HUD 40076-LGA Loan Guarantee Assistance

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(Exp. 5/31/2008)

Application Kit

Loan Guarantee Assistance
for Places of Worship and
Other Nonprofit Institutions
Damaged by Acts of Arson or
Terrorism

Sponsored by the

U.S. Department of Housing and Urban Development
Office of Community Planning and Development

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Table of Contents
Part I
Introductory Memorandum
Fact Sheet

Part II - Submission Forms
A. Nonprofit Institution, including Places of Worship ("Borrower")
[Documents are to be submitted to Financial Institution]
1. Authorization t to Seek Loan Guarantee
2. Eligibility Statement
3. Certification of Eligible Activities
4. Statement of Sources of Assistance
5. Borrower Certification for Assisted Activities
6. Certification of an Act of Arson - State or Local Official
7. Information Regarding Incident
8. Environment Thresholds
9. Certification - Information on Damaged Property
10. Features of Damaged Structure(s)
11. General Guidelines - Financial Data - Loan Questionnaire
12. Refinancing and Existing Loan
B. Financial Institution
[Documents to be submitted to HUD, along with underwriting analysis of the Financial Institution]
13 Financial Institution Submission Information and Documents
14. Statement of Eligibility
15. Application for Federal Assistance [SF-424]
C. Refinancing
16. Form - Refinancing an Existing Loan

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Part I

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To:

Places of Worship, Other Nonprofit Organizations and Financial Institutions

From:

United.States. Department of Housing and Urban Development
Office of Community Planning and Development

Subject:

Submission Information and Guidance for Loan Guarantee Pursuant to Section 4 of the Church
Arson Prevention Act of 1996

The U.S. Department of Housing and Urban Development (HUD) welcomes your interest in the Loan
Guarantee Recovery Fund. The enclosed materials and information have been prepared to assist your
organization in better understanding the types of assistance available for affected organization and to have indepth information on this loan guarantee program for rebuilding purposes.
For Loan Guarantee Assistance.
Rebuilding assistance from HUD may be obtained in the form of a guaranteed loan. To inform you in more
detail about this program, this Application Kit includes a Table of Contents with a listing of application forms
in Part I this communication, as well as a Fact Sheet and guidelines to the program regulations at 24 CFR 573.
Part II includes forms for submission of a guarantee application.
Actions to be taken by Nonprofit Organization and State or Local Government Official.
Please note that this submission package includes forms to be completed by the Place of Worship or other
eligible nonprofit organization the "Nonprofit" or "Nonprofit Organization") or by a State or local government
official. We note in particular the importance of two of these forms, the Certification of an Act of Arson and
the Features of Damaged Structure(s). The first is to be signed by a State or local official authorized to
investigate possible acts of arson. The Features of Damaged Structure(s) form is to provide to the Financial
Institution and HUD as much information as possible about the structure and property that has been damaged or
destroyed so that an estimate can be made of what it would cost to rebuild, in your local market, the same or
similar structure and related property.
The eligible Nonprofit Organization is to complete the attached forms 1-13, as identified in the Table of
Contacts, and to submit the documents to the Financial Institution as part of its loan request. If the loan
requested is for a refinancing of an existing loan. the Nonprofit should complete the form identified as number
15 in the Table of Contents.

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Fact Sheet
Section 4 Loan Guarantee Recovery Fund
United States Department of Housing and Urban Development
Office of Community Planning and Development
The Loan Guarantee Recovery Fund is a program authorized under Section 4 of the Church Arson Prevention
Act of 1996. Section 4 authorizes HUD to guarantee loans made by financial institutions to certain nonprofit
organizations to finance activities designed to remedy the damage and destruction to real and personal property
caused by acts of arson or terrorism. Regulations governing the Section 4 Loan Guarantee Recovery Fund are
found at 24 CFR part 573. [See also the web site at
http://www.hud.gov/offices/cpd/economicdevelopment/programs/section4/index.cfm.]
An application for a loan guarantee is submitted to HUD by a qualified Financial Institution on behalf of an
eligible Borrower.
"Eligible Borrower" means an organization described in section 501(c)(3) of the Internal Rvenue Code of
1986, as amended, whose property has been damaged or destroyed as a result of an act of arson or terrorism and
that incurs a debt obligation to a financial institution for the purpose of carrying out activities eligible under 24
CFR 573.3. Though the organization may not have sought or obtained a ruling from the IRS under the section,
its purpose must be consistent with that of organizations described therein. [See 24 CFR 573.2]
"Financial Institution" means a lender, which may be a bank, trust company, savings and loan association,
credit union, mortgage company, or other issuer regulated by the Federal Deposit Insurance Corporation, the
Office of Thrift Supervision, the Credit Union Administration, or the U.S. Comptroller of the Currency. A
Financial Institution may also be a Pension Fund. [See 24 CFR 573.2]
"Eligible activities" [See 24 CFR 573.3] include the following activities when certified in accordance with
§573.6(e) that the activity is necessary to address damage caused by an act or acts of arson or terrorism as
certified in accordance with §573.6(f):
(a) Acquisition of improved or unimproved real property in fee or under long term lease.

