RD 3550-02 Request for Verification of Gift/Gift Letter

Form RD 3550-2
(Rev. 12-08)

Form Approved
OMB No. 0575-0172

United States Department of Agriculture
Rural Housing Service

REQUEST FOR VERIFICATION OF GIFT/GIFT LETTER
Instructions: Lender - Complete items 1 through 7. Have applicants complete item 8. Forward directly to donor listed in item 1.
Donor - Please complete items 9 through 12 as applicable and return directly to lender named in item 2.
The form is to be transmitted directly to the donor and is not to be transmitted through the applicant or any other party.

Part I - Request
1. To (Name and Address of Donor)

2. From (Name and Address of Lender)

4. Title

3. Signature of Lender

7. Name and Address of Applicant(s)

5. Date

6. Loan Number (Optional)

8. Signature of Applicants

X
X
We have been advised that you are the donor of a monetary gift to the applicant(s) for the purpose of a home purchase. Please complete Part II below.

Part II - To be Completed by Donor
9. Dollar Amount of Gift

10. Donor's Phone Number

11. Relationship to Applicant

12. Donor's Statement and Signature
I state that no repayment of this gift is expected.

(Signature)

Date:

(Signature)

Date:

According to the Paperwork Reduction Act of 1995, no persons are 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 0575-0172. The time required to complete this information collection
is estimated to average 5 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.

SEE ATTACHED PRIVACY ACT NOTICE

Position 3

UNITED STATES DEPARTMENT OF AGRICULTURE
Rural Development

PRIVACY ACT STATEMENT TO REFERENCES

Rural Development is authorized by the Consolidated Farm and Rural Development Act (7 U.S.C. 1921 et.
seq.); and Title V of the Housing Act of 1949, as amended (42 U.S.C. 1471 et. seq.), to solicit the
information requested.
Disclosure of the information requested is voluntary. However, information provided is of considerable
value to Agencies in determining the repayment ability of individuals and their eligibility for Agency
programs. There will be no consequences to you if you do not provide the information requested.
Your name, and the information you provide, will be released to the applicant at the applicant's request.
Some information will be available to any requester under the provisions of the Freedom of Information Act.

The information you provide may be referred to another agency, whether Federal, State, local or foreign,
charged with the responsibility of investigating or prosecuting a violation of law, or of enforcing or
implementing the statute, rule, regulation or order issued pursuant thereto, of any record within this system when
information available indicates a violation of law, whether civil, criminal or regulatory in nature, and whether
arising by general statute or particular program statute, or by rule, regulation or order issued pursuant thereto.

Rural Development is a Equal Opportunity Lender.
Complaints of discrimination based on race, sex, religion,
national origin or marital status should be sent to:
Secretary of Agriculture. Washington D. C. 20250