FSA2570_Ins_proposal 2

FSA-2570 Date of Modification: proposal 2

OFFER TO CONVEY SECURITY

INSTRUCTIONS FOR PREPARATION

Purpose: This form is used by borrowers to make an offer for voluntarily conveying security property to the government. Generally, the form will be completed by agency personnel after the borrower has made a verbal offer, and then signed by the borrower after completion.
Handbook Reference: 5-FLP	Number of Copies: Original and one
Signatures Required: Borrower, and Authorized Agency Official
Distribution of Copies: The original will be retained in the official agency casefile. A copy to the borrower.
Automation-Related Transactions: (Instructions for writers: provide only the information required, i.e. ADPS TC 3K. If no automation actions are required, insert N/A) N/A

Generally, all items, with the exception of borrower signature(s) are completed by the Agency. The Borrower may, however, complete the form in accordance with the following and submit it to the agency for consideration.

Part A – BORROWER OFFER TO CONVEY SECURITY

Fld Name / Item No.	Instruction
(1) Name(s)	Enter the name or names of the borrower.
(2) Type of Request	Check the box which represents the offer being made.
(4) Cost items	Select the appropriate choice for each of the four items listed, determining if the items will be paid for by the borrower or by the Government.
(5)(c) Assignment of funds	Enter the name of the bank/financial institution that currently holds funds in a construction, supervised, or other account that will be assigned to the Government with this offer. If no account exists leave blank or enter NA

FSA-2570 Date of Modification: 12-31-07

Fld Name / Item No.	Instruction
9-12A Borrower Name	The agency official will type the name of the borrower that should sign the form. This will be one of the parties that executed the promissory note or assumption agreement. All borrowers (entity and individual persons) that executed the promissory note or assumption agreement, and have not been previously released of liability for the debts, must execute a form in order to be considered for servicing. They may all sign one form or each sign separate forms.
9-12B Signature	The borrower named in block 3A will sign the response form. All borrowers (entity and individual persons) that executed the promissory note or assumption agreement, and have not been previously released of liability for the debts, must execute a form in order to be considered for servicing. They may all sign one form or each sign separate forms.
9-12C Date	The date will be entered by the borrower when they sign the form.

Part B – FSA Recommendation/Approval (For FSA completion Only.)

A recommendation is needed if the offer is made in full satisfaction of the debt and the value of property to be received is less than the debt, resulting in a loss to the government, as only the SED can accept or reject the offer. If no loss to the government is anticipated, the approving official can leave 1-4 blank and complete 5-8.

Fld Name / Item No.	Instruction
(1) Recommen-dation	Select either recommended or not recommended
2 Date	Enter the date of the recommendation
3 Justification	Enter the Justification to support the recommendation being made
(4)(A) Authorized Agency Official Name	Enter (type or print) the name of the Authorized Agency Official that will recommend the acceptance of the offer to convey. A recommendation is needed if the offer is made in full satisfaction of the debt and the value of property to be received is less than the debt, resulting in a loss to the government, as only the SED can accept or reject the offer. If no loss to the government is anticipated, the approving official can leave 1-4 blank and complete 5-8.

FSA-2570 Date of Modification: 12-31-07

Fld Name / Item No.	Instruction
(4)(B) Signature	Enter the signature of the Authorized Agency Official that is making the determination to either recommend or not recommend the offer.
(4)(C) Title	Enter (type or print) the title of the Authorized Agency Official that will execute the recommendation of the offer to convey.
5 Acceptance/ Rejection	Check the box corresponding to either accepting or rejecting the offer to convey.
6 Date	Enter the date of the recommendation
7 Justification	Enter the Justification to support the recommendation being made
(8A) Authorized Agency Official Name	Enter (type or print) the name of the Authorized Agency Official that will either accept or reject the offer to convey. Only the State Executive Director can accept an offer in full satisfaction of the debt when the value of property to be received is less than the debt, resulting in a loss to the government, If no loss to the government is anticipated, the approving official can leave 1-4 blank and complete blocks 5-8.
(8B) Signature	Enter the signature of the Authorized Agency Official that is accepting or rejecting the offer.
(8C) Title	Enter (type or print) the title of the Authorized Agency Official that will accept or reject the offer to convey.

Contact the State Office if additional guidance is needed.

Page 3