FSA-2376 Borrower training course evaluation

OMB Approval No.: 0560-0237

OMB Expiration Date: 12/31/2025

FSA-2376 U.S. DEPARTMENT OF AGRICULTURE Farm Service Agency BORROWER TRAINING COURSE EVALUATION
INSTRUCTIONS: Vendor shall return this completed form to the FSA Office.
PART A – VENDOR INFORMATION
1. Vendor’s Name						2. Course Title
     						     
3A. Address Line 1						4A. Primary Phone Number Home Cell
     						     
3B. Address Line 2						4B. Alternate Phone Number Home Cell
     						     
3C. City	3D. State		3E. Zip			5. Instructor's Name
     	     		     			     
6. Dates of Training Course						7. Location
     						     
PART B - TO BE COMPLETED BY BORROWER
1. The topics covered in class were helpful to me in my business..........		Yes			Partially			No		11. Comments on the strong points of the course:      
2. The coverage of the subject matter was................................................		Excellent			Sufficient			Poor
3. The suitability of the instruction material was..................................		Excellent			Sufficient			Poor
4. The level of the course was.............		Too Advanced			Appropriate			Too Easy
5. The length of the course was ..........		Too Long			Appropriate			Too Short
6. The amount of outside work was......		Too Much			Appropriate			Too Little		12. Comments on the weak points of the course:      
7. The instructor was...........................		Excellent			Good			Poor
8. The facilities were...........................		Excellent			Good			Poor
9. Will you continue to take training courses in financial management if not required?		Yes			Maybe			No
10. Would you recommend this course to other individuals?		Yes			No Comment			No
13A. Applicant’s Signature											13B. Date (MM/DD/YYYY)
     											     
After you have completed this evaluation, please return it to the Vendor.

Privacy Act Statement: The following statement is made in accordance with the Privacy Act of 1974 (5 U.S.C. 552a - as amended). The authority for requesting the information identified on this form is the Consolidated Farm and Rural Development Act, as amended (7 U.S.C. 1921 et. seq.). The information will be used to determine eligibility and feasibility for loans and loan guarantees, and servicing of loans and loan guarantees. The information collected on this form may be disclosed to other Federal, State, and local government agencies, Tribal agencies, and nongovernmental entities that have been authorized access to the information by statute or regulation and/or as described in the applicable Routine Uses identified in the System of Records Notice for USDA/FSA-14, Applicant/Borrower. Providing the requested information is voluntary. However, failure to furnish the requested information may result in a denial for loans and loan guarantees, and servicing of loans and loan guarantees. The provisions of criminal and civil fraud, privacy, and other statutes may be applicable to the information provided.

Public Burden Statement (Paperwork Reduction Act): 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 0560-0237 and is voluntary. The time required to complete this information collection is estimated to average 23 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. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden by emailing to: askUSDA@usda.gov (OMB NO. 0560-0237).

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Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the responsible agency or USDA's TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.

To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at How to File a Program Discrimination Complaint | USDA and at any USDA office or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: program.intake@usda.gov.

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