B

Date of Origination

Enter the origination date of the loan or account.

1C

Current Principal Balance

Enter the current principal balance of the loan or account.


1D

Accrued Interest

Enter the current accrued interest balance.

1E

Daily Interest Accrual

Enter the dollar amount of the daily interest accrual.

1F

Effective Date

Enter the effective date of Items 1C and 1D.

1G

Original Loan Amount /LOC Ceiling

Enter the original loan amount or line of credit ceiling.

1H

Last Payment Date

Enter the most recent date of payment on the loan or account.

1I

Interest Rate

Enter the interest rate the loan or account is being charged and whether it is fixed or variable.

1J

Installment Amount

Enter installment amount of the loan.

1K

Installment Due Date

Enter the installment due date.

1L

Amount Past Due

Enter the amount that is currently past due if applicable.

1M

Description of Collateral

Enter a brief description of the collateral in the case of a loan.

1N

Maturity Date

Enter the maturity or final due date.

2

Repayment Record

Rate the applicant’s repayment record in one of the following three checkboxes:


Prompt. Enter a checkmark in this box if the applicant was prompt.


Usually Prompt. Enter a checkmark in this box if the applicant was usually prompt.


Not Prompt. Enter a checkmark in this box if the applicant was not prompt.

3

Years

Enter the number of years the applicant has conducted business with your institution.

4

Hereafter Acquired Clause

Check “YES” if your lien instruments contain a hereafter acquired clause. If not, check “NO”.

5

Future Advance Clause

Check “YES” if your lien instruments contain a future advance clause. If not, check “NO”.

6

Additional Credit

Check “YES” if you would extend additional credit. If not, check “NO”.

7

Additional Credit with an FSA Guarantee

Check “YES” if you would extend additional credit with an FSA guarantee. If not, check “NO”.


PART C – Verification of Assets


Items 1 through 2 are completed by the Financial Institution.

Fld Name /
Item No.

Instruction

1

Type of Asset

Enter the type of asset.

1A

Account Number

Enter the number of the account.

1B

Date of Origination

Enter origination date of account.


1C

Balance

Enter the current balance on the account.


1D

Interest Rate

Enter the current interest rate the asset is earning.

1E

Annuity

Enter the annuity amount the applicant is receiving.

1F

Maturity Date

Enter the maturity date of the applicant’s account.

2

Withdrawal Penalty

Check “YES” if you impose a penalty should the applicant’s deposit or investment account be withdrawn prior to maturity. If not, check “NO”.


PART D - Certification


Items 1 – 6 are completed by the Financial Institution.

Fld Name /
Item No.

Instruction

1

Additional Information

Enter any pertinent comments.

2

Name of Institution’s Repres.

Enter the financial institution’s representative name.

3

Title of Institution’s Repres.

Enter the financial institution’s representative title.

4

Signature

Enter the financial institution’s representative signature.


If you are mailing 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.

5

Date

Enter the date the financial institution’s representative signed the form.

6

Telephone Number

Enter the financial institution’s telephone number, including area code.


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File Typeapplication/msword
File TitleTemplate Users: Select the text for each of the instruction components below and type over it without changing the font type,
AuthorPreferred Customer
Last Modified Byniki.chavez
File Modified2007-03-04
File Created2006-03-27

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