FSA-2522 Delinquent Borrower Response to Denial of Loan Servicing

This form is available electronically.

FSA-2522

U.S. DEPARTMENT OF AGRICULTURE
Farm Service Agency

(12-19-08)

Form Approved - OMB No. 0560-0233
Position 4

BORROWER RESPONSE TO DENIAL OF PRIMARY LOAN SERVICING
AND INTENT TO ACCELERATE
FOR BORROWERS WHO RECEIVED FORM FSA-2510 OR FSA-2514 AND APPLIED FOR SERVICING
(See page 2 for Privacy Act and Public Burden Statement)

TO:

Farm Service Agency
[FSA Office Name/Address]
[Office Address]
[City, State, Zip Code]

1. I have received and read your Denial of Primary Loan Servicing and Intent to Accelerate. (Check the
appropriate blocks below:)
A. I will pay my FSA account current immediately, if I am delinquent, and resolve any non-monetary default.
(FSA will continue to process your account to acceleration until it is paid current.) (Please contact your local
office if you require any further information.)
B. I will pay FSA current using the value of my non-essential assets as described in Form FSA-2521. (This is only
Applicable if the value of your non-essential assets is sufficient to pay your account current.)
C. I will pay FSA the full amount of the Current Market Value Buyout as described in Form FSA-2521.
(This is only applicable if you were offered CMV.)
D. I would like to request Reconsideration as described in Form FSA-2521.
E. I would like to request Mediation as described in Form FSA-2521.
F. I would like to request Negotiation of the Appraisal as described in Form FSA-2521
G. I would like to Appeal as described in Form FSA-2521.

This form must be signed by at least one party (entity or individual) that executed the promissory note(s) or assumption
agreement(s), and has not previously been released of liability for the debt.
2A. Borrower’
s Name

2B. Signature

2C. Date

3A. Borrower’
s Name

3B. Signature

3C. Date

4A. Borrower’
s Name

4B. Signature

4C. Date

5A. Borrower’
s Name

5B. Signature

5C. Date

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where
applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual's
income is derived from any public assistance program. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for
communication of program information (Braille, large print, audiotape, etc.) should contact USDA's TARGET Center at (202) 720-2600 (voice and TDD). To file a complaint of
discrimination, write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, or call (800) 795-3272 (voice) or
(202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.

FSA-2522 (12-19-08)
Note:

Page 2

The following statement are made in accordance with the Privacy Act of 1974 (5 USC 552a): the Farm Service Agency (FSA) is authorized by the Consolidated
Farm and Rural Development Act, (7 USC 1921 et seq , and the regulations promulgated thereunder, to solicit the information requested on this form. The
information requested is necessary for FSA to determine eligibility for financial assistance, service your loan, and conduct statistical analyses. Supplied information
maybe furnished to other Department of Agriculture agencies, the Department of the Treasury, the Department of Justice or other law enforcement agencies, the
Department of Defense, the Department of Housing and Urban Development, the Department of Labor, the United States Postal Service, or other Federal, State, or
local agencies as required or permitted by law. In addition, information may be referred to interested parties under the Freedom of Information Act (FOIA), to
financial consultants, advisors, lending institutions, packagers, agents, and private or commercial credit sources, to collection or servicing contractors, to credit
reporting agencies, to private attorneys under contract with FSA or the Department of Justice, to business firms in the trade area that buy chattel or crops or sell
them for commission, to Members of Congress or Congressional staff members, or to courts or adjudicative bodies. Disclosure of the information requested is
voluntary. However, failure to disclose certain items of information requested, including your Social Security Number or Federal Tax Identification Number, may
result in a delay in the processing of this form or its rejection.
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not 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 0560-0233. The time required to complete this
information collection is estimated to average 30 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. RETURN THIS COMPLETED FORM TO YOUR LOCAL FSA OFFICE.