Instructions for Form FSA2330

 

REQUEST FOR MICROLOAN ASSISTANCE

 

Used by the FSA to obtain information on applicants applying for services. Submit the original of the completed form in hard copy to the appropriate FSA office.

 

Customers who have established electronic access credentials with USDA may electronically transmit this form to the FSA office, provided that the customer submitting the form is the only person required to sign the transaction.

 

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.

All applicants complete Part A.  Individual applicants complete Parts B, D, F and G.  Entities complete Parts C, D, F and G; Part E if applicable.  FSA completes Part H.

 

ld Name /
Item No.

Instruction

PART A – Applicant

 

Items 1 – 3 are completed by all applicants.

1

Exact Full Legal Name

Enter the applicant’s exact full legal name, and list all names the business is currently using.

2

Address

 

Enter applicant’s complete mailing address, physical address if different from mailing address.  If operating as an entity, list where incorporated or otherwise registered.

3

Contact Information

Enter the applicant’s home or cell telephone number, as applicable, and e-mail address.

PART B – Individual Applicant Information

 

Items 1 – 9 are completed by the applicant.  *Items 7-9 are voluntary. Item 10 is for FSA use only.

1

Social Security No.

 

Enter applicant’s Social Security Number (9-digit number).

 

 

2

Birth Date

Enter applicant’s date of birth.

3

County of

Operation Head-Quarters

Enter the county where the operation headquarters is located.

4

Veteran Status

Check “YES” if applicant is a veteran and enter the appropriate dates of service and branch of the military.  Check “NO” if not a veteran. 

5

Marital Status

Check the appropriate block depending on whether the applicant is married, separated or unmarried.

6

Citizenship

 

 

Check “Citizen” if applicant is a U.S. citizen. Check “Non-citizen National” if applicant is a non-citizen national. Check “Qualified Alien” if applicant is a qualified alien.  If non-citizen national or qualified alien, applicant must provide a copy of appropriate documentation of immigration status.

7

*Ethnicity

Check the appropriate box indicating applicant’s ethnicity.

8

*Race

Check the appropriate box indicating the applicant’s race.  More than one box may be checked.

9

*Gender

Check the appropriate box indicating the applicant’s gender.

Item 10 is for FSA Use Only.
PART C – Entity Applicant Information

 

Items 1 – 5 are applicable to entities.  Informal entities may leave Items 2-4 blank, if not applicable.

1

Entity Type

Check the appropriate box indicating the entity type.

2

State of Registration

Enter the State where the entity is registered.

3

Registration No.

Enter the entity’s registration number.

4

Tax ID No.

Enter the entity’s Tax Identification number (9-digit number).

5

Exact Full Legal Name of Primary Entity Contact

Enter the exact full legal name of the primary entity contact.

PART D – Financial Statements of Applicant

 

Individual applicants and entities will fill out this part.  Entity members will provide their financial statement information on Part E.

 

1A

Income Description

Describe the projected farm income source (type of crop(s), livestock, etc).

1B

Amount

Enter the projected annual dollar amount for each source.

2

Total Annual Farm Income

Enter the total dollar amount of projected annual farm income.

3A

Expenses Description

Describe the projected farm expenses.

 

 

3B

Amount

Enter the projected annual dollar amount for each of the farm expenses listed in Item 3A.

4

Total Annual Farm Expenses

Add the amounts entered for 3B and enter the total amount here.

 

 

5

Net Farm Income

Subtract Item 4 from Item 2 above and enter dollar amount here.  This is your total projected net farm income.

6

Total Annual Non-Farm Income

Enter the dollar amount of total annual projected non-farm income (do not include farm income in this estimate).

7

Total Annual Family Living Expenses

Enter the dollar amount of total projected annual family living expenses (do not include farm expenses in this estimate).

8

Net Non-Farm Income

Subtract Item 7 from Item 6 above and enter dollar amount here.  This is your total projected net non-farm income.

9

Net Total Annual Income

Add Item 5 to Item 8 and enter dollar amount here.  This is your total projected net annual income from farm and non-farm sources.

10A

Assets

Description

Enter description of assets owned by applicant.

10B

Value

Enter the dollar value of each asset listed.

11

Total Assets

Add the value of each asset listed in Item 10B above and enter the total dollar value here.

12A

Creditor

List the name(s) of creditors.

 

12B

Payment

Enter the annual dollar amount of payments due to each of the creditors listed.

12C

Balance

Enter the total balance due (as of Balance Sheet Date) to each of the creditors listed.

13

Total Debts

Add the balance due for each debt listed in Item 12C above and enter the total dollar value here.

14

Total Assets

Enter the dollar amount from Item 11.

15

Total Debts

Enter the dollar amount from Item 13.

16

Net Worth

Subtract Item 15 from Item 14 and enter the dollar amount here.

