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.
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Fld Name / |
Instruction |
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1 Case No |
Enter the Borrower’s Case Number. Show the state and county code and the borrower’s Social Security or Internal Revenue Service Tax Identification Number. Example: 2 9 0 3 7 0 9 8 7 6 5 4 3 2 8. |
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2A Agency Loan No |
Enter Agency assigned Loan Number. Example: 0 2. |
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2B Loan Type |
Enter loan type. (2nd field item 2) RH = Rural Housing — Single Family; FO = Farm Ownership; SW = Soil and Water; RL = Recreation Loans; OL = Operating Loans; EE = Economic Emergency Loans; EL = 2 Emergency Livestock; EM = Emergency Loans; B&I = Business and Industry; CF = Community Facilities; and WW = Water & Waste Disposal. Example: F O. |
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3A Report Type Code |
Enter applicable Report Type Code. Example: 1 1 - Estimated Loss - (Liquidation) 2 - Final Loss - (Liquidation) 3 - Finance Office Use Only 4 - Recovery Received after Final Loss (Liquidation) 5 - Loss - Bankruptcy Reorganization 6 - Loss - Debt Restructuring (write down) 7 - Interest Loss Payment 8 - Shared Appreciation Recapture. |
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3B Is the Final Estimated Loss Payment Under the Type Code Checked? |
Check Yes and refer to note above Item 41, if this is the final estimated loss payment under the type code entered in Item 3A,. Example- revised estimated loss in connection with close of bankruptcy reorganization. |
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4 Borrower Name |
Enter Borrower’s Name – abbreviate when necessary. Example: T|H|O|M|P|S|O|N|R|O|B|E|R|T|L. |
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5 Lender ID No |
Enter the lender’s Internal Revenue Service Tax Identification Number. Example: 0|7|6|5|4|3|2|4|5|6||. |
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6 Agency’s Lender Branch No |
Enter the Lender’s Branch number that has been assigned by the Agency. Example: 0|3. |
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Fld Name / |
Instruction |
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11 Principal Balance |
Enter unpaid principal balance on loan. Example: 9|8|5|4|5|.0|0. |
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12–14 Accrued Interest Owed, Principal Balance Owed on Protective Advances, Accrued Interest on Protective Advances |
Lender must provide, as an attachment, its calculation of
unpaid accrued interest showing advances, payments, periods
of time, interest rate and amount.
Items 13 & 14 should not be completed on an estimated loss claim,
except according to paragraph 342-A of FSA Handbook 2- FLP. Example:12. ||8|6|5|4.|4|5| 13. ||0.|0|0| 14. |0.|0|0 In Interest Loss Cases. Item 12 will be the average outstanding principal balance for the past 12 months multiplied by the difference between the original note rate of interest and the court ordered rate. The lender must attach a copy of their loan ledger for the claim period and a calculation of the average principal balance. |
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15 Total |
Enter total of items 11 thru 14. Example: 1|0|7|1|0|9.|4|5 NOTE: COMPLETE ITEMS 16 - 29 FOR REPORT CODES 1,5 & 6 FOR INTEREST LOSS PAYMENTS COMPLETE ITEMS 30 - 32, 34, 38 - 40. |
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16–18 Real Estate Debts, Personal Property Debts, Unpaid Taxes, Assessments, Ground Rents, etc |
Include principal and interest, or other items for which lien priority exists. Item 18 shows only the amount not paid by the borrower and not included in the Protective Advances. Do not include improvement assessments to be paid periodically in the future. Example: 16. |6|9|0|0.|0|0| 17. |-|-|-|-|-|-.|-|-| |18. |4|2|5|2.|0|0. |
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19 Total Prior Liens |
Enter total of items 16, 17 and 18. If zero, enter 0.00. Example: 19. |1|5|2|.0|0. |
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20-22 Real Property Value, Chattel Property Value, Value of Personal and Corporate Guarantees |
22 Enter appropriate amounts. If zero, enter 0.00. Example: 20. |5|0|0|0|0|.0|0 21. |7|5|0|0|0|0| 22. | 0|.0|0|. |
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23 Total |
Enter the total of items 20 thru 22. If zero, enter 0.00. Example: 0|0|0|5|7|5|.0|0. |
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24 Net Collateral |
Enter the amount of net collateral. Item 23 minus item 19. If negative, enter 0.00. Example: 0|0|0|5|7|5|.0|0. |
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25 Basic Loss |
Subtract item 24 from item 15 and enter result in item 25. When a final loss is prepared, insert figure in item 15 in item 25. Example: 6|0|8|5|1.|4|5. |
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26-28 Funds Being Held, Income to be Applied to Debt, Borrower’s Debt Payment Ability – Present Value |
Enter the appropriate amounts. Items 26, 27, and 28 include amount(s) of other assets of the borrower which have not been pledged as security for the loan from which collections can readily be made. Example: 26. 6|5|0.||0|0 27. |0|0|0.||0|0 28. |1|5,|0|0|0.||0|0. |
