Form RD 5001-19 RD 5001-19 Lender's Guaranteed Loan Payment to USDA

UNITED STATES DEPARTMENT OF AGRICULTURE
FORM RD 5001-19
(00-00)

LENDER’S GUARANTEED LOAN PAYMENT TO THE AGENCY

FORM APPROVED
OMB NO. 0000-0000

TRANSACTION 4036
INSTRUCTIONS Complete all items.
1. CASE NO.

2. LENDER ID NO.

3. LOAN NO.

4. BORROWER NAME

5. LENDER NAME

6. RECEIVABLE NO.

7A. DATE INTEREST PAID THROUGH
TO THE AGENCY
MO
DA
YR

7B. DATE PRINCIPAL PAID

8. AMOUNT OF PRINCIPAL PAYMENT

9. AMOUNT OF INTEREST PAYMENT

MO

$

12. AUTHORIZED LENDER’S SIGNATURE

YR

$

10. TOTAL REMITTANCE
$

DA

11. DATE OF DEPOSIT
(Item 8 + Item 9)

MO
13. TITLE

DA

YR

(To be completed by the Agency)
14. DATE

This report contains information which must be furnished by the lender in order to fulfill requirements and retain the benefit of an Agency loan guarantee. This statement
is furnished pursuant to P.L. 96-511.
According to the Paperwork Reduction Act of 1995, no persons are 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 0000-0000. The time required to complete this information collection is estimated to average 1 hour 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.

Form RD 5001-19 Page 1 of 2

INSTRUCTIONS FOR PREPARATION
To transmit any funds due the Agency when the Agency has purchased a part or all of the guaranteed portion of the loan, including the Agency’s pro-rata share of any payments
received from the borrower or any funds received by the lender in the process of liquidation. The distribution of the funds between interest and principal should be in the same
proportion as the lender’s application to the borrower’s account, however, the lender’s application to the borrower’s account should have been applied to interest first and any
remaining balance to principal.
Item 1.

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.

Item 2.

Enter the Lender’s Identification Number. Fill all leading zeros.

Item 3.

Enter the Agency assigned Loan Number.

Item 4.

Enter the Borrower’s Name - Abbreviate when necessary.

Item 5.

Enter the Lender’s Name - Abbreviate when necessary.

Item 6.

Enter the applicable Receivable Number. (Assigned by Finance Office at time of purchase.)

Item 7A.

Enter the date through which the accompanying payment pays accrued interest on the Agency held portion of loan.

Item 7B.

Lender will enter date principal paid.

Item 8.

Enter the Agency’s pro-rata share of funds received and applied to principal on the borrower’s loan (e.g. payments from the borrower or proceeds from rents, escrow
balances, sale of collateral, etc.)

Item 9.

Enter the Agency’s pro-rata share of funds received and applied to the interest on the borrower’s loan (e.g. payments from the borrower or proceeds from rents, escrow
balances, sale of collateral, etc.)

Item 10.

Enter the total of items 8 and 9.

Item 11.

Finance Office or field office will enter the date the check was deposited.

Items 12-14.

Self-explanatory.

Form RD 5001-19 Page 2 of 2