HUD-11701-D Title II Mortgagee Annual Verification Report

Title II Mortgagee Annual Verification Report

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

OMB Approval No. 2502-0005 (exp. 10/31/2006)

Instructions: Review the preprinted data listed on your company below and correct as necessary via the FHA Connection. Execute the certification and follow instructions provided below for submission of this report.

Mortgagee Number: ____________Office ID: ____________ Mortgagee Name: ___________________________________ Doing Business As: _________________________________ GNMA ID: ______ Title I ID: _____________		Report Date: ________________ Approval Date: ______________
Telephone Number: __________________ Tax ID: ___________________ Mortgagee Type: ____________________ Fiscal Year End: ____________ Institution Type: _____________________ Supervising Agency: __________________ Servicing/Origination Status: ___________
Sponsor, Loan Correspondent and Branches: Review/Update Sponsors, Loan Correspondents and Branches via FHA Connection	Approved HUD Jurisdictions and Mortgagee Addresses: Review jurisdiction data via FHA Connection. Review/Update Address Data via FHA Connection
Geographic Address:	Conditional/Firm Commitment Address:
Mailing Address:	Endorsement Address:
Premium Billing Address:	Payee Address:
Recertification Fee: (Pay this fee using Pay.gov via of your company’s FHA Connection account) Home Office @$500 ____ Approved Branches @ $200 ea ____ Total Payment Due: ____	Return one signed copy of this report to: HUD Office of Lender Activities 451 7th Street SW Room B-133/P3214 Washington, DC 20410
I certify that none of the principals, owners, officers, directors, and/or employees of the above named mortgagee are currently involved in a proceeding and/or investigation that could result, or has resulted in a criminal conviction, debarment, limited denial of participation, suspension, or civil money penalty by a Federal, State, or local government. I certify that the above named mortgagee has not been refused a license and has not been sanctioned by any State(s) in which it originates and or services HUD-FHA insured mortgages. I know, or am in the position to know, whether the operations of the above named mortgagee conforms to HUD-FHA regulations, handbooks and policies. I certify that to the best of my knowledge, the above named mortgagee conforms to all HUD-FHA regulations necessary to maintain its HUD-FHA approval, and that the above named mortgagee is fully responsible for all actions of its employees including those of its HUD-FHA approved branch offices. _________________________________ ________________________________ (signature) Printed Name President ___ Vice President ___ ______________________ _______________________ ________________________ Date Phone Number Fax Number

Public Reporting Burden for this collection of information is estimated to average .10 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. The information requested on this form is required by 24 CFR Part 202. The information collected assists FHA in determining which lenders should be approved to participate in the FHA single and multifamily insurance programs. It is used to help FHA minimize its risk in insuring single family and multifamily mortgages to minimize its risk. Applicants are not required to respond to this collection of information unless a currently valid approved OMB control number is displayed.

Form HUD-11701-D (1/25/2005)