REVISED PlainLanguageChecklistToAccompanyURLA_7.19.22

American Rescue Plan Act (ARPA) Refinance
Checklist of items to accompany the Uniform Residential Loan Application

Return this completed checklist along with all applicable items
	Form RD 410-4: Uniform Residential Loan Application  Provide all applicable information, details, and data for the following sections: Section III. APPLICANT INFORMATION (Page 1 of 10) Section IV. EMPLOYMENT INFORMATION (Page 2 of 10) Section V. MONTHLY INCOME AND COMBINED HOUSING EXPENSE INFORMATION (Page 2 of 10) Section VI. ASSETS (Page 3 of 10. Do not complete the Liabilities information within this section) Section VIII. DECLARATIONS (Page 4 of 10) Section IX. ACKNOWLEDGMENT AND AGREEMENT – Sign and date (Page 5 of 10) Section X. INFORMATION FOR GOVERNMENT MONITORING PURPOSES (Page 5 of 10) Additional Information Required for RHS Assistance (only complete items with an asterisk) (Page 6 of 10) Sign and date (Page 8 of 10)
	Form 3550-1: Authorization to Release Information   Each adult member of the household must sign and date a separate release form.
	Verification of identity  You must provide a copy of your government-issued photo identification (ID), and include evidence of your age. Standard ID verifications include a valid driver’s license or U.S. passport. If you do not have these standard verifications, contact us to discuss possible alternatives.
	Form RD 3550-4: Employment and Asset Certification  You must check the appropriate blocks and account for all adult household members’ employment and nonretirement assets as instructed, then sign and date the certificate.
	Income Documentation:  Submit your most recent signed federal income tax return, including all W-2s, 1099s, and all applicable schedules. If filed electronically, include a copy of the signature page with the self-select PIN, confirmation the return was accepted, or evidence it was filed by an authorized E-File provider. NOTE: If you are self-employed or are seasonally employed, submit your last two signed federal income tax returns and schedules. The last four consecutive weeks of pay stubs for all employed adult household members. Recent benefit statements demonstrating regular unearned income for all household members who receive:   Social Security or Supplemental Security Income  Public assistance   Retirement (recent retirement fund statements covering at least a two-month period)  Any other type of regular unearned income  The most recent 12-month payment history of alimony and / or child support received by all adult household members as provided by the court-appointed entity responsible for handling payments. If this is not available, provide a copy of the separation agreement or divorce decree.
	Two most recent brokerage or bank statements for all household members   Excludes tax-advantaged plans for education, health and medical, and retirement. If you get this information online, you must provide printed statements, not just online transaction histories.
	School transcripts for household member(s) ages 18 or older who are full-time students
	Written evidence of child care expenses for dependents ages 12 years or younger
	If you are 62 years of age or older, are disabled, or have a disabled household member and wish to be considered for a deduction to household income, provide evidence of unreimbursed annual medical expenses.

American Rescue Plan Act (ARPA) Refinance Checklist of items to accompany the Uniform Residential Loan Application
Return this completed checklist along with all applicable items
	List other creditors who have a lien against the property:  Creditor name:                                                  Amount of lien:
	Calculating Recapture - Capital Improvements Credit Notification
	Are there any major property deficiencies that require repair? Yes No If yes, please describe: ________________________________________________________________ In limited circumstances, (for example, to correct health and safety hazards) additional loan funds may be requested to repair major property deficiencies.
	Provide your personal email address(es) below if you authorize Rural Development to contact you via email. Note: USDA password protects emails containing personally-identifiable information (PII).

Last updated DRAFT USDA is an equal opportunity provider, employer, and lender. 1