Instructions for RD3555-0021

Request for Single Family Housing Loan Guarantee.�

The purpose of this form is for lenders to request a loan guarantee from RHS, and certifying to RHS facts known by the lender.

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.

A lender requesting an RHS Single Family Housing loan guarantee should complete this form and submit it to the appropriate RHS State Office. Mail all completed forms and any attachments to the address printed on the form.

Fld Name / Item No.	Instruction
Approved Lender	The lender should enter their corporate name or the name under which they do business.
Approved Lender Tax ID No.	The lender should enter their 9 digit tax identification number.
Contact	The lender should enter the name of their contact person whom the Agency may communicate with concerning the request for an RHS loan guarantee.
Approved Lender E-Mail	The lender should enter the e-mail address of the contact person identified under �Contact.�
Phone Number	The lender should enter the telephone number, including area code, of the �Contact� person.
Fax Number	The lender should enter the telephone number, including area code, of the fax number of the �Contact� person.

Permanent Resident/Qualified Alien	Indicate YES or NO.
Veteran	Indicate YES or NO.
Disabled	Indicate YES or NO.
Gender	Indicate �M� (male) or �F� (female)
First Time Homebuyer	Indicate YES or NO.
Ethnicity	Check applicable box.� Check only one box.
Race	Check applicable boxes.� Multiple boxes may be checked.
Marital Status	Check applicable box.
The applicant�.	Check if the applicant/co-applicant has or does not have a relationship with any current Rural Development employee.�
Explain	Explain relationship � i.e. employee, member of family, close relative, associate.
Applicant�s Credit Score	Enter credit score OR check �No Score� box.
CAIVRS #	Enter the CAIVRS number obtained from the HUD website.
GSA/SAM Exclusion	Complete YES or NO.� This response is applicable to all parties to the transaction, as provided in further guidance in HB-1-3555.� Complete YES if any party is excluded, otherwise check NO.
Date GSA/SAM checked	Complete the date the GSA/SAM was checked.

2b Current adjusted income�	Enter the current adjusted income for the household (all adult members) � used to determine program eligibility.
3 PITI ratio/TOTAL DEBT ratio	The lender should enter the applicant�s PITI ratio and total debt ratio in the appropriate blank space.
4 We propose to loan�	The lender should enter the proposed loan amount, the proposed interest rate, and the proposed monthly payments.
5 The interest rate is based on�	Check the box �Fannie Mae�. Identify the date the interest rate was based upon. Confirm one of two approaches the rate will be based: � Check if the interest rate disclosed is locked.� Confirm the date the lock will expire. � Check if the interest rate is floating (documentation of the lock date will be required as a condition of a commitment.)
8 Loan funds will..	In the appropriate blank space the lender should enter the purpose or purposes for which the loan funds will be used and the dollar amount for each purpose. The lender should enter the sum of the loan request in the �Total Request� amount in the last line of the column.
Purchase/Refinance Amount	Identify transaction type.� Enter the amount of purchase and/or refinance in the transaction that will be financed with loan funds.
Financed Loan Closing Costs	Identify/summarize costs, followed by the amount that will be financed with loan funds.

Repairs/Other	Identify repairs/other costs to be financed with loan funds.� Enter the amount.

�Guarantee Fee	Enter the amount of guarantee fee to be financed with loan funds.
Total Request	Enter the total amount requested.� This amount should equal the guarantee request and will be equal to the amount on the �Loan Terms� page when a lender utilizes the Guaranteed Underwriting System (GUS).
Initials	Initials of each applicant acknowledging the information on each page are required.

Certifica�tions (page 2)	The Lender�s Authorized Representative should sign and date the form where indicated. The Borrower and Co-Borrower should also sign and date the form where indicated.
Lender�s Authorized Representative Signature/Title	The Lender�s authorized representative will sign, insert their title.
Date	Insert the date signed by the Lender�s Authorized Representative
Name of Authorized Representative	Identify the name of the Lender�s Authorized Representative
Title/Company	Identify the title of the Lender�s Authorized Representative followed by the Company represented.
Print Applicant�s Name	Insert the applicant�s name as referenced on the loan application.
Applicant�s Signature	The applicant will execute acknowledging/certifying to information provided/completed on document.
Date	Insert date signed by applicant.
Print Co-Applicant�s Name	Insert the co-applicant�s name as referenced on the loan application.
Co-Applicant�s Signature	The co-applicant will execute acknowledging/certifying to information provided/completed on document.
Date	Insert date signed by co-applicant.� Note:� Additional co-applicant will require documentation and acknowledgement on a separate form.
Initials	Initials of each applicant acknowledging the information on each page are required.

Page 3 � Worksheet for Documenting Eligible Household and Repayment Income

Fld Name / Item No.	Instruction
Applicant	Insert the applicant�s name as referenced on the loan application.
Co-Applicant	Insert the co-applicant�s name as referenced on the loan application.
Identify all Household Members	List each household member regardless if the member is a party to the note.�
Age	List the age of the household member.

Full-time Student Y/N	Insert �Y� (YES) if the household member is a full-time student. Insert �N� (NO) if the household member is not a full-time student.
Disabled Y/N	Insert �Y� (YES) if the household member is disabled. Insert �N� (NO) if the household member is not disabled.
Receives Income Y/N	Insert �Y� (YES) if the household member receives income. Insert �N� (NO) if the household member does not receive income.
Source of Income	Identify the income source for all members who receive income.

