HUD-92013-E Supplemental Application and Processing Form housing for

Supplemental Application
and Processing Form
Housing For The Elderly/Disabled

OMB Approval No. 2502-0029
(exp. 05/31/2006)

U.S. Department of Housing
and Urban Development
Office of Housing
Federal Housing Commissioner

See Instructions on pages 2 & 3
Project Name

A. Non-Rent Congregate Living Space
1. Congregate Kitchen and Dining
2. Lobbies
3. Community Room
4. Hobby Shop
5. Infirmary or Health Facility
6. Other
7. Other
8. Total Square Feet
B. Project Composition
1. Number of
Bedrooms

2. Total No.
of Units

Area Square Feet

3. No. of Units
With Kitchens

4. No. of
Units with
Kitchenettes

0-Bedroom Units
1-Bedroom Units
2-Bedroom Units
C. Food Service
1. Payroll
Number of cooks
x salary
$
Number of waitresses
x salary
$
Number of helpers

Annual Expense
Sponsor
___________
___________
___________
___________
___________

x salary
$ ___________
2. Food Cost
3. Supplies
4. Dining Room Furniture Exp.
a. Repl. Res: 10% x
Equip. Cost
$ ___________
b. Int: on Inv: ____%
Int. Rate x Cost $ ___________
c. Maintenance and Repairs
5. Other (Specify)
6. Other (Specify)
7. Total Food Service Expense
8. Average No. of Persons Serviced ______
9. Proposed Charger per Person per Month
10. No. of Meals per Person per Day _____

HUD

Congregate
Mixed
Non-Congregate
E. Health Service
1. Nursing Payroll
Number of Nurses
___________
x salary
$ ___________
2. Equipment Expense:
a. Repl. Res: 10% x
Equipment Cost $ ___________
b. Int. on Inv.: _____%
Int. Rate x Cost $ ___________
c. Maintenance and Repairs
3. Medical Supplies
4. Utilities
5. Laundry Service
6. Other (Specify)
7. Total Health Service
8a. No. of Beds In Infirmiry _________
8b. No. of Persons Serviced__________
9. Proposed Charge per Mo. per
Patient ______ per Person _______

$ ___________

$ __________

F. Furniture in Units

$ ___________

$ __________

$ ___________
$ ___________
$ ___________

$ __________
$ __________
$ __________

1. Furniture Exp. when Leased
2. Furniture Exp. if Not Leased:
a. Repl. Res: 10% x Furniture
Cost $ _________
b. Int. on Inv: _____ % Int.
Rate x Cost $ __________
3. Total Furniture Expense
4. Number of Units Furnished ________
5. Proposed charge per unit per month
to cover furniture rent

$ ___________

$ __________

$ ___________
$ ___________
$ ___________
$ ___________
$ ___________

$
$
$
$
$

$ ___________

$ __________

D. Maid Service
1. Payroll
Number of maids
_____________
x salary $ ____________ $
2. Supplies
$
3. Other (Specify)
$
4. Other (Specify)
$
5. Total Maid Service
$
6. Average Number of Units
Using Service
___________ $

__________
__________
__________
__________
__________

Annual Expense
Sponsor
HUD
____________
____________
____________
____________
____________

$
$
$
$
$

__________
__________
__________
__________
__________

Project Number

Annual Expense
Sponsor
$ ___________

$ ____________

$ ___________

$ ____________

$ ___________
$ ___________
$ ___________
$ ___________
$ ___________
$ ___________
$ ___________

$
$
$
$
$
$
$

$ ___________

$ ____________

____________
____________
____________
____________
____________
____________
____________

Annual Expense
HUD
Sponsor
$

$

$

$

$
$
$

$
$
$

$

$

G. Other Non-Shelter Services
1.
2.
3.
4.
4.
6.

HUD

Program & Activities Payroll
Other (Specify)
Other (Specify)
Chg. per Person (Unit) for Item 1
Chg. per Person (Unit) for Item 2
Chg. per Person (Unit) for Item 3

$
$
$
$
$
$

Annual Expense
Sponsor
HUD
__________
$ ___________
__________
$ ___________
__________
$ ___________
__________
$ ___________
__________
$ ___________
__________
$

Official Use Only

____________ $ __________

7. Proposed Charge per Unit per Month $ ____________ $ __________
H. Remarks & Signatures
Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)
The above estimates in "Sponsor'' column for Sections C through G represent estimates of income and expense in non-shelter budgets.
Signed