(b) Acquisition and installation of personal property.
(c) Rehabilitation of real property owned, acquired, or leased by the Borrower.
(d) Construction, reconstruction or replacement of real property improvement.
(e) Clearance, demolition, and removal, including movement of structures to other sites, of buildings,
fixtures and improvements on real property.
(f) Site preparation, including construction, reconstruction, or installation of site improvements,
utilities, or facilities, which is related to the activities described in paragraph (a), (c), or (d) above.
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(g) Architectural, engineering and similar services necessary to develop plans in connection with
activities financed under paragraph (a), (b), (c), or (d) above.
(h) Acquisition, installation and restoration of security systems.
(i) Loans for refinancing existing indebtedness secured by a property which has been or will be
acquired, constructed, rehabilitated or reconstructed, if such financing is determined to be appropriate to
achieve the objectives of the Act and this part.
(j) Other necessary project costs such as insurance, bonding, legal fees, appraisals, surveys, relocation,
and closing costs, which have been paid or incurred by the Borrower in connection with the completion
of the above activities.
Replacement of Damaged Property [See 24 CFR 573.7(a)(4)]
As provided in Section 24 CFR 573.7(a)(4) of the regulations governing the use of the guaranteed loan funds,
HUD may limit loan guarantees to loans financing the replacement of damaged property with comparable new
property.
HUD considers the term “comparable new property” to mean a structure or structure(s) with similar
quantitative and qualitative features as the damaged property. Generally, the comparable new property would
be approximately the same or similar in size, materials, and design as the orginal structure
prior to the arson or terrorism incident. A comparable new property must meet local building codes (as well as
local or national historic property standards, if applicable) and is handicapped accessible.
Where a need can be demonstrated for features not required by the local building codes, such as fire retardent
materials, security systems or the like, HUD may allow up to an additional 20% of the replacement cost of the
comparable new property to be used to defray such additional expenditures. HUD may finance the construction
of a comparable new property larger in square footage than the damaged property. However, a new property
may be permitted to be larger than 20% of the damaged property on a case-by-case basis only where reasonable
growth assumptions can be supported.
Estimating the cost of a comparable new property requires as much knowledge as possible about the damaged
or destroyed property. That knowledge may be gained from one or more of the following sources: (1) original
building plans of the property before the act of arson or terrorism; (2) foundation layout, footprint, drawings or
sketches, surveys, and/or photos of the original structure’s dimensions (total square footage), exterior and
interior materials, equipment and systems (i.e. heat, air and plumbing) that were in place before the property
was damaged or destroyed.
Submission Requirements
Nonprofit Organization.
A nonprofit organization, including a place of worship, applies to a Financial Institution for a loan to to finance
eligible activities. The Financial Institution, in turn, applies to HUD for a guarantee of the loan it will make to
the nonprofit organization. The nonprofit's loan application shall include the following information [See also
forms 1-14 identified in the Table of Contents]:
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o a description of the assistance needed, including eligible activities
o a statement of other funds available to finance the eligible activities;
o a certification from the nonprofit organization that the activities to be assisted resulted from an act of
arson or terrorism;
o a certification by a Qualified Certification Official (QCO) that the damage or destruction to be
remedied resulted from an act of arson or terrorism;
o environmental documentation required under the regulations;
o replacement information on the damage/destroyed structure;
o construction/rebuilding plans for the new structure; and
o other information required by the Financial Institution.
Financial Institution.
A Financial Institution shall sumbit its request for a loan guarantee to HUD. The submission is to include:
o the nonprofit’s loan application;
o a narrative of the Financial Institution’s underwriting standards used in underwriting the nonprofit’s
loan request that includes an analysis of the nonprofit organization’s ability to pay loan debt service
and the value of the collateral assigned or pledged as security for the repayment of the loan. (In
refinancing transactions, advise HUD of any premium or discount to be assessed);
o the interest rate on the loan (which rate shall take into account the value of the HUD guarantee) plus
any fees to be charged; and
o the percentage of the loan for which a guarantee is requested.
Loan Term and Repayment Schedule.
Loans may be guaranteed for up to 20 years with flexible repayment terms.
Underwriting Criteria.
Nonprofits seeking a loan will note that a Financial Institutions may use its usual underwriting standards which
may include a review of:
financial statements for the past 3 to 5 years
the size of the congregation or membership for the past 3 to 5 years
monthly collections or revenues
real and personal property owned and pledged as collateral
a formal cost proposal for construction or rehabilitation of all damaged or destroyed real property
a formal cost proposal or use of loan other than for the construction or rehabilitation of all damaged
or destroyed real property
o property replacement information
o a history of debt service performance or cash flow available from collections and other revenues to
repay the loan
o
o
o
o
o
o

