RD 1944-60 Landlord's Verification

USDA
Form RD 1944-60
(Rev 12-08)

UNITED STATES DEPARTMENT OF AGRICULTURE
RURAL HOUSING SERVICE

Form Approved
OMB No. 0575-0172

LANDLORD'S VERIFICATION

The Rural Housing Service (RHS) is evaluating the below named applicant's eligibility for a home ownership loan and we need to
evaluate the applicant's rental payment history and care of the rental property. Please see the attached Form RD 3550-1, ''Authorization
to Release Information.'' RHS appreciates your assistance in helping us evaluate the applicant's credit history. A postage paid return
envelope is provided for convenience in returning this verification. Please return this complete form to:
Applicant's Name and Address:
USDA, Rural Development
Rural Housing Service

Telephone:

LANDLORD - Please

complete

Date of occupancy: From:

all

of

the

following

information:

Current rent amount:

To:

Rent due date:

Is rent subsidized?

If subsidized, amount: $

Who pays subsidy?

Lease expiration date:
Does rent include utilities or allowances?

Amount of utilities or allowances included in rent: $

List names and approximate ages of all persons occupying the property:

RENTAL HISTORY DURING THE LAST 24 MONTHS:
(please check one)
Always pays by the due date

CURRENT STATUS OF RENT:
Current?

Amount behind: $

Pays over 30 days late: (Dates of Occurrences:
)
Generally stays behind schedule

Landlord's signature

Behind?

Date last paid:
Next due date:

Date completed

SEE ATTACHED PRIVACY ACT NOTICE
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 0575-0172. The time required to complete this information collection is estimated to
average 5 minutes 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.

Position 3

UNITED STATES DEPARTMENT OF AGRICULTURE
Rural Development

PRIVACY ACT STATEMENT TO REFERENCES

Rural Development is authorized by the Consolidated Farm and Rural Development Act (7 U.S.C. 1921 et.
seq.); and Title V of the Housing Act of 1949, as amended (42 U.S.C. 1471 et. seq.), to solicit the
information requested.
Disclosure of the information requested is voluntary. However, information provided is of considerable
value to Agencies in determining the repayment ability of individuals and their eligibility for Agency
programs. There will be no consequences to you if you do not provide the information requested.
Your name, and the information you provide, will be released to the applicant at the applicant's request.
Some information will be available to any requester under the provisions of the Freedom of Information Act.

The information you provide may be referred to another agency, whether Federal, State, local or foreign,
charged with the responsibility of investigating or prosecuting a violation of law, or of enforcing or
implementing the statute, rule, regulation or order issued pursuant thereto, of any record within this system when
information available indicates a violation of law, whether civil, criminal or regulatory in nature, and whether
arising by general statute or particular program statute, or by rule, regulation or order issued pursuant thereto.

Rural Development is a Equal Opportunity Lender.
Complaints of discrimination based on race, sex, religion,
national origin or marital status should be sent to:
Secretary of Agriculture. Washington D. C. 20250