RD 3555-13 Annual Interest Assistance Agreement

ANNUAL INTEREST ASSISTANCE AGREEMENT
Guaranteed RH Loans

Form RD 3555-13
(Rev. 12-14)
Date of Note

Amount of Note

Note Rate

Floor Rate

%

Loan Number

Type of Agreement

%

Corrected
1
New 2
RHS Borrower ID

3

Lender Identification Number

FORM APPROVED
OMB NO. 0575-0179

Mid-Term Revision
Effective Date

4

Cancellation

Branch Number

I. This agreement between the United States of America, acting through the Rural Housing Service (RHS) pursuant to Title V of the Housing Act of 1949,
(called ''the Government") and the borrower whose name appears below (called ''Borrower'') supplements the Master Interest Assistance and Shared
Equity Agreement with Promissory Note dated
(called Master Agreement whether one or more).
II. TO BE COMPLETED BY BORROWER (If additional space is needed, attach additional sheets)
A.
Complete the following for borrower, co-borrower,
all adult members of the household who will
receive income.
Name

Age

Planned Income
Next 12 Months
Wages

Names and addresses of employer or source of income

Other

1.
2.
3.
B.

Number of dependents (not including foster children) residing in the dwelling .

SIGNATURES OF BORROWERS. I (we) certify that this information is correct to the best of my (our) knowledge and have read and understand the
requirements and conditions on the Master Agreement.
WARNING: Section 1001 of Title 18, United States Code, provides: ''Whoever, in any matter within the jurisdiction of any department or agency

of the United States knowingly and willfully falsifies, conceals or covers up by any trick, scheme, or device a material fact, or makes any false,
fictitious or fraudulent statements or representations, or makes or uses any false writing or document knowing the same to contain any false,
fictitious or fraudulent statement or entry, shall be fined under this title or imprisoned not more than 5 years, or both.''
(Borrower)

(Date)

(Co-Borrower)
Complete this column for each Loan Note

III. TO BE COMPLETED BY THE LENDER

4. Installment (@ Note Rate)
5. Installment (@ Note Rate)

1. Annual Income

6. Difference

2. Deductions

7. Interest Assistance Monthly
Overpayment to be Offset

3. Adjusted Annual Income (1
minus 2)
Low-Income Limit - Maximum

Total Amount
Monthly Amount

IV. MONTHLY INSTALLMENT NOTE: Subject to the provisions of this agreement, the borrower will pay
dollars per month for 12 months
beginning
(not including any amounts required for taxes and insurance escrow accounts). This agreement may be revised or
cancelled as provided by the conditions listed on the Master Agreement.
Prepared by (Authorized Lender Signature & Title)
UNITED STATES DEPARTMENT OF AGRICULTURE
Rural Housing Service (Authorized Signature & Title)

Date

Date

V. The Government's share of payments made under this agreement are reduced by
months to offset the amount of
assistance for the period

to

dollars per month for

which the Government and Borrower agree represents an overpayment of
.

Information provided on this form is used by RHS to calculate the amount of interest subsidy the borrower will receive and the amount of loan
installment the borrower will pay in the ensuing year. Information collected is necessary to receive the subsidy benefits.
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 0575-0179. The time required to complete this information collection is estimated to average 40
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

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