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Get USDA RD 3555-21 2021-2024

Form RD 3555-21 Rev. 10-18 Form Approved OMB No. 0575-0179 UNITED STATES DEPARTMENT OF AGRICULTURE RURAL DEVELOPMENT RURAL HOUSING SERVICE REQUEST FOR SINGLE FAMILY HOUSING LOAN GUARANTEE Approved Lender Contact Phone Number Third Party Originator TPO TPO Tax ID No Please issue a Conditional Commitment for Single Family Housing Loan Guarantee in the following case Applicant Information Please complete or mark as appropriate Co-Applicant Information Please complete or mark as appropriate Name SSN Veteran Yes No does not have a relationship with any current The applicant has Rural Development employee. Explain GSA/SAM Exclusion No Check Yes if any party is excluded otherwise check No Date GSA/SAM Checked ANY ADDITIONAL APPLICANTS MUST BE FULLY DOCUMENTED ON A SEPARATE FORM. Property Address City State Zip Code 1. Is this a refinance loan County Yes If Yes refinanced loan is an RD Single Family Housing If Yes Non-Streamline Guaranteed Loan Direct Loan Streamline-Assist 2a* The interest rate is locked and based on the Fannie Mae 30 Year Fixed Actual/Actual rate as of the following date 2b. NOTE If the interest rate increases at loan closing the loan must be re-underwritten and this document must be recertified* 3a* Number of persons in the household 3b. Number of dependents under the age of 18 or full-time students 4a* Current annual income in the household is 4. b Current adjusted income for the household is Initial non-verified income may vary from calculated income reflected on income worksheet listed on page 3 and 4 conditions in which the applicant could reasonably be expected to fulfill* See 7 CFR 3555 HB-1-3555 Chapter 5 and 8 for conventional credit definition. 7. Loan funds will be used for the following purpose s Purchase/Refinance Amount Financed Loan Closing Costs Repairs/ Other Guarantee Fee Total Request 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 0575-0179. The time required to complete this information collection is estimated to average 25 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* Page 1 of 7 Applicant Certifications In order to induce the Agency to issue the requested guarantee we certify that we have originated the loan in compliance with all Agency loan requirements. This form contains or is supplemented with all information required by 7 CFR 3555. 107 e and further clarified in Chapter 15 of HB-1-3555 of 7 CFR 3555. Lender s Authorized Representative Signature / Title Date Name of Authorized Representative Title/Company Applicant s Acknowledgments and Certifications CERTIFICATION As the applicant I certify to the best of my knowledge and belief 1 I am not presently debarred suspended declared ineligible or voluntarily excluded from covered transactions by any Federal department or agency 2 I have not within a three year period preceding this proposal been convicted or had a civil judgment rendered against me for commission of fraud or a criminal offense in connection with obtaining attempting to obtain or performing a public Federal state or local transaction or contract under a public transaction or commission of embezzlement theft forgery bribery falsification or destruction of records making false statement or receiving stolen property 3 I do not have an outstanding judgment lien on any property for a debt in favor of the United States which was obtained in any Federal court other than the United States Tax Court and 4 I am not delinquent on any outstanding debt to the Federal Government excluding any Federal Tax debt.

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