Annual Income Calculation	The worksheet provides space to identify the anticipated income for all adult members of the household.�
1. Applicant	Calculate and record how the calculation of each income source/types was determined in the space provided.� In the column adjacent insert the annual total income.
2. Co-Applicant	Calculate and record how the calculation of each income source/types was determined in the space provided.� In the column adjacent insert the annual total income.
3.� Additional Income to Primary Income	Calculate and record how the calculation of each income source/types was determined in the space provided.� In the column adjacent insert the annual total income.
4.� Additional Adult Household Member(s) who are not a Party to the Note	Calculate and record how the calculation of each income source/types was determined in the space provided.� In the column adjacent insert the annual total income.
5.� Income from Assets	Calculate and record how the calculation of each income source/types was determined in the space provided.� In the column adjacent insert the annual total income.
6.� Annual Household Income	Insert the total of items 1 through 5.
Initials	Initials of each applicant acknowledging the information on each page are required.

Page 4 - Adjusted Income Calculations

Adjusted Income Calculation	The worksheet provides space to identify the qualifying deductions for the household.� This figure is used to qualify the household for eligibility for the program.
7.� Dependent Deduction	Insert the number of dependents eligible for the deduction.� In the column adjacent insert the total of the dependent deduction.
8. Annual Child Care Expenses	Calculate and record how the calculation of the deduction was determined in the space provided.� In the column adjacent insert the total of the deduction.
9. Elderly Household	Calculate and record how the calculation of the deduction was determined in the space provided.� In the column adjacent insert the total of the deduction.
10.� Disability	Calculate and record how the calculation of the deduction was determined in the space provided.� In the column adjacent insert the total of the deduction.
11.� Medical expenses	Calculate and record how the calculation of the deduction was determined in the space provided.� In the column adjacent insert the total of the deduction.
12.� Total Household Deduction	Enter the total of items 7 through 11.
13. Adjusted Annual Income	Enter the result of item 6 minus item 12.
Moderate Income Limit $	Enter the moderate income limit for the state and county in which the property to the transaction is located.
State	Identify the state.
County	Identify the county in which the property to the transaction is located.
Initials	Initials of each applicant acknowledging the information on each page are required.

Page 5 � Monthly Repayment Income Calculation

Fld Name / Item No.	Instruction
Applicant	Insert the applicant�s name as referenced on the loan application.
Co-Applicant	Insert the co-applicant�s name as referenced on the loan application.
14.� Stable Dependable Monthly Income	Calculate and record how the calculation of each income source/type was determined in the space provided for the parties to the note.� This is the income that qualifies the loan.
Borrower/Co-Borrower Base Income	Insert the amount of base income determined to be stable for each borrower/co-borrower in the 2^nd and 3^rd column.� Directly beneath each entry, record the calculation of the income utilized.� In the 4^th/last column record the total base income of the borrower/co-borrower.
Borrower/Co-Borrower Other Income	Insert the amount of other income determined to be stable for each borrower/co-borrower in the 2^nd and 3^rd column.� Directly beneath each entry, record the calculation of the income utilized.� In the 4^th/last column record the total other income of the borrower/co-borrower.

Borrower/Co-Borrower Total Income	Insert the total amount of base and other income determined to be stable for each borrower/co-borrower in the 2^nd and 3^rd column.� In the 4^th/last column record the total of base and other income of the borrower/co-borrower.
15.� Monthly Repayment Income	Enter the total of 14.
Prepared by (Signature)	The authorized representative who prepared the determination of annual, adjusted and repayment income.� This certification represents the figures provided are true, accurate, verified and conform to documentation in the lender�s permanent loan file.� The authorized representative of the lender should execute the document.
Name	Identify the name of the individual representing the lender.
Title	Identify the title of the name of the individual representing the lender.
Lender	Identify the Lender represented.
Date	Record the date executed.
Taxing ID	Insert the taxing identification number of the lender represented.
Initials	Initials of each applicant acknowledging the information on each page are required.

Page 6 � Notice to Applicant Regarding Privacy Act Information

Initials

Initials of each applicant acknowledging the information on each page are required.

Page 7 � Notification to Applicant on Use of Financial Information from Financial Institution

Initials

Initials of each applicant acknowledging the information on each page are required.

Applicant and Co-Applicant Information	Complete, circle or mark as appropriate for the applicant and each co-applicant.� Any additional applicants must be fully documented on a separate form.
Name	The lender should enter the applicant/co-applicant�s name in which the loan will be closed.
Social Security No	The lender should enter the applicant/co-applicant�s nine digit social security number.
Date of Birth	Enter the applicant/co-applicant�s date of birth.
U.S. Citizen	Indicate YES or NO.

Property Address	Complete the physical address of the property in this loan transaction.
City, State, Zip Code	Complete the city, state and zip code (including zip +4).
County	Complete the county in which the property is located.
Is this a Refinance�	Complete YES or NO.� If YES, identify the type of loan.
1a Number of persons..	The lender should indicate the number of persons in the applicant/co-applicant�s household.
1b Number of dependents�	The lender should indicate the number of dependents under the age of 18 or full-time student.
2a Current annual income�	Enter the current annual income of the household (all adult members) � used to determine program eligibility.