5001-10 Lender's Guaranteed Loan Payment to USDA

UNITED STATES DEPARTMENT OF AGRICULTURE

FORM APPROVED
OMB NO. 0572-0155

LENDER’S GUARANTEED LOAN PAYMENT TO USDA

FORM RD 5001-10
(00-00)

2. LENDER ID NO

1. BORROWER'S ID

ST - CO - SSN or TIN
3. LOAN NO.

4. BRANCH NO.

5. BORROWER NAME

6. LENDER NAME

7. AMOUNT RECEIVED FROM BORROWER

8. DATE RECEIVED

9. RECEIVABLE NO.

10. DATE INTEREST PAID THROUGH
TO USDA
MO
DA
YR

11. AMOUNT OF PRINCIPAL PAYMENT

12. AMOUNT OF INTEREST PAYMENT

13. TOTAL REMITTANCE

14. DATE OF DEPOSIT
(Item 11 + 12)

15. AUTHORIZED LENDER’S SIGNATURE

10A. DATE PRINCIPAL PAID
(F.O. USE ONLY)
MO
DA
YR

MO

DA

YR

16. TITLE

(To be completed by USDA)
17. DATE

This report contains information which must be furnished by the lender in order to fulfill requirements and retain the benefit of a USDA loan guarantee. This statement is furnished pursuant
to P.L. 96-511.

FINANCE OFFICE

SERVICING OFFICE

LENDER

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 currently
valid OMB control number. The valid OMB control number for this collection is 0572-0155. 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.
Responses to this collection of information are mandatory (7 CFR 5001). Send comments on the agency's need for this information, the accuracy of the provided burden estimates, and any
suggested methods for minimizing respondent burden, including through the use of automated collection techniques to InnovationCenterRegulations@usda.gov. Include the OMB control
number in any correspondence. Do not send the completed form to this address.