Form RD 1951-66 Form Approved

(10-03) OMB No. 0575-0184

FEDWIRE WORKSHEET

(1) Date to Process Wire : ____ -____ - ________

 MM DD CCYY

(2) SENDER F.I. DATA (ODFI) (4) BENEFICIARY DATA (BNF)

(3) FUNDS DATA (OGB) (5) RECEIVER F.I. DATA (RDFI)

 Payor Information

Bank Account No. ____________________________

Name on Acct : _______________________________

Ttl Amt to Wire : $________________________ . ___

 ___________________________________________

 Financial Institution Name

 Routing Transit No.

Financial Institution Name/Address Federal Agency Name/Location/Phone

USDA Rural Development

Cash Management Branch

Mail Code FC 363

P.O. Box 200011

St. Louis, MO 63120-0011

Wire Field Wire Data Tag

Routing Transit No. 021030004 (3400)/Field 1

Financial Institution: TREAS NYC (3400)/Field 2

Business Function Code: CTR (3600)

Beneficiary ID: D (4200)/Field 1

Account: 12200408 (4200)/Field 2

Beneficiary Name: TREASURY (4200)/Field 3

Beneficiary Addr /Line 1: NY (4200)/Field 4

Beneficiary Addr /Line 2: NY (4200)/Field 5

(6) ORIGINATOR to BENEFICARY DATA

Wire Field Wire Data Tag Message for Wire (No spaces between Digits)

 ORG (5000)

 Originator ID 1T Field 1 D

 {Taxpayer ID No.} 2N (-) 7N Field 2 __ __ - __ __ __ __ __ __ __ -

 {Borrower Name} 35T Field 3 ______________________________________

 {Addr/Line1} 35T Field 4 ______________________________________

 {Addr/Line2} 35T Field 5 ______________________________________

 {City/State/Zip} 35T Field 6 __________________________________

 OBI (6000)

 {Borrower Ref./Case No.} Field 1 __ __ - __ __ __ - __ __ __ __ __ __ __ __ __ __

 {Loan Pgm-Amt} 3T Pgm (-) 11D Amt Field 2 __ __ __ - __ __ __ __ __ __ __ __ __ . __ __ /

(/) 3T Pgm (-) 11D Amt __ __ __ - __ __ __ __ __ __ __ __ __ . __ __

 { [Loan Pgm-Amt] } 3T Pgm (-) 11D Amt Field 3 __ __ __ - __ __ __ __ __ __ __ __ __ . __ __ /

(/) 3T Pgm (-) 11D Amt __ __ __ - __ __ __ __ __ __ __ __ __ . __ __

 { [Advice Memo] } 35T Field 4 _______________________________________

Required Info. by Originator: { } / Optional Info. Further Application Instructions: [ ] / Required Sign: ( )

N = Max. Numeric Digits / T = Max. Text Digits / D = Max. Numeric with2 Pos. Decimal

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 0575-0184. The

time required to complete this information collection is estimated to average 30 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.

Privacy Act Statement

The following information is provided to comply with the Privacy Act of 1974 (P.L. 93-579). The information requested on the form is required under

various provisions of title 15 U.S.C. 1601, 12 CFR 205 and 31 CFR 202, for the purpose of providing the authority to the Department of Treasury

to designate financial institutions to collect payments, by electronic means, from your account. The information will be used for identification with

the records of the government agency and the financial institution to direct your payments to the point you authorize.