Fillable Va Form 26-6807 - Financial Statement (Page 4 of 4) in pdf

Privacy Act Notice: VA will not disclose information collected on this form to any source other than what has been authorized

under the Privacy Act of 1974 or Title 38, Code of Federal Regulations 1.576 for routine uses (i.e., to service your loan and to

evaluate your application for release of liability and, if applicable, substitution of entitlement) as identified in the VA system of

records, 55VA26, Loan Guaranty Home, Condominium and Manufactured Home Loan Applicant Records, Specially Adapted

Housing Applicant Records, and Vendee Loan Applicant Records - VA, and published in the Federal Register. Your obligation to

respond is required to obtain or retain benefits. Giving us your SSN account information is voluntary. Refusal to provide your

SSN by itself will not result in the denial of benefits. VA will not deny an individual benefits for refusing to provide his or her

SSN unless the disclosure of the SSN is required by a Federal Statute of law in effect prior to January 1, 1975, and still in effect.

Respondent Burden: We need this information to service your loan and to evaluate your application for release of liability and, if

applicable, substitution of entitlement. Title 38, United States Code, allows us to ask for this information. We estimate that you

will need an average of 45 minutes to review the instructions, find the information, and complete this form. VA cannot conduct or

sponsor a collection of information unless a valid OMB control number is displayed. You are not required to respond to a

collection of information if this number is not displayed. Valid OMB control numbers can be located on the OMB Internet Page at

If desired, you can call 1-800-827-1000 to get information

on where to send comments or suggestions about this form.

NOTICE TO APPLICANTS

This is notice to you as required by the Right to Financial Privacy Act of 1978 that the Department of Veterans Affairs Loan

Guaranty Service or Division has a right of access to financial records held by a financial institution in connection with the

consideration or administration of assistance to you. Financial records involving your transaction will be available to the

Department of Veterans Affairs Loan Guaranty Service or Division without further notice or authorization but will not be

disclosed or released to another Government Agency or Department without your consent except as required or permitted by law.

VOLUNTARY INFORMATION FOR GOVERNMENT MONITORING PURPOSES

The information in Items 12A, 12B, 12C, and 13A, 13B, and 13C is requested by the Federal Government to monitor compliance

by VA as a lender with Equal Credit Opportunity and Fair Housing laws. The law provides that a lender may neither discriminate

on the basis of this information nor on whether or not it is furnished.

VA FORM 26-6807, OCT 2004

Va Form 26-6807 - Financial Statement Page 4