Further Definitions [See also 24 CFR 573.3]
Arson means a fire or explosion causing damage to (or destruction of) real or personal property that a
Qualified Certification Official determines, or reasonably believes, to be deliberately set.

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Terrorism means an act of violence causing damage to (or destruction of) real or peronal property tht
the Secretary or his designee, in consultation with the Federal Bureau of Investigation, determines to be,
or reasonably believes to be, a terrorist act, as defined by applicable Federal law or guidelines.
Qualified Certification Official (QCO) (1) For the purpose of certifying an act of arson. A State or
local official authorized to investigate possible acts of arson. For the purposes of this definition, such an
official is authorized to execute an Official Incident Report or its equivalent. The term “Qualified
Certification Official” also includes HUD, which will consult with the Bureau of Alcohol, Tobacco, and
Firearms of the Department of the Treasury in making its determintations. (2) For the purpose of
certifying an act of terrorism. The Secretary or his designee, in consultation with the Federal Bureau of
Investigation, shall determine whether an act of violence is a terrorist act or is reasonably believed to be
a terrorist act.
Additional Information
For more information contact the HUD Washington, D.C. office at (202)708-2290. Information, including
regulations for the Section 4 Guarantee Recovery Fund, is also available on the web site at
http://www.hud.gov/offices/cpd/economicdevelopment/programs/section4/index.cfm.

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Part II

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Authorization to Seek Loan Guarantee
Certification Authorizing Person(s) to Seek Loan Guarantee Assistance and to Execute
Loan Documents under Section 4 of the Church Arson Prevention Act of 1996
The governing body of [name of Borrower] __________________________________________ (the
"Borrower") has duly adopted or passed as an official act a resolution, motion or similar action authorizing the
below identified person(s) as the official representative(s) of the (church/nonprofit) to submit to a financial
institution for Section 4 Loan Guarantee Assistance an application and amendments thereto and all
understandings and assurances contained therein, and directing and authorizing the person(s) identified as the
official representative(s) of the (church/nonprofit) to act in connection with the application to provide such
additional information as may be required. Such person(s) is also authorized by resolution to execute all
documents necessary or desirable to accomplish the transaction.
Name of Authorized Person

Title

1.

______________________________________

________________________________________

2.

______________________________________

________________________________________

3.

______________________________________

________________________________________

4.