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29 Total Deductions |
Enter the total of items 26 thru 28. If zero, enter 0.00). Example: 1|5|6|5|0.||0|0. |
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30 Adjusted Basic Loss |
Enter the adjusted basic loss. (Item 25 minus item 29). For interest loss payments carry the figure from item 12 to this column. Example: 4|5|2|0|1.||4|5. |
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31 Percent of Loss Guaranteed |
Enter applicable percentage of guarantee. Example: 9|0|0|0.||0|0. |
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32 Amount to be Paid |
Enter the amount of item 30 X item 31. Example: $ 4|0|6|8|1|.|3|1. |
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33 Sum |
Enter the total principal advanced plus unpaid accrued interest (item 12)] X item 31. If a line of credit, enter the maximum allowed balance plus unpaid accrued interest (item 12) X item 31. Example: 4|2|7|8|9.|3|1. |
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34 Maximum Loss Allowed |
Enter the amount of the maximum loss to be paid (Lesser of item 32 or 33). Example: 4|0|6|8|1.|3|1 For a DARBE loan the amount cannot exceed $2,500,000. |
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35 Allowances to Lender Liquidation Cost |
To be completed by the Finance Office
only. |
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36 Protective Advances Plus Interest |
For final loss claims only add item 13 and 14 and multiply the sum by the percentage in item 31. If estimated loss claim, enter zeros. Example: 0.|0|0. |
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37 Remaining Balance Loss Guarantee |
Enter the difference remaining from Item 34less item 36. Example: |4|0|6|8|1.|3|1. |
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38 Percent of Guaranteed Portion Held by Lender |
Enter the percentage of the Guaranteed portion held by the lender that has not been purchased from the secondary market holder by the Agency. If the Agency has purchased the entire guaranteed portion of the loan from the holder, then enter 0. If the Agency purchased less than the entire guaranteed portion of loan from the holder, enter the percentage of the guaranteed portion that the lender still holds. If the loan was not sold or the lender will forward the holder or holders their pro-rata share of any loss payment received, then enter 100. Example: 3|3.|3|3|3|3|3|3. |
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39 Loss on Guaranteed Portion Held by Lender |
Multiply item 37 by the percentage in item 38. Example: 1|3|5|6|0.|4|3. |
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40 Amount Due Lender |
Enter the amount due lender. (Item 36 plus item 37. ) Example: |4|0|6|8|1.|3|1. |
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Fld Name / |
Instruction |
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41 Amount Paid on Estimated Loss |
If an estimated loss claim was filed, enter the total amount paid to lender on the estimated loss claim. If zero, enter 0.00. Example: 0.|0|0. |
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42 Balance Due Lender |
Enter Balance Payable to the Lender. If zero, enter 0.00. (Item 40 minus item 41.) USDA will verify this amount and issue payment. Example: 0.|0|0. |
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43 Interest on Overpayment |
When the estimated loss payment made by USDA exceeds the actual loss, USDA is entitled to interest on the overpayment. Interest will be charged on the amount of overpayment at the note rate from the check date of the estimated loss payment by USDA to the final date of settlement as shown in item 10. The lender must attach a loan ledger to this form showing advances, interest charges, and payments. The ledger should reflect the application of liquidation proceeds ad the termination of interest accrual no later than the date of the estimated loss payment. The ledger, and items 11 and 12 on this form when coded as a Type 1, should not reflect that the Agency estimated loss claim has been applied as a payment on the loan. If an estimated loss claim was not submitted, enter zero. Example: 0.|0|0. |
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44 Amount Due USDA by Lender |
Enter Amount Due to USDA. If zero, enter 0.00. (Item 41 minus item 40 plus item 43.) Lender check for overpayment of this amount should accompany report and be delivered to a USDA authorized representative. If at the end of the shared appreciation period, USDA’s share of the recapture will be entered. Example: 0.|0|0. |
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45 Lender Loss Un-guaranteed |
Lender is to insert the amount of any loss it incurred on the un-guaranteed portion of the loan. (Item 30 thru item 40). Example: 0.|0|0. |
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46 Name of Lender |
Enter the name of the lender. |
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47 Signature |
Enter the signature of the person authorized to sign for the lender. |
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48 Title |
Enter the title of the lender’s authorized representative. |
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49 Date |
Enter the date the lender’s representative signed the form. |