Date (mm/dd/yyyy)

Valuation Processor

Date (mm/dd/yyyy)

Sponsor

Replaces FHA 2013-E

Page 1 of 2

Reviewer

Mortgagor

Borrower

Owner

Date (mm/dd/yyyy)

form HUD-92013-E (5/93)
ref. Handbooks 4571.1, 4571.2, 4571.3, 4571.4, & 4571.5

Public reporting burden for this collection of information is estimated to average 8 hours 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. This is part of the basic application package for insured mortgages for construction of rental housing
projects. This is a requirement under Section 207(b) of the National Housing Act (Public Law 479, 48 Stat. 1246, 12 U.S.C., 1701 et. seq.), authorizing the Secretary of HUD to insured mortgages.
The information will be used by the Department to analyze specific information to determine the feasibility of a proposed multifamily project and mortgagor/contractor acceptability. The information
is required to obtain benefits.

General Instructions
Form HUD-92013E must accompany form HUD92013, Application–Project Mortgage Insurance,
for each project intended to provide housing for
the elderly or the disabled.
Preparation of the forms HUD-92013 and HUD92013E must separate the budget for shelter
(and utilities included in the rent) from other
budgets concerned with supplying services other
than shelter, such as food service, main service,
program and recreation service, rented furniture,
and any other non-shelter services which may be
planned. The non-shelter budgets concerned
with supplying food, furniture, maid service, and
other personal services are shown on the form
HUD-92013E.
All non-shelter services and amenities offered
with a charge to the tenant and as a condition of
occupancy must be identified on this form. Special circumstances regarding items to be included in an amenity package such as additional
charges for additional persons that cannot be
readily shown on this form must be explained on
an addendum sheet to the form HUD-92013E.
Form HUD-92013E must accompany all requests for
feasibility analysis, conditional and firm commitments.

Definitions
An elderly person is defined as one who is age 62
or over. A disabled person is one whose impairment (a) is expected to be of continued and
indefinite duration; (b) substantially impedes his
ability to live independently; and (c) is such that
his ability to live independently could be improved by more suitable housing. (See appropriate
program regulations for more detailed definitions.)
Congregate Housing is designed for persons,
normally well and ambulatory, who prefer residential accommodations but need some assistance in day-to-day living. While not a nursing or
medical facility, it offers services that protect
residents and provide for their needs.
Congregate housing projects have a central dining room generally serving three meals a day,
with emergency room service available. There
are common areas for lounges, recreation, special activities; limited housekeeping and laundry
services may be provided. Some projects have
an infirmary with personnel qualified to control
and administer medications.

Instructions
Projects having congregate dining facilities with
only kitchenettes in the living units, are checked
in the box marked ''Congregate.'' Projects having
no congregate dining facilities, but having full
sized kitchens in the living units are checked in
the box marked ''Non-Congregate.'' Projects having congregate dining facilities and having some
living units with complete sized kitchens, are
checked in the box marked, ''Mixed.''
Section A. Non-Rent Congregate Living Space
Areas
Enter the net area, in square feet, for various
kinds of non-rent congregate living space shown,
such as, congregate kitchen and dining, lobbies,
community rooms, hobby shop, infirmaries, or
other non-rented common buildings area. When
plans are available, these net areas should be
calculated from the plans. Congregate dining
facilities should be large enough to serve the
probable total number of diners within a single
meal period, but not necessarily at a single
Replaces FHA 2013-E

