U.S. USDA Form usda-rd-3550-21
USDA
United States
Department of
Agriculture
Rural Housing Service
Centralized Servicing Center
P, 0. Box 66835
St. Louis, MO 63166
Dear Homeowner:
It is time to review your eligibility for payment subsidy on your Rural Housing Service loan. Your current subsidy
agreement will expire on
. It is essential that you return the information requested in this letter no
later than
, or your payments will increase to your unsubsidized monthly installment. If the necessary
information is received after this date. a new subsidy agreement will not be backdated and you will be responsible
for the full note rate installment until a new agreement is processed.
The amount of subsidy you will receive depends upon your income, the number of persons in your household,
and in some instances, medical, child care. and handicap assistance expenses. The information requested in
this letter is required for us to calculate any assistance for which you qualify.
PLEASE SEND ALL OF THE FOLLOWING DOCUMENTS IN THE ENCLOSED ENVELOPE TO:
USDA Rural Development
Centralized Servicing Center
P.O. Box 66835
St. Louis, Missouri 63166
The following information MUST be provided for you to receive subsidy:
1. INCOME TAX RETURN: IRS 1040 Form -- DO NOT SEND W-2 FORMS
If you are a seasonal worker, send the IRS 1040 and W-2 forms.
If self-employed Schedule C or F with the 1040 Form.
If you do not file, please check 'No' on the front of Form 3550-21.
2. INCOME VERIFICATION:
* TWO MOST RECENT PAY STUBS FOR EACH EMPLOYED ADULT,
* BENEFIT STATEMENT OR AWARD LETTER FROM SOCIAL
SECURITY, UNEMPLOYMENT, SSI, VA, ETC., AND/OR
* DOCUMENTATION OF CHILD SUPPORT ORDERED/RECEIVED.
3. SIGNED AND COMPLETED FORM 3550-21; ''PAYMENT SUBSIDY RENEWAL
CERTIFICATION''. Please send the original; do not send a copy of this form.
4. SIGNED FORM 3550-1, ''AUTHORIZATION TO RELEASE INFORMATION''.
PLEASE NOTE: Only Payment Assistance Renewal Information is to be returned in the
enclosed envelope. All payments must be mailed in the envelope provided with your
billing statement. Mailing payments and other correspondence not related to your Payment
Assistance Renewal to the address above will significantly delay processing of your subsidy
agreement and slow response to your inquiries.
FOR ASSISTANCE CALL 1-800-414-1226
THE RURAL HOUSING SERVICE RESERVES THE RIGHT TO REQUEST FURTHER DOCUMENTATION
BEFORE APPROVING ANY PAYMENT SUBSIDY RENEWAL.
USDA is an Equal Opportunity Lender, Provider, and Employer.
Complaints of discrimination should be sent to: USDA, Director.
Office of Civil Rights, Washington, DC
Form RD 3550-21
Revised 03/98
RURAL HOUSING SERVICE
PAYMENT SUBSIDY RENEWAL CERTIFICATION
Please provide the following information in ink. IF ANY REQUESTED INFORMATION IS NOT PROVIDED,
YOUR PAYMENT SUBSIDY REQUEST CANNOT BE PROCESSED!
The information I have provided is complete and true to the best of my knowledge. I understand that the information
below is being collected to determine if I am eligible to receive payment subsidies and that failure to provide
complete and accurate information can result in criminal and civil penalties.
Borrower Signature
AREA CODE
Home Phone No:
Date
Borrower Signature
Date
AREA CODE
Alternate Phone or Work No:
YOU MUST RETURN THIS FORM (NOT A COPY) BY MAIL. DO NOT FAX!
1. SIGN AND RETURN THE ATTACHED ''AUTHORIZATION TO RELEASE INFORMATION'' FORM 3550-1.
2. PLEASE FILL OUT THE FOLLOWING CHART COMPLETELY:
HOUSEHOLD MEMBER'S
RELATIONSHIP
AGE
FULL NAME; BEGIN
TO THE HEAD
WITH YOURSELF
SELF
SOCIAL SECURITY
NUMBER
FULL TIME DISABLED
STUDENT
YES/NO
YES/NO
3. Yes No
Did anyone living in your household file Federal Income Tax last year?
YOU MUST INCLUDE A COPY OF LAST YEAR'S IRS FORM(S) 1040, 104OEZ, 1040A, PLANILLA DE
CONTRIBUCION, OR TELEFILE TAX RECORDS FOR ALL ADULTS WHO FILE.
DO NOT SEND W-2 FORMS!!!
4. Yes No
ls anyone living in your household self-employed?
IF YES -- YOU MUST INCLUDE A COPY OF LAST YEAR'S FEDERAL INCOME TAX
SCHEDULE FOR C OR F.
5.
$ Amount of Real Estate Taxes due each year.
I am exempt from paying.
6.
$ Amount of Property Insurance paid each year.
I do not have Insurance.
7. ATTACH THE TWO (2) MOST RECENT PAY STUBS FOR ALL JOBS IN YOUR HOUSEHOLD
AND COMPLETE THE FOLLOWING FOR EACH JOB:
.
EMPLOYER
HOUSEHOLD
EMPLOYER ADDRESS
EMPLOYER
AMOUNT OF
PHONE
NAME
MEMBER'S
YEARLY
NUMBER
FULL NAME
INCOME
* * * COMPLETE THE BACK OF THIS FORM * * *