HUD-92563 Application for Fee or Roster Personnel Designation

Application for Fee or Roster
Personnel Designation

Check One

HUD OMB Approval No. 2502-0538
(exp. 7/31/2009)

U.S. Department of Housing
and Urban Development (HUD)
Department of Veterans Affairs (VA)

VA OMB Approval No. 2900-0113

Respondent Burden: The information you provide will enable the designated agency to determine whether you qualify for designation in the position for which
you are applying. HUD is authorized to collect this information by Title 1, Section 1 of the National Housing Act (Pub. L 479, 48 Statute 1246,12 U.S.C., 1701 et
seq.). VA is authorized to collect this information by Chapter 37, Title 38 U.S.C. Public reporting burden for this collection is estimated at an average of 30
minutes to review the instructions, find the information, and complete this form. These agencies cannot conduct or sponsor a collection of information unless a
valid OMB number is displayed. You are not required to respond to a collection of information if this number is not displayed. Valid OMB numbers can be located
on the OMB Internet page at http://www.whitehouse.gov/library/omb/OMBINVC.html - HUD or http://www.whitehouse.gov/library/omb/OMBINVC.html - VA. If
desired you can call 1-800-827-1000 to get information on where to send comments or suggestions about this form.
Privacy Act Statement: These agencies 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 1.526 for routine uses (for example: Authorized for release of information to Congress when
requested for statistical purposes) identified in the VA systems of records, 17VA26, Loan Guaranty Fee Personnel and program Participant Records, and
published in the Federal Register. Reporting your social security number (SSN) is mandatory. The Housing and Community Development Act of 1987, 42 U.S.C.
3543 authorizes HUD to collect the SSN. VA is authorized to collect this information by Chapter 37, Title 38 U.S.C.
Penalty: The provision of the SSN is mandatory. Failure to provide any of the requested information could affect the decision to approve your application since
this decision will be made only on the basis of available information we currently have on record. This may result in a delay in the processing of your application.
Instructions: Please print clearly. Completed HUD applications must be mailed to the U.S. Department of Housing and Urban Development, Office of Single
th
Family Housing, 451 7 Street SW, Room 9270, Washington, DC 20410 Or via facsimile to 202-401-0416. HUD/FHA appraisers and inspectors may ascertain
the roster status from HUD's web sites at https://entp.hud.gov/idapp/html/apprlook.cfm or https://entp.hud.gov/idapp/html/insplook.cfm?in_fha=No. Completed
VA applications may be submitted electronically or by mail to the VA Regional Loan Center. Completed VA applications may be submitted electronically or by
mail to the VA Regional Loan Center.
Ethnicity and Race: Please provide both ethnicity and race. For race, you may check more than one designation.
Appraisers: The application is to be submitted to HUD only after the appraiser is State licensed or certified with credentials based on the minimum licensing/
certification criteria issued by the Appraiser Qualifications Board (AQB) of the Appraisal Foundation.
Compliance Inspectors: This application is to be submitted to HUD only after the inspector is licensed or certified to inspect repairs and construction, when
such licensing or certification is required by the State or local jurisdiction where work will be performed. Upon availability, all inspector applicants currently
recognized by HUD to conduct inspections must provide evidence of passing the HUD/FHA Inspector Examination.
Designation being applied for:

Real Estate Appraiser

1. Name of Applicant (first – middle – last)

Compliance Inspector

2. Date of Birth (mm/dd/yy)

3. Social Security Number

HUD required / VA Voluntary
3a. Sex
(1) Male
4. Residence Address (number and street or rural route, city or P.O., State, zip code)
5. Telephone Number (include area code)
(2) Female
3b. Ethnicity
(1) Hispanic or Latino
(2 )Not Hispanic or Latino
3c. Race
(3) American Indian or
6. Business Address (address where field reviews are to be sent)
7. Business Phone (include area code)
Alaskan Native
(4) Asian
(5) Black or African
American
(6) Native Hawaiian or
Other Pacific Islander
(7) White
8. Present Occupation
9. Name and Address of Present Employer
10. Education
No. of Years
a. High School
b. College
c. Degree(s) Awarded (if applicable)
11. Special Education or Training, Vocational, Business, or Special courses (Enter course and school name and location)