______________________________________

________________________________________

Certification Officials

Signature

Signature

Name

Name

Title

Title

Date

Date

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Eligibility Statement
___________________________________________________________________________________________________________

Eligibility Statement by Nonprofit Entity for Assistance under Section 4 of the Church
Arson Prevention Act of 1996
The Borrower, [name of Borrower] ________________________________________________________ is an
organization described in the following Section 501(c)(3) of the Internal Revenue Code of 1986 as amended:
"Corporations, and any Community chest, fund, or foundation, organized and operated exclusively
for religious, charitable, scientific, testing for public policy, literary, or educational purposes, or to
foster national or international amateur sports competition (but only if no part of its activities
involve the provision of athletic facilities or equipment) for the prevention of cruelty to children or
animals, no part of the net earnings of which inures to the benefit of any private shareholder or
individual, no substantial part of the activities of which is carrying on propaganda, or otherwise
attempting to influence legislation (except as otherwise provided in subsection (h)), and which
does not participate in, or intervene in (including the publishing or distributing of statements), any
political campaign on behalf of (or in opposition to) any candidate for public office."

Signature

Signature

Name

Name

Title

Title

Date

Date

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Certification of Eligible Activities
The governing body of [name of Borrower] _____________________________________________ hereby
certifies that funds to be guaranteed by the U.S. Department of Housing and Urban Development will be used to
finance the following eligible activities which are necessary to address damage or destruction caused by an act
or acts of arson or terrorism as certified under appropriate provisions of the regulations governing the "Loan
Guarantee Recovery Fund."
Activity

Activity To Be Assisted
Yes
No

(a) Acquisition of improved or unimproved real property in fee or under
long term lease.

___

___

(b) Acquisition and installation of personal property.

___

___

(c) Rehabilitation of real property owned, acquired or leased by the Borrower.

___

___

(d) Construction, reconstruction or replacement of real property improvement.

___

___

(e) Clearance, demolition, and removal, including, movement of structures to
other sites, of buildings, fixtures and improvements on real property.

___

___

(f) Site preparation, including construction, reconstruction, or installation of site
improvements, utilities, or facilities, which is related to the activities pursuant
to items (a), (c) or (d) above.

___

___

(g) Architectural, engineering and similar services necessary to develop plans in
connection with activities financed under items (a), (b), (c) and (d) above.

___

___

(h) Acquisition, installation and restoration of security systems.

___

___

(i) Loans for refinancing existing indebtedness secured by a property which has been
or will be acquired constructed, rehabilitated or reconstructed. If' such financing is
determined to be appropriate to achieve the objective of title regulations and the statute. ___

___

(j) Other necessary project costs such as insurance, bonding, legal fees, appraisals,
surveys, relocation, closing costs, etc., paid or incurred by the Borrower in connection
with the completion of the above activities.

___

Signature:

Signature:

Name:

Name:

Title:

Title:

Date:

Date:

___

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Statement of Sources of Assistance
Statement of Sources of Assistance
Sources of Funds

Yes

No

Estimated Amount

Financial Institution (Loan guaranteed by HUD)
Financial Institution (Loan not guaranteed by HUD)
National Council of Churches
Congress of National Black Churches
Borrower/ [Nonprofit/Church] Funds
Private Donations
Insurance Funds
Other

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Borrower Certification for Assisted Activities
Borrower Certification for Assisted Activities as a Result of a Qualified Incident of Arson
or Terrorism
Background
The Church Arson Prevention Act of 1996, Section 4, (P.L. 104-155) authorizes the U.S. Department of
Housing and Urban Development (HUD) to guarantee loans made by financial institutions to certain nonprofit
organizations to finance activities designed to remedy the damage and destruction to real and personal property
caused by acts of arson or terrorism. Prior to HUD's provision of the loan guarantee, the Borrower of funds
from a financial institution seeking a Section 4 Guaranteed Loan must certify that the activities to be assisted by
the Guaranteed Loan are the same activities that are certified to by a Qualified Certification Official, pursuant
to 24 CFR Part 573.6(f).
Summary of Incidence(s) of Arson or Terrorism
The Secretary of HUD or his designee, in consultation with the Federal Bureau of Investigation, shall
determine whether an act of violence is a terrorist act or is reasonably believed to be a terrorist act. The
Borrower is requested to complete the following information to assist in that certification.
1. Description of Real or Personal Property:
2. Address/Location of Real or Personal Property
Street:
City/Town:

State:

Zip Code:

3. Date(s) of Incident(s) of Arson or Terrorism [if exact date is unknown, provide date of first report of
incident(s)]:
4. Brief description of damage to or destruction of the Real or Personal Property described in 1. above and/or
description of act(s) of arson or terrorism:

The Borrower certifies that the activities for which funds are sought are the same activities that are the subject
of the certification provided (or to be provided) by the Qualified Certification Official.
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I am an authorized representative of the Borrower and I am authorized to execute this Certification on behalf of
the Borrower.
Signature of Borrower’s Authorized Official:
Name:
Street Address:
City

State

Zip Code

Definitions:
Borrower means an organization described in section 501 (c) (3) of the Internal Revenue Code of 1986, as
amended, whose property has been damaged or destroyed as a result of an act of arson or terrorism and that
incurs a debt obligation to a Financial Institution for the purpose of carrying out activities eligible under 24
CFR 573 Loan guarantee Recovery Fund.

