FSA-2153ins

Instructions For FSA-2153

RELEASE BY CLAIMANTS

This form is used by contractors to provide certification of release of any claims on property improved with agency funds.

Submit the original of the completed form in hard copy or facsimile to the appropriate USDA office.

Producers who have established electronic access credentials with USDA may electronically transmit this form to the USDA office, provided that the producer submitting the form is the only person required to sign the transaction.

Features for transmitting the form electronically are available to those producers 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.

Items 1 through 6 are completed by the contractor or subcontractor. Subcontractors must complete Items 7 through 10.

Items 1-6 (Completed by contractor or subcontractor)

Item No. Field Name	Instruction
1 Name	Enter the contractor’s name.
2 Property address	Enter address of property where construction or repair has taken place.
3 Contract date	Enter date of construction or development contract between the contractor and the property owner.
4 Name	Enter the property owner’s name.
5 Work Performed	Enter a complete, detailed description of the work that was completed by the subcontractor.
6 Materials Provided	Enter a complete, detailed description of all materials that were provided by the subcontractor.

Items 7-10 (Completed by subcontractor)

Item No. Field Name	Instruction
7 Name	Enter the subcontractor’s name.
8 Title	Enter the subcontractor’s title.
9 Signature	After reading the warning, enter subcontractor’s signature. If faxing or mailing the form, print the form and manually enter your signature. This form is approved for electronic transmission. If 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. Electronic transmission may only be completed if you are the only person required to sign this form.
10 Date	Enter the date the subcontractor signed the form.

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