Fsa2007ins

FSA-2007

INSTRUCTIONS FOR PREPARATION
COSIGNER APPLICATION AND AGREEMENT
Purpose: This form is used to obtain and solicit information it deems necessary from a cosigner to support an FSA application.
Handbook Reference: 1-FLP and 3-FLP	Number of Copies: Original only
Signatures Required: Original by cosigner
Distribution of Copies: County Office Case File
Automation-Related Transactions: DLS

Cosigner must complete Parts A, B and C. FSA completes Part D.

PART A – Cosigner

Items 1 – 11 are completed by the cosigner.

Fld Name / Item No.	Instruction
1 Exact Full Legal Name	Enter the cosigner’s exact full legal name as shown on a state driver’s license or State ID card.
2 Email Address	Enter the cosigner’s email address.
3 Mailing Address	Enter the cosigner’s complete mailing address. Indicate if the mailing address is different from the cosigner’s physical address.
4A Physical Address	Enter the cosigner’s complete physical address if different from the mailing address.
4B County of Residence	Enter the county where the cosigner’s residence is located.
5 Contact Numbers	Enter the cosigner’s home, cell, or business telephone number, as applicable. Indicate cosigner’s best contact telephone number by selecting “Primary” in the applicable box.
6 Applicant	Enter the name of the applicant for which the cosigner is agreeing to cosign for.
7 Birth Date	Enter the cosigner’s date of birth.
8 Social Security Number	Enter the cosigner’s social security number (9 digit number).
9 Name and Address of Employer/ Telephone	Enter the name, address and telephone number of the cosigner’s employer, if applicable.
10 Citizenship	Check applicable citizenship status. If non-citizen national, qualified alien, or refugee, as defined by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), 8 U.S.C. 1641, cosigner must provide copies of appropriate documentation of immigration status, including and not limited, to a current I-551, Naturalization Certificate, or I-688B.
11 Race	Check the appropriate box indicating applicant’s race. More than one box may be checked. Providing applicant’s race is voluntary; however, if applying as a socially disadvantaged applicant based on race, this information is required.
12 Veteran Status	Check the appropriate box indicating applicant’s veteran status.
13 Marital Status	Check the appropriate block depending on whether the applicant is unmarried, separated, or married and applying as an individual applicant.
14 Ethnicity	Check the appropriate box indicating applicant’s ethnicity. Providing applicant’s ethnicity is voluntary; however, if applying as a socially disadvantaged applicant based on ethnicity, this information is required.
15 Gender	Check the appropriate box indicating applicant’s gender. Providing applicant’s gender is voluntary; however, if applying as a socially disadvantaged applicant based on gender, this information is required.
16 For FSA Use Only	Check the appropriate box indicating if information collected was provided or observed.
17 Legal Capacity/ Authority	Check the appropriate box to indicate if the cosigner has the legal capacity, age, mental capacity and authority to enter into a legal binding agreement.
PART B – Notifications, Certifications and Acknowledgement for the Cosigner Items 1 – 12 are completed by the cosigner.
1 Business Under Other Name	Check “YES” if you ever conducted business under any other name; otherwise check “NO.”  If “YES,” provide the names used in Item 8.
2 Previous FSA or FmHA Loans	Check “YES” if you ever obtained a direct or guaranteed farm loan from FSA or the Farmers Home Administration; otherwise check “NO.”
3 Debt Forgiveness	If Item 2 is “YES,” check “YES” if the government ever forgave any debt through write-down, write-off, compromise, adjustment, reduction, charge-off, paying a loss on a guarantee, or bankruptcy.  If “YES,” provide details in Item 8; otherwise check “NO.”
4 Delinquent on Federal Debt	Check “YES” if you are delinquent on any federal debt (i.e. “Federal Debt” includes but is not limited to education loans, delinquent taxes, obligations to Natural Resources Conservation Service, obligations to FCIC, etc., or have an outstanding Federal judgement).  If “YES,” provide details in Item 8; otherwise check "NO."
5 Pending Litigation	Check “YES” if you are involved in any pending litigation.  If “YES,” provide details in Item 8; otherwise check “NO.”
6 Bankruptcy	Check “YES” if you have ever been in receivership, been discharged, or filed a petition for reorganization in bankruptcy.  If “YES,” provide details in Item 8; otherwise check “NO.”
7 Employee Relationship	Check “YES” if you are an employee, related to an employee, or closely associated with an employee of the Farm Service Agency. If “YES,” provide details in Item 8; otherwise check “NO.”
8 Additional Answers	Provide explanations to any “YES” responses to Items 1 - 7.  Use additional sheets if necessary.
9 - 12 Statements	Read statements and certifications in Items 9 - 12.
PART C – Certification and Cosigner Signatures Items 1A and 1B are completed by the cosigner.
1A Signature	Enter the signature of the cosigner.
1B Date	Enter the date the cosigner signed.   If mailing the form, print the form and manually enter your signature.  This form is approved for electronic transmission.  If you have established credentials with USDA to submit forms electronically, use the buttons provided on the form for transmitting the form to the USDA servicing office.  Electronic submission may only be completed if you are the only person required to sign this form.
PART D – FSA Use Only Items 1 – 5 are completed by FSA.

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