PART E – Entity Applicant Information

 

Items 1A – 10 are applicable to entity members. *Items 1J – 1L are voluntary. Each entity member will complete Part E.  Part E can be duplicated as needed.

1A

Exact Full Legal Name of Entity Member

Enter the individual member’s exact full legal name.

 

1B

Social Security Number

Enter the individual member’s social security number (9 digit number).

1C

Birth Date

Enter the individual member’s birth date.

1D

Address

Enter the individual member’s complete address.

1E

Contact Numbers

Enter the individual member’s contact numbers.

1F

Percent of Ownership

Enter the individual member’s percentage of ownership in the entity.

1G

Annual Non Farm Income

Enter the individual member’s gross annual non-farm income in U.S. dollars.

1H

Marital Status

Check the appropriate box to indicate the individual member’s marital status as married, separated or unmarried.

1I

Citizenship

Check the appropriate box to indicate the individual member’s status as a citizen, non-citizen national or qualified alien.

1J

*Ethnicity

Check the appropriate box to indicate the individual member’s ethnicity.

1K

*Race

Check the appropriate box to indicate the individual member’s race.

1L

*Gender

Check the appropriate box to indicate the individual member’s gender.

1M - FSA Use Only.  FSA to complete this item.

2A

Assets Description

Enter description of assets owned by the individual member.

2B

Value

Enter the dollar value of each asset listed.

3

Total Assets

Add the value of each asset listed in Item 2B above and enter the total dollar value here.

4A

Creditor

List the name(s) of creditors.

 

4B

Payment

Enter the annual dollar amount of payments due to each of the creditors listed.

4C

Balance

Enter the total balance due (as of Balance Sheet Date) to each of the creditors listed.

5

Total Debts

Add the balance due for each debt listed in Item 4C above and enter the total dollar value here.

6

Total Assets

Enter the dollar amount from Item 3.

7

Total Debts

Enter the dollar amount from Item 5.

8

Net Worth

Subtract Item 7 from Item 6 and enter the dollar amount here.

9

Signature

Enter the individual member’s signature to indicate that they have read the statements and certifications on Pages 3 through 5.

10

Date

Enter the date the individual member signed the form.

PART F – General Information

 

Items 1 – 6 are completed by all applicants.

1

Counties Being Farmed

Enter the names of the counties which are being farmed by the operation.

2

Acres Owned

Enter the number of acres that the individual/entity owns.

3

Acres Rented

Enter the number of acres that the individual/entity rents.

4A

Purpose of Loan

Enter the purpose the loan funds will be used for.

4B

Amount Requested

Enter the amount of loan funds requested.

5

Description of Operation

Enter a description of the operation.

6

Description of Training

Enter a description of the applicant’s farm training and experience. Include number of years farming, involvement with agriculture-related organizations, and details of apprenticeship, if applicable.

PART G – Notifications, Certification and Acknowledgement

 

Items 1 – 17C are completed by all applicants.

1

Business Under Other Name

Check “YES” if you or any member of the entity ever conducted business under any other name, otherwise check “NO”.  If “YES” provide names used in Item 8.

2

Previous FSA or FmHA Loans

Check “YES” if you or any member of the entity ever obtained a direct or guaranteed farm loan from FSA or the Farmers Home Administration; if not check “NO”.

3

Debt Forgiveness

If Item 2 is “YES”, check “YES” if the government ever forgave any debt through a write-down, write-off, compromise, adjustment, reduction, charge-off, paying a loss on a guarantee, or bankruptcy.  If “YES”, provide details in Item 8; otherwise check “NO”. 

4

Delinquent on Federal Debt

Check “YES” if you or any member of the entity is delinquent on any federal debt (i.e. “Federal Debt” includes but is not limited to education loans, delinquent taxes, obligations at Natural Resources Conservation Service, obligations to FCIC, etc.)  If “YES,” provide details in Item 8, otherwise check "NO".

5

Pending Litigation

Check “YES” if you or any member of the entity or the entity itself is involved in any pending litigation.  If “YES,” provide details in Item 8, otherwise check “NO”. 

6

Bankruptcy

Check “YES” if you or any member of the entity has ever been in receivership, been discharged, or filed a petition for reorganization in bankruptcy.  If “YES,” provide details in Item 8, otherwise check “NO”. 

7

Employee Relationship

Check “YES” if you are an employee, related to an employee, or closely associated with an employee of the Farm Service Agency. If not, check “NO.”  If “YES” provide details in Item 8.

8

Additional Answers

Provide explanations to any “YES” responses for Items 1 – 7.  Use additional sheets as necessary.

9 – 16

Statements

Read statements and certifications in Items 9 – 16.

17A

Signature

Enter the signature of the individual applicant or the authorized entity representatives.

17B

Title/relationship

Enter the title/relationship of the individual if signing in a representative capacity.

17C

Date

Enter the date the applicant signed.

 

Part H – FSA Use Only