VA Form 26-8736c Request for Agent Recognition

OMB Approved 2900-0252
Respondent Burden: 5 Minutes
Expiration Date: XXXXXXX

REQUEST FOR AGENT RECOGNITION
IMPORTANT - READ THE INFORMATION AND INSTRUCTIONS CAREFULLY BEFORE COMPLETING THIS FORM.
PRIVACY ACT INFORMATION: Agents cannot be approved to process loans for a sponsoring lender unless a completed application form has been received (38 U.S.C. 3702 and
3710). We need this information to establish sponsor-agent relationships. VA will not disclose information collected on this form to any source other than what has been authorized
under the Privacy Act of 1974 or Title 38, Code of Federal Regulations 1.576 for routine uses (for example: authorize release of information to Congress when requested on behalf of a
lender) as identified in the VA system of records, 55VA26 , Loan Guaranty Home, Condominium and Manufactured Home Loan Applicant Records, Specially Adapted Housing
Applicant Records, and Vendee Loan Applicant Records - VA, published in the Federal Register.
RESPONDENT BURDEN: Agent recognition must be obtained prior to closing any loans using the sponsor-agent relationship. Title 38, U.S.C., section 3702 and 3710 authorizes
collection of this information. We estimate that you will need an average of 5 minutes to review the instructions, find the information, and complete this form. VA cannot conduct or
sponsor a collection of information unless a valid OMB control number is displayed. You are not required to respond to a collection of information if this number is not displayed. Valid
OMB control numbers can be located on the OMB Internet Page at http://www.reginfo.gov/public/do/PRAMain. If desired, you can call 1-800-827-1000 to obtain information on
where to send comments or suggestions about this form.

PART I: SPONSORING LENDER INFORMATION
1B. SPONSOR VA-LENDER ID

1A. NAME OF SPONSORING LENDER

2A. SPONSOR POINT OF CONTACT (POC)

2C. POC TELEPHONE NUMBER

2B. POC E-MAIL

PART II: AGENT INFORMATION
3. NAME OF AGENT (Include DBA, if applicable)

5. AGENT FEDERAL TAX ID

4. AGENT VA ID NUMBER (If previously issued)

6. AGENT HOME OFFICE ADDRESS:

7. AGENT WEBSITE (If applicable):

8A. AGENT POINT OF CONTACT (POC)

8B. POC E-MAIL

PART III: REQUIRED DOCUMENTATION
A. APPLICATION FEE: $100 MADE PAYABLE TO THE DEPARTMENT OF VETERANS AFFAIRS
B. SIGNED CORPORATE RESOLUTION OR BLANKET CORPORATE RESOLUTION
VA FORM
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26-8736c

8C. POC TELEPHONE NUMBER