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Appendix 3 

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APPENDIX 3

FORMS REFERENCED IN THIS HANDBOOK

Below is a list of forms that are mentioned in the text of this handbook. Since the Rural 

Development forms may change more frequently than the handbook, users are 

encouraged to obtain the most updated copy of these forms from the Rural Development 

Resources home page (https://www.rd.usda.gov/resources) for their own reference.

Form AD-425, Contractor’s Affirmative Action Plan for Equal Employment Opportunity 

Form AD 1047, Certification Regarding Debarment, Suspension and Other 

Responsibility Matters – Primary Covered Transactions 

Form AD 1048, Certification Regarding Debarment and Suspension: Ineligibility and 

Voluntary Exclusion – Lower Tier Covered Transactions

Form ASTM Standard E-1528 (TSQ), Transaction Screen Questionnaire 

Form FEMA 81-93, Standard Flood Hazard Determination 

Form HUD 935.2, Affirmative Fair Housing Marketing Plan 

Form IRS 8609, Low-Income Housing Credit Allocation Certification 

Form RD 400-1, Equal Opportunity Agreement 

Form RD 400-3, Notice to Contractors and Applicants 

Form RD 400-4, Assurance Agreement

Form RD 400-6, Compliance Statement 

Form RD 410-7, Notification to Applicant on Use of Financial Information from 

Financial Institution

Form RD 410-9, Statement Required by the Privacy Act

Form RD 440-34, Option to Purchase Real Estate Property 

Form RD 1910-5, Request for Verification of Employment 

Form RD 1910-11, Applicant Certification Federal Collection Policies for Consumer or 

Commercial Debts

Form RD 1924-6, Construction Contract 

Form RD 1924-7, Contract Change Order 

Form RD 1924-9, Certification of Contractor’s Release 

Form RD 1924-10, Release by Claimants 

Form RD 1924-12, Inspection Report 

Form RD 1924-13, Estimate and Certificate of Actual Cost

Form RD 1924-16, Record of Pre-Construction Conference 

Form RD 1924-18, Partial Payment Estimate 

Form RD 1924-19, Builder’s Warranty 

Form RD 1924-25, Plan Certification

Form RD 1927-5, Affidavit Regarding Work of Improvement 

Form RD 1940-20, Request for Environmental Information 

Form RD 1940-22, Environmental Checklist for Categorical Exclusions

Form RD 2006-38, Civil Rights Impact Analysis 

Form RD 3550-6, Notice of Special Flood Hazards, Flood Insurance Purchase 

Requirements, and Availability of Federal Disaster Relief Assistance

Form RD 3560-7, Multiple Family Housing Project Budget/Utility Allowance 

(02-24-05) SPECIAL PN

Revised (03-31-21) SPECIAL PN
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Form RD 3560-8, Tenant Certification 

Form RD 3560-9, Interest Credit and Rental Assistance Agreement 

Form RD 3560-13, Management Certification 

Form RD 3560-25, Initial Request for Rental Assistance or Operating Assistance 

Form RD 3560-29, Notice of Payment Due Report 

Form RD 3560-30, Certification of No Identity of Interest (IOI)

Form RD 3560-31, Identity of Interest Disclosure/Qualification Certificate

Form RD 3560-33, Loan Agreement 

Form RD 3560-34, Loan Agreement 

Form RD 3560-35, Loan Resolution 

Form RD 3560-37, Previous Participation Certification 

Form RD 3560-38, Application for Cooperative Housing Membership 

Form RD 3560-51, Obligation Fund Analysis 

Form RD 3560-52, Promissory Note 

Form RD 3560-53, Cancellation of U.S. Treasury Check and/or Obligation 

Forms SF-100, Equal Employment Opportunity Employer Information Report EEO-1 

Form SF 424, Application for Federal Assistance