12. Professional Organizations of which you are a member

14a. Have you been previously approved
by VA or HUD for a Fee Position?
Yes (If “Yes,” complete Items 14b & 14c)
No

All previous editions are obsolete

13. Registration/License Information (Attach copy(ies) of appraisal license)
Kind
Registration/License No.
State Where Issued

14b. Office Name & Address

Page 1 of 3

Expiration Date
(mm/dd/yyyy)

14c. Dates of Fee Activity for VA or HUD
From: (mm/dd/yyyy)
To: (mm/dd/yyyy)

form VA 26-6681
form HUD-92563 (4/2006)
ref Handbooks 4145.1 Rev-2, 4910.1, 4150.1 REV-1, 4905.1 REV-1,
4150.2 CHG-1, Permanent Foundations Guide for Manufactured Housing

15. Geographic Area(s) of Practice (List your appraisal/inspection area(s), by state)

16. Provide an estimate of the number of principal assignments (appraisals or inspections as applicable) during at least the past 5 years. If less than 5 years, provide an
explanation (i.e., not licensed for past 5 years) Attach additional sheet as necessary.
Period (mm/dd/yyyy)
Number of Assignments
Names of Clients or Organizations

17. Employment History During Past 10 Years (attach additional sheet as necessary)
Dates (mm/dd/yyyy)
Occupation
Name of Employer
From
To

Address

18. HUD requires applicants to list three reference contacts only. For VA, List and Submit at least 3 letters attesting to your qualifications
References
Occupation
Address

19. To be completed by HUD applicants only: To avoid the possibility of any conflict of interest and to ensure compliance with HUD appraisal and/ or
inspector roster standards, the following certifications are to be completed by personnel qualified to receive assignments from HUD or HUD approved
lending institutions for HUD/FHA mortgage insurance applications. The term “interest” refers to direct interest as well as any “interest” held by relatives,
business associates, or other controlled persons.
Note: Any of the following items that have been struck out and initialed are exempted from this certificate and are to be explained truthfully in an attached
letter.
(a) I certify that I do not own more than 10% interest in any lender doing business with HUD in the local HUD office jurisdiction.
(b) I certify that I do not actively engage in the management or operation of a lending institution doing business with HUD.
(c) I certify that I will not accept any assignments for fee work in a transaction in which I have an interest.
(d) I certify that I am not currently suspended, debarred, or in any way disqualified from participating in HUD programs.
(e)

For appraisers, I certify that I will comply with HUD Handbook 4150.2, "Valuation Analysis for Home Mortgage Insurance for Single Family One- to
Four-Unit Dwellings" (with particular emphasis on Appendix D, “Valuation Protocol”), any updates to the Handbook, Mortgagee Letters, and all other
instructions and standards, in performing all appraisals on properties that will be security for HUD/FHA insured mortgages.

(f)

For Inspectors, I certify that I have a minimum of three years experience in one or more construction-related fields and that such experience has
equipped me with a thorough familiarity and understanding of residential construction techniques as related to new construction and repairs of a
structural nature. I certify I will conduct my inspections in accordance with HUD/FHA requirements. I further certify that if licensing or certification is
required by the state or local jurisdiction(s) in which I will operate, I will maintain such licensing or certification in good standing with the applicable
jurisdiction for the duration of my tenure on the FHA Inspector Roster. I further certify that I have read and fully understand the inspection
requirements, including any update to those requirements, including Mortgagee Letters, in performing all inspections on properties that will be
security for HUD/FHA insured mortgages and contained in the following documents:
(i) HUD Handbook 4905.1 REV-1 (Requirements for Existing Housing, One to Four Family Units);
(ii) HUD Handbook 4910.1 (Minimum Property Standards for Housing);
(iii) HUD Handbook 4145.1 REV-2 (Architectural Processing and Inspections for Home Mortgage Insurance);
(iv) HUD Handbooks 4150.1 REV-1 (Valuation Analysis for Home Mortgage Insurance) and 4150.2 CHG-1 (Valuation Analysis for Home Mortgage
Insurance for Single Family One to Four Unit Dwellings);
(v) Permanent Foundations Guide for Manufactured Housing (formerly known as HUD Handbook 4930.3G, Permanent Foundations Guide for
Manufactured Housing);
(vi) All applicable local, state, or Council of American Building Officials (CABO) code(s) for the jurisdictions in which I will operate; and
(vii) The HUD requirements at 24 CFR 200.926

(g)

HUD or its authorized agent(s) may inspect my work files at my place of business during normal business hours after providing me reasonable notice
of such inspection.

