Lenders who have established electronic access
credentials with USDA may electronically transmit this form to the USDA
servicing office. The application will
be processed; however, the original, signed copy of the form must be submitted
to the local servicing office before FSA can issue a loan guarantee. Features for transmitting the form
electronically are available to those customers with access credentials
only. If you would like to establish
online access credentials with USDA, follow the instructions provided at the
USDA eForms web site.
Loan applicants
who have not already provided the requested information to their lender must
complete Items 1 through 25. Items 30
and 31 are required. Items 26 through 28
are voluntary.
Lenders must complete Items 32 through 66. Items 67-70 can be used as a checklist of documentation needed to request a guarantee.
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Fld. Name/ |
Instruction |
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1 Applicant’s Name |
Enter the applicant’s complete name. |
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2 Co-Applicant’s Name |
Enter co-applicant’s complete name. |
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3 Applicant’s Telephone Number |
Enter applicant’s home or business telephone number, including area code. |
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4 Applicant’s Address |
Enter applicant’s complete mailing address, including physical address if different from mailing address. |
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5 Applicant’s SSN or Tax ID Number |
Enter applicant’s social security number or tax ID number. |
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6 Applicant’s Birth Date |
Enter applicant’s date of birth (MM-DD-YYYY). |
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7 Co-Applicant’s Birth Date |
Enter co-applicant’s date of birth (MM-DD-YYYY). |
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8 Co-Applicant’s Social Security Number |
Enter co-applicant’s social security number or tax ID Number. |
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9 Total Number of Household Members |
Enter the total number of persons living in the applicant’s household. |
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10 Type of Operation |
Select appropriate entity type that applies to the applicant. |
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11 Acres Owned |
Enter total number of acres currently owned. |
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12 Acres Rented |
Enter total number of acres currently rented. |
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13 Marital Status |
Check the appropriate box for marital status. |
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14 Have you ever conducted business … |
Check “YES” if you have conducted business under any other name and enter the name of the business. If not, check “NO.” |
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15 Have you or any member of the … |
Check “YES” if you or any member of the entity obtained a direct or guaranteed loan from FSA or other USDA agencies. If not, check “NO.” |
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16 If you answered “YES”… |
Check “YES” if you previously had an FSA direct or guaranteed loan that was paid in full. If you are currently an FSA direct or guaranteed loan borrower, check “NO” and enter “active borrower” in the space provided. Check “NO” and provide an explanation if you previously had an FSA farm loan which: 1. Was not paid in full, and/or 2. You were released from personal liability as part of a debt settlement for a direct or guaranteed FSA loan, and/or 3. The Government ever paid a loss claim to a Lender under a guaranteed loan. |
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17 Have you or any member of the… |
Check “YES” if you or any member of the entity ever been in receivership, been discharged in bankruptcy, or filed a petition for bankruptcy. Otherwise check “NO.” |
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18 If you answered “YES” … |
If you answered “YES” to item 17, provide details. |
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19 Are you or any member of the… |
Check “YES” if you or any member of the entity is delinquent on any debt to the United States Government. If not, check “NO.” Debt to the United States Government includes but is not limited to education loans, obligations to the Commodity Credit Corporation, Natural Resources Conservation Service, Veterans Administration, FSA, Rural Housing Service or Federal Crop Insurance Corporation/Risk Management Agency. |
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20 Are you … |
Check “YES” if you or the majority of members of the
entity are citizens of the |
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21 If “NO” … |
If you answered “NO” to item 20, check “YES” if you are a non-citizen national, or a qualified alien. Otherwise check “NO.” (Please provide
documentation.) |
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22 Are you a veteran? … |
Check “YES” if you are a veteran and indicate branch and dates of service. If not, check “NO.” |
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23 Are you an employee, related … |
Check “YES” if you are an employee, related to an employee, or an associate of an employee of the lender or Farm Service Agency. If not, check “NO.” |
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24 Are you farming… |
If you are currently farming or ranching, check "YES" and indicate the number of years. If you are not farming or ranching check "NO." The years counted should be years that you or any entity in which you were an owner, reported income or loss from farming to the Internal Revenue Service. If there is more than one applicant, the number should be the greatest number calculated for any one applicant. |
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25 If you answered “NO” … |
If you answered “NO” to item 24, but you have operated a farm in the past, list dates. The years counted should be years that you or any entity in which you were an owner, reported income or loss from farming to the Internal Revenue Service. If there is more than one applicant, the number should be the greatest number calculated for any one applicant. |
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Fld. Name/ |
Instruction |
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26 Ethnicity |
Check the appropriate box indicating your ethnicity. |
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27 Race |
Check the appropriate box or boxes indicating your race. |
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28 Gender |
Check the appropriate box indicating your gender. |
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Fld. Name/ |
Instruction |
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Certifications |
Please read the statements in this section carefully before signing. |
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30A Applicant’s Signature |
Enter the signature of the applicant. If you are mailing or faxing this form, print the form and manually enter your signature. If this form is approved for electronic transmission and you have established credentials with USDA to submit forms electronically, use the buttons provided on the form for transmitting the form to the USDA servicing office. |
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30B Date |
Enter the date (MM-DD-YYYY) the applicant signed the form. |
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31A Co-Applicant's Signature |
Enter the signature of the co-applicant. If you are mailing or faxing this form, print the form and manually enter your signature. If this form is approved for electronic transmission and you have established credentials with USDA to submit forms electronically, use the buttons provided on the form for transmitting the form to the USDA servicing office. |
