Form Approved – OMB No

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OMB Approval No. 0560-0238
 (See Page 2 for Privacy Act and Public Burden Statements)					                OMB Expiration Date XX/XX/XX
FSA-2141                                                       U.S. DEPARTMENT OF AGRICULTURE                                                                Position 2
(XX-XX-26)                                                                            Farm Service Agency


INTEREST-BEARING DEPOSIT AGREEMENT



                BECAUSE certain funds of (1)                                                        
     
referred to
as the "Depositor," are now on deposit with (2)
     
     
referred to as the "Financial Institution," under a Deposit Agreement dated (3)                 
     
, providing for
supervision by the United States of America, acting through the Farm Service Agency, referred to as the "Government," 
which Deposit Agreement grants to the Government security and/or other interest in the funds covered by the Deposit Agreement, and

               BECAUSE certain of these funds are not now required for immediate disbursement and it is the desire of the Depositor to place these funds in interest-bearing deposits with the Financial Institution:

               THEREFORE, the Depositor and the Government authorize and direct the Financial Institution to place
(4)                 
     
Dollars ($
     
)
of the funds subject to that Deposit Agreement in interest-bearing deposits as follows:


(a) $
     
for a period of
   
months at
    
% interest
(b) $
     
for a period of
   
months at
    
% interest
(c) $
     
for a period of
   
months at
    
% interest


These interest bearing deposits and the income earned on them at all times shall be considered a part of the account covered 
by said Deposit Agreement, except that the right of the Depositor and the Government to jointly withdraw all or a portion of 
the funds in the account covered by the Deposit Agreement by an order of the Depositor countersigned by a representative of the Government, and the right of the Government to make written demand for the balance or any portion of the balance, is modified by the above time deposit maturity schedule.  The evidence of such time deposits shall be issued in the names of the Depositor and the Farm Service Agency.
FSA-2141 (XX-XX-26)                                                                                                                                                                         Page 2 of 2

A copy of this Agreement shall be attached to and become a part of each certificate, passbook, or other evidence of deposit
that may be issued to represent such interest-bearing deposits.
5A.  Name of Financial Institution's Representative
5B.  Title
     
     
5C.  Signature
5D.  Date

     
6A.  Name of FSA's Representative
6B.  Title
     
     
6C.  Signature
6D.  Date

     
7A.  Depositor's Signature
7B.  Date

     

Privacy Act Statement: The following statement is made in accordance with the Privacy Act of 1974 (5 USC 552a – as amended). The authority requesting the information on this form is the Consolidated Farm and Rural Development Act, as amended (7 U.S.C. 1921 et seq.), and other applicable statutes and regulations governing USDA Farm Service Agency supervised accounts and financial assistance programs. The information provided will be used to establish and administer an interest‑bearing deposit arrangement for supervised funds, determine eligibility for credit or other financial assistance, service your loan, and support required program oversight and statistical analyses. The information collected on this form may be disclosed to USDA contractors and cooperators, as well as to Federal, State, local, Tribal, or territorial government agencies and other authorized entities, as permitted by law or as described in the Routine Uses identified in the System of Records Notices USDA/FSA‑2 and USDA/FSA‑14. Providing the requested information is voluntary; however, failure to furnish the requested information may delay processing or result in a determination of ineligibility for supervised account servicing, program benefits, or other financial assistance administered by USDA.

Public Burden Statement (Paperwork Reduction Act): According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not 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 0560-0238.  The time required to complete this information collection is estimated to average 10 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.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden by emailing to: [email protected].   RETURN THIS COMPLETED FORM TO YOUR COUNTY FSA OFFICE[B.

Non-Discrimination Statement: In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, disability, age, marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident.

Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the State or local Agency that administers the program or contact USDA through the Telecommunications Relay Service at 711 (voice and TTY). Additionally, program information may be made available in languages other than English.

To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at https://www.usda.gov/oascr/how-to-file-a-program-discrimination-complaint and at any USDA office or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, SW, Mail Stop 9410, Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: [email protected]. 

USDA is an equal opportunity provider, employer, and lender.