20a. Number of assignments
you will accept per week

All previous editions are obsolete

20b. or Hours you will work

20c. Maximum No. of assignments
you will accept at one time

Page 2 of 3

20d. Email address

form VA 26-6681
form HUD-92563 (4/2006)
ref Handbooks 4145.1 Rev-2, 4910.1, 4150.1 REV-1, 4905.1 REV-1,
4150.2 CHG-1, Permanent Foundations Guide for Manufactured Housing

20e. To be completed by HUD appraiser applicants only:
HUD published in the Code of Federal Regulations (24 CFR 200.202(b)) a set of eligibility requirements for appraisers seeking placement on
the FHA Appraiser Roster.
Appraisers can check on the Department’s website, under FHA Approved Appraisers, at https://entp.hud.gov/idapp/html/apprlook.cfm, to verify
placement on the FHA Appraiser Roster. Appraisers will not receive a registration conformation if approved. However, HUD will send a denial
letter to appraisers whose applications are determined not eligible, indicating that the appraiser did not meet one or more of the requirements.
20f. To be completed by HUD inspector applicants only:
HUD published in the Code of Federal Regulations (24 CFR 200.171(b)) a set of eligibility requirements for inspectors seeking placement on
the FHA Inspector Roster.
Inspectors can check on the Department’s website under, under Inspectors, at https://entp.hud.gov/idapp/html/insplook.cfm?in_fha=No, to
verify placement on the FHA Inspector Roster. Inspectors will not receive a registration conformation if approved. However, HUD will send a
denial letter to inspectors whose applications are determined not eligible, indicating that the inspector did not meet one or more of the
requirements.
I, the undersigned, understand and agree that:
(a)

The approval of this application does not constitute my appointment as an agent or employee of HUD/FHA or DVA/VA.

(b)

In performing fee work my status is that of an independent contractor.

(c)

My sole interest in all transactions shall be to perform fee assignments as required by HUD or VA standards and criteria.

(d)

An appraisal/inspection is a substantial and material element in the determination of the eligibility of an application for FHA mortgage insurance,
and HUD/FHA will rely upon the accuracy and truthfulness of an appraisal/inspection completed by me in approving any insurance.

Warnings
I hereby certify that to the best of my knowledge all the information stated herein, as well as any information provided in the accompaniment herewith, is
true, accurate, and complete. I further certify that I have read the Warnings set forth below.
Any person who knowingly presents materially false, fictitious, or fraudulent statements in a matter within the jurisdiction of HUD is subject to penalties,
sanctions, or other regulatory actions, including but not limited to:
(i)

Fines and imprisonment under 18 USC 287, 1001, 1010, 1012, which provides for fines of a maximum of $25,000 for individual and $500,000
for organizations of imprisonment for up to 5 years, or both; or
(ii) civil penalties and damages under 31 USC 3729, of not less than $5000 and not more than $10,000, plus 3 times the amount of damages which
the government sustains; and
(iii) administrative sanctions, claims, and penalties by HUD pursuant to 24 CFR Part 24, 28, and 30.
21. Date Signed (mm/dd/yyyy)

22. Applicant’s Signature (do not print, must be legible)

Reviewing Official

Complete the following items
23. This application has been reviewed
24. Date of Action
and I hereby recommend
(mm/dd/yyyy)

Designation

25. Signature of Reviewing Officer

Disapproval

This applicant is being recommended in the county(ies) appraisal areas and/or State shown below
27. State

26. County(ies)

____________________________________________________________________________________________________________________________
All previous editions are obsolete

Page 3 of 3

form VA 26-6681 form HUD-92563 (4/2006)
ref Handbooks 4145.1 Rev-2, 4910.1, 4150.1 REV-1, 4905.1 REV-1,
4150.2 CHG-1,Permanent Foundations Guide for Manufactured Housing