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31B Date |
Enter the date (MM-DD-YYYY) the co-applicant signed the form. |
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Fld. Name/ |
Instruction |
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32 Request Number |
Enter number of requests for each guarantee request submitted on FSA-2211. For example: If form FSA-2211 is submitted for Guaranteed FO assistance only, this item should be completed to show “1" of “1" and Parts C, D, and E would be completed only once. If form FSA-2211 is submitted for Guaranteed FO assistance, Guaranteed CL assistance, Guaranteed OL assistance, and Guaranteed OL-Line of Credit assistance, Parts C, D, and E must be completed for each guarantee requested. The separate request section should be completed to show “1” of “4", “2" of “4", and “3" of “4", and “4” of “4” respectively. |
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33 Loan Type |
Check the appropriate box for the type of loan the applicant is requesting. |
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34 Loan Amount or LOC Ceiling |
Enter the amount of the loan request or Line-of-Credit (LOC) ceiling. |
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35 Interest Rate |
Enter the rate of interest the loan applicant will be charged and check the appropriate box if the rate is “Fixed” or “Variable.” Note: If the interest rate is variable or fixed for less than five years, check “Variable”. If the interest rate is fixed for five or more years, check “Fixed.” |
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36 Interest Assistance Requested |
Check “YES” if Interest Assistance is requested. Otherwise check “NO." |
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37 Repayment Period |
Enter the repayment period (years) for the loan requested. |
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38 Subsequent Loan in Same Operating Cycle |
Check “YES” if this is a subsequent loan in the same operating cycle. If not, check “NO.” |
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39 Repayment Terms |
Enter the repayment terms for the loan requested. |
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Fld. Name/ |
Instruction |
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40 Funds Purpose |
Enter purpose for which loan funds obtained under FSA guarantee will be used. Example: OL
Request for Guarantee Annual
operating costs for cash grain operations Annual
family living costs |
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Fld. Name/ |
Instruction |
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41 Funds Amount |
Enter the amount of money to be used for each purpose. Example: OL
Request for Guarantee Annual
operating costs for cash grain operations $50,000 Annual
family living costs $18,000 |
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Fld. Name/ |
Instruction |
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42-46 Proposed Security |
Enter specific security information for each field. Example: OL Request
for Guarantee Item Description Lien Position Est.
Value Amount of Prior
Lien Collateral Value Crops 1st $ 96,000 $0 $ 96,000 Machinery 2nd $ 82,000 $50,000 $ 32,000 Beef Calves 1st $200,000 $0 $200,000 Totals $378,000
$50,000 $328,000 |
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Fld. Name/ |
Instruction |
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47-51 Environmental Information |
Lenders shall carefully consider questions 47 through 51
and respond with the appropriate
answers for the farm operation proposed for loan guarantee. If the lender has questions regarding these
issues, the FSA Farm Loan Manager at the local Lenders have to do site visit to operation and conduct environmental reviews as applicable. |
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47 Floodplains |
Check “YES” if the real estate is located within the 100-year floodplain. Otherwise check “NO.” If “YES” please provide an explanation and attach it to this form. |
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48 State Water Quality Standards |
Check “YES” if the operation may violate State Water Quality Standards. Otherwise check “NO.” If “YES” please provide an explanation and attach it to this form. |
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49 Historical and Archaeological Sites |
Check “YES” if the property has any historical significance. Otherwise check “NO.” If “YES” please provide an explanation and attach it to this form. |
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50 Wetlands and HEL |
Check “YES” if loan funds will affect any Wetlands and Highly Erodible Land. Otherwise check “NO.” If “YES” please provide an explanation and attach it to this form. |
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51 Hazardous Substances |
Check “YES” if lenders have to do site visit to operation and conduct environmental reviews as applicable. Otherwise check “NO.” If “YES” please provide an explanation and attach to this form. |
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Fld. Name/ |
Instruction |
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52 Net Cash Flow W/O I/A |
Enter information from the applicant’s cash flow budget. This item should be completed for all requests for assistance. |
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53 Net Cash Flow W I/A |
Complete item 53 only if item 52 is negative and the lender is requesting interest assistance. If applicant has multiple guaranteed loans, lender is to indicate on which loans interest assistance is requested. |
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Fld. Name/ |
Instruction |
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54 Lender’s Name, Address & Telephone Number |
Enter the Lender’s name, complete mailing address and phone number. |
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55 Lender Tax ID Number |
Enter the Lender’s Tax ID Number. |
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56 Regulatory Agency |
Enter the lender’s primary oversight agency (e.g., FDIC, OCC, FCA). |
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57a-f |
Please read these certifications before signing. |
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57g Applications will Be … |
Enter appropriate date. |
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57h Application filed as a … |
Check the appropriate box. |
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58A Name of Lender's Representative |
Enter the name of official authorized to execute official binding documents on the lender’s behalf. |
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58B Title of Lender Representative |
Enter the title of official authorized to execute official binding documents on the lender’s behalf. |
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59A Signature of Authorized Lender Representative |
Enter the signature of the individual whose name appears in item 65A. The lender should promptly submit the completed application to FSA for consideration. If you are mailing or faxing this form, print the form and manually enter your signature. If this form is approved for electronic transmission and you have established credentials with USDA to submit forms electronically, use the buttons provided on the form for transmitting the form to the USDA servicing office. |
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59B Date |
Enter the date the official authorized to execute official binding documents on the lender's behalf signed this form. |
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Fld. Name/ |
Instruction |
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60-62 Supporting Documentation |
Lenders may use these items as a checklist of supporting documentation to be submitted to FSA to request a guarantee. |