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Get Usda Form 3555 21

Form Approved OMB No. 0575-0179 UNITED STATES DEPARTMENT OF AGRICULTURE RURAL DEVELOPMENT RURAL HOUSING SERVICE Form RD 3555-21 Rev. 12-14 REQUEST FOR SINGLE FAMILY HOUSING LOAN GUARANTEE Approved Lender Contact Phone Number Fax 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 circle or mark as appropriate Co-Applicant Information Please complete circle or mark as appropriate Name SSN Date of Birth U.S. Citizen Yes No Permanent Resident/Qualified Alien Veteran Gender Disabled M F First Time Homebuyer Ethnicity Check only One Box Marital Status Married Hispanic or Latino Not Hispanic or Latino Check as many boxes as applicable Race American Indian or Alaska Native Black or African American Native Hawaiian or Other Pacific Islander Separated Asian White Unmarried The applicant has does not have a relationship with any current Rural Development employee. Explain Applicant s Credit Score No Score CAIVRS GSA/SAM Exclusion Development employee. Explain Co-Applicant s Credit Score Date GSA/SAM Checked Check Yes if any party is excluded otherwise check No ANY ADDITIONAL APPLICANTS MUST BE FULLY DOCUMENTED ON A SEPARATE FORM. Property Address City State Zip Code Is this a Refinance Loan County If Yes refinanced loan is an RD Single Family Housing Guaranteed Loan Direct Loan 1a* Number of persons in the household 1b. Number of dependents under age 18 or full-time students 2a* Current annual income for the household is 2b. Current adjusted income for the household is See page 3 for documentation of annual income 3. PITI ratio TOTAL DEBT ratio 4. We propose to loan for 30 years at per annum with payments P I of per month. 5. The interest rate is based on the Fannie Mae on // required to be completed. NOTE If the interest rate increases at loan closing the loan must be re-underwritten and this document must be recertified* which the applicant could reasonably be expected to fulfill* See 7 CFR 3555 HB-1-3555 Chapter 5 and 8 for conventional credit definition. 8. Loan funds will be used for the following purpose s Purchase / Refinance Amt 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 30 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* Initials Initials 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.

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