sitting. The number of diners shall be estimated
to include all of the occupants of the units having
kitchenettes only, plus a reasonable portion of
the occupants of units with full kitchens.
Section B. Project Composition
For each number of bedrooms enter in Column 2
the total number of units. In Column 3, enter the
number of units with complete kitchens. In Column
4, enter the number of units with kitchenettes only.
Non-Shelter Income and Expense Budgets.
Sections C through G contain budgets of income
and expense for furnishing various non-shelter
services. The sponsor enters his estimates of
items of income and expense for each budget in
the column headed ''Sponsor,'' thus using form
HUD-92013E as a supplemental application form.
Subsequently, copies of the same form will be
used as a processing form, with HUD personnel
entering estimates in the Column headed, ''HUD.''
Section C. Food Service: Annual Expenses.
Line C-1– Estimate the number of cooks times the
average annual salary. The number of waitresses,
and other employees needed to operate the dining
room are also estimated to arrive at payroll, including payroll tax. When the food service operation is
large or complex, a detailed explanation of kinds of
staff, numbers of employees, rates of pay, payroll
tax, and total payroll for food service, should be
shown in an attachment. The annual food cost and
cost of supplies is also entered.
Line C-4a.–Dining room furniture expense includes
an annual reserve for replacement of dining room
furniture and equipment. Estimate the replacement
reserve by multiplying furniture cost by 10%.
Line C-4b–Return on investment in dining room
furniture and equipment is estimated by multiplying the furniture cost by the market interest rate
for similar investments.
Line C-4c–Enter the estimated annual allowance
for maintenance and repairs to the furniture.
Line C-7–Show the total annual food service expense.
Line C-8–Estimate the probable number of tenants
customarily using the congregate dining facility.
Line C-9–Enter the proposed charge per person
per month for food service. This charge should be
sufficient to provide an annual income at least 3%
more than the total food service expense estimated
in Line C-7. If a food service concessionaire is
contemplated, the proposed terms of the concession
shall be completely explained in an attachment.
Line C-10–Enter the number of meals per person per
day covered by the proposed food service charge.
Section D. Maid Service: Annual Expense.
Line D-1–Enter the number of mains multiplied by the
average annual salary to result in annual payroll.
Line D-2–Enter the annual expense for cleaning
supplies.
Line D-3 and 4–If clean sheets are to be provided
as part of this service, the word ''Laundry'' is
entered after ''other'' followed by the annual
amount of this expense. Enter other expenses of
supplying maid service.
Line D-5–Enter the sum of Lines D-1 through D-4.
This represents total maid service expense.
Line D-6–Enter the estimated number of units
using this service.
Page 2 of 2

Line D-7–Enter the proposed charge per unit to
cover this service.
Section E. Health Service: Annual Expense.
Line E-1–Enter the anticipated number of nurses
needed times the average salary including payroll tax.
If the health service operation is large or complex, the
sponsor should submit a more detailed estimate of
health service payroll in an attachment.
Line E-2–Equipment expenses includes an annual reserve for replacement of beds and other
furniture and equipment in the infirmary.
Line E-2– Estimate the replacement reserve by
multiplying equipment cost by 10%.
Line E-2b–Return on investment in equipment is
estimated by multiplying the furniture cost by the
market interest rate for similar investments.
Line E-2c–Enter the estimated annual allowance
for maintenance and repairs to the equipment.
Line E-3, 4, 5, and 6–Enter the annual amounts
to be expended for medical supplies, utilities,
laundry or linen service, and other expenses of
the health service facility.
Line E-–Enter the sum of lines E-1 through E-6.
This represents total health service expense.
Line E-8– Enter the number of beds in the
infirmary.
Line E-8–Enter the average number of patients
in the infirmary.
Line E-9–Enter the proposed charge per patient
or per person. Indicate method of payment.
Section F. Furniture in Living Units.
Line F-1–Indicate the amount of total a nnual
payments to the leasing company when furniture
for some or all of the living units is obtained by the
mortgagor by leasing it.
Line F-2a–The renting of furniture by tenant
must be optional and not a condition of occupancy. For those units in which the project owns
the furniture, furniture expense includes an annual reserve for replacement of living unit furniture. Estimate the replacement reserve by multiplying furniture cost by 10%.
Line F-2b–Return on investment in furniture is
estimated by multiplying furniture cost by the
market interest rate for similar investments.
Line F-2–Enter the estimated annual allowance
for maintenance and repairs to the furniture.
Line F-3–Enter the Total Furniture Expense.
Line F-4–Indicate the number of units furnished
by the mortgagor.
Line F-5–Enter the proposed charge per unit per
month to cover the furniture expense.
Section G. Other Non-Shelter Services
Line G-1–Enter the salaries of persons employed to furnish guidance and recreation during
the leisure time of the resident's occupancy in the
project.
Lines G-2 and G-3–Enter the amounts covering
any other service or facility included in the proposal that would contribute to the health, comfort
and recreation of elderly persons, and specify.
Lines G-4, 5 and 6–Enter the charges per person or unit for the respective service of facility.
Section H. Remarks and Signatures
Self Explanatory.

form HUD-92013-E (5/93)
ref. Handbooks 4571.1, 4571.2, 4571.3, 4571.4, & 4571.5