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Certification of an Act of Arson
(To be completed by a State or Local Official as Qualified Certification Official (QCO))
Background
The Church Arson Prevention Act of 1996, section 4, (P.L. 104-105) authorizes the U.S. Department of
Housing and Urban Development (HUD) to guarantee loans mabe by financial institutions to certain nonprofit
organizations to finance activities designed to remedy the damage and destruction to real and personal property
caused by acts of arson or terrorism. Prior to HUD’s provision of the loan guarantee, a certification must be
provided by a Qualified Certification Official (QCO) that the damage or destruction to be remedied by the use
of the Guaranteed Loan Funds resulted from an act or arson or terrorism.
Description of Incidence(s) of Arson
If the following information is contained in an official incident or other equivalent report that has been
completed, it may be attached in lieu of completing this section. Otherwise, complete the description of the
property and related damage, as well as completing the Certification of an Act of Arson below. Check if
Incident Report is attached.
1. Description of Real or Personal Property:

2. Address/Location of Real or Personal Property
Street:
City/Town:

State:

Zip Code:

3. Date(s) of Incident(s) of Arson (if exact date is unknown, provide date of first report of incident(s)):

4. Brief description of damage to or destruction of the Real Personal Property described in item 1. above:

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Certification of Qualified Certification Official
I, (enter name) _________________________________, have determined or reasonably believe that the
damage or destruction to the real or personal property described on the front was deliberately set.
I am a State or local official authorized to investigate possible acts of arson and am authorized to execute an
Official Incident Report or its equivalent.
Signature:
Name: ________________________________
Title:
Agency/Office:
Street:
City: _________________________________________ State: __________ Zip Code: ___________
Telephone:
Definitions:
1. Arson means a fire or explosion causing damage to (or destruction of) real or personal property that a
Qualified Certification Official determines, or reasonably believes, to be deliberately set.
2. Qualified Certification Official (QCO)
(a) For the purpose of certifying an act of arson. A State or local official authorized to investigate possible
acts of arson. For the purposes of this definition, such an official is authorized to execute an Official
Incident Report or its equivalent and may be an official or employee of such agencies as the local fire
department, the local police department, or the State Fire Marshall’s Office or its equivalent. The term
"Qualified Certification Official" also includes HUD, which will consult with the Bureau of Alcohol,
Tobacco, and Firearms of the Department of the Treasury in making its determinations.
(b) For the purpose of certifying an act of terrorism. The Secretary or his designee, in consultation with the
Federal Bureau of Investigation, shall determine whether an act of violence is a terrorist act or is
reasonably believed to be a terrorist act.
3. Terrorism means an act of violence causing damage to (or destruction of) real or personal property that the
Secretary or his designee, in consultation with the Federal Bureau of Investigation, determines to be, or
reasonably believes to be, a terrorist act, as defined by applicable Federal law or guidelines.

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Information Regarding Incident
To assist in determining or better understanding why your organization's property was damaged or destroyed by
fire, please provide any information (copies of newspaper articles, police reports or other accounts you or others
may have) which might help to document the motivation or likely reason ( i.e. religious hatred ) this incident
took place.

List of information attached:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Additional Comments:

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Environmental Thresholds
HUD will need your assistance to determine whether an environmental assessment is required in connection
with your rebuilding initiative. In providing this assistance, we encourage you to use the expertise of
architectural and engineering consultants who should answer the list of questions on environmental factors.
They may also provide information in their plan narratives as to how their construction plans conform with the
environmental factors. Have these consultants assist you in answering the questions below for submission with
your application to the Financial Institution.
In addition to assistance from an architect or engineer in answering the questions below, you can use qualified
data sources to obtain relevant environmental information about the property you are rebuilding. A qualified
data source includes any Federal, State, or local agency with expertise or experience in environmental
protection (e.g., the local community development agency; the local planning agency; the State environmental
protection agency, or the State Historic Preservation Officer) or any other source qualified to provide reliable
information on the particular property.
Answer either Section A or Section B.
A. For rebuilding plans involving minor rehabilitation of a building and acquisition of any property, please
answer the following questions.
Please answer the following questions:

Yes

No

(1) Is the property to be assisted located within designated coastal barrier resources?

___

___

(2) Is the property contaminated by toxic chemicals or radioactive materials?

___

___

(3) Is the property located within a floodplain?

___

___

(4) Is a building involved for which flood insurance protection is required?

___

___

(5) Is the property located within a runway clear zone at a civil airport or within
a clear zone or accident potential zone at a military airfield?

___

___

(6) Is the property listed on, or eligible for listing on, the National Register of
Historic Places; located within, or adjacent to, an historic district, or is a
property whose area of potential effects includes a historic district or property?

___

___

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B. For rebuilding plans involving major rehabilitation of a building or for new construction or rebuilding, an
environmental assessment under NEPA is required.
Please answer the following questions:

Yes

No

(1) Does the property affect coastal zone management?

___

___

(2) Is the property located near hazardous industrial operations,
handling fuels or chemicals of an explosive or flammable nature?

___

___

(3) Does the property affect a sole source aquifer?

___

___

(4) Does the property affect endangered species?

___

___

(5) Is it located within a designated wetland?

___

___

(6) Is it located in a high noise area?

___

___

Signature:
Name:
Title:
Agency/Organization/Firm:

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Certification: Information on Damaged Property
Name of Church/Nonprofit:
Date of Incident:
To help ensure the best estimation of the cost to replace the property damaged or destroyed by arson, the
following information is requested:
Option I. If available, please provide photos of the property prior to and after the arson damage. Also
provided the original building plans, foundation layout, footprint, other drawings, sketches and/or surveys of
the original structure.
Also, please check which of the following enhancement features will be part of your rebuilt structure:
Fire Retardent Materials
Security Systems
Life and Safety Improvements

Handicap Accessibility Features
Energy Conservation Items

Option II. If the items requested under Option I are not available, please answer the questions below and
complete the chart to identify quantitative and qualitative features of the property prior to its damaged or
destruction. You are welcome to add comments in narrative form to elaborate or explain any feature(s) of the
property.
What was the gross square feet of the original structure(s)?
Was the damage limited to one structure or more? Please explain.
Were additions made to the original structure?
Dates of those additions?

Yes____

No____

What was the seating capacity of the former structure?
Do you anticipate any unusual site improvements or landscaping at the site to prepare it for the new structure?
Please explain.
Will any special utilities (i.e.,water, sewer) be brought to the site for the new property? Please explain.
Will you be assessed any special fees by the city/county as part of the cost of rebuilding? Please explain.

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Features of Arson-damaged Structure(s)
Exterior Wall: Circle the primary type or combination:
Wood-Frame

Solid Masonry

Hollow Cinder Block

Brick Veneer

Stucco

Wood Siding

Vinyl Siding

Aluminum Siding

Brick

Other

Tile

Other

Roofing Material: Circle the primary type or combination:
Asphalt

Gravel

Shingle

Interior Features: Mark the interior features and provide information requested:

Features

Was part
of original
structure

Was not part
of original
structure

Square feet

Other information
required

-------------------------------------------------------------------------------Sanctuary

Ceiling Height*

Choir Seating
Pastor’s Office
Church Office

Ceiling Height*

Choir Room
Fellowship Hall
Kitchen
Dining Hall
Rest Rooms
Class Rooms
Nursery
A/C
Heating
Security System
Stain Glass Windows
Basement (Circle one)

Partial Full None

Floor Type?
* Height of ceilings impact cost, so please explain.

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General Guidelines - Financial Data
The examples below are possible items of information the financial institution may request from
nonprofit organizations seeking a loan to be guaranteed by HUD:
1. Financial Statements for the last two years and year-to-date.
a. Income Statement showing income received and disbursed. (Weekly information may need to be
summarized, or submit the organization's annual report).
b. Balance Sheet showing assets, liabilities, etc.
2. A brief history of when the organization was founded; how it developed over the years and its incorporation
status.
3. Size: now and over the next 3 to 5 years.
4. Projected revenues based on active membership and expected future active members.
5. Basis for the amount of loan funds requested.
6. Profile of the organizational structure.
7. History of debt or recent debt account(s) paid and an authorization for the bank to obtain a copy of this
information from a credit agency or have a credit agency send such information to the organizations which
would in turn send the credit report to the bank. In lieu of this, the bank may accept credit applications on
certain members.
8. An environmental report on the building assessing termites, asbestos, and other possible contamination
conditions.
9. An appraisal of the property preferably by an MIA appraiser with local area experience.

Items to consider prior to seeking a loan from a bank.
General Information
Name of organization:
Legal structure (Corporation, Partnership, Other):
Is the organization incorporated under the laws of State where located? Yes ___ No ___
Address:
Telephone:

form HUD-40076-LGA (2/2006)

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OMB # 2506-0159
(Exp. 5/31/2008)

Name of Primary contact
Tax ID number
Inception date of organization
Length of time at current location
Number of worship services held per week
When are offerings collected
Seating capacity of current facility
Name of head clergyman
Length of time with organization
Full or part time
Age of head clergyman
Names of other staff clergyman
Member of denomination body, if any?
How is body structured?

Contributions to body annually, if any?
What committee is in charge of financial related affairs?
What committees are in charge of other decisions?
What is the length of service for persons involved in decision making functions ?

__________________________________________________________________________________________
Financial Information
Copy of financial statement
Fiscal Year
Operating Budget
Actual Operating Income
Membership
Giving Units (family units or single, employed adults)
Average Worship Attendance
Average Sunday School Attendance

form HUD-40076-LGA (2/2006)

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OMB # 2506-0159
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Breakdown of Current Membership:
Under 18
18-25
25-35
35-45
45-55
55-65
65 +
When was the membership list last purged
List the individual amount given by your top ten donors:
1 $_________ 2 $__________ 3 $ __________ 4 $ ___________ 5 $ _____________
6 $ _________ 7 $__________ 8 $ __________ 9 $ ___________ 10 $ ____________
Please provide a summary of any borrowings or capital additions completed in the last ten years.
Property Information
How many acres do you currently own?
Square footage of current facility
Date facility acquired
List a description, year completed, and cost of any improvements

and cost $

How far to the nearest associated church? ________________________________________________________
Project Information (Please attach all permanent budget, drawings, etc. ) Please describe the current project
(square footage, number of buildings, etc.)
Who is the architect?
Who is the contractor?
What is the total cost of the project?
Construction
Soft cost
Furniture Fixtures
Contingency
Land
Interest during construction
What is the amount of the loan request?
form HUD-40076-LGA (2/2006)

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OMB # 2506-0159
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What is the estimated length of construction?
Are you/will you be involved in a special fund
raising campaign for the project?
What is/was the start date?
What is/was the length of the campaign?
How much is pledged to date?
How much has been collected to date?
Please list any pledges over $25,000?
Did you/will you use a professional fund raiser?
If yes, which one?
Is the following insurance coverage in place?
Fire
Yes ___
Vandalism
Yes ___
Will this coverage remain in force? Yes ___
Have all necessary local permits
been received?
Yes ___

No ___
No ___
No ___

Yes ___ No ___
______________________________
______________________________
______________________________
______________________________
______________________________
Yes___ No___

Extended Coverage Yes___ No___
Malicious Mischief Yes___ No___

No ___

Does the organization understand that in the mortgage there will be a clause that, in the event the organization
ceases to cooperate with the local association in which the organization is located or affiliated, or if the property
should be sold, leased or otherwise disposed of, the remaining indebtedness will become due and payable
immediately?
Yes ___ No ___
Additional Information Requested:
1.
2.
3.
4.
5.

Resume from head clergyman
Brief history of organization
Last 5 years fiscal year end statements
Current budget
Operating projections for the next three years

form HUD-40076-LGA (2/2006)

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OMB # 2506-0159
(Exp. 5/31/2008)

Refinancing an Existing Loan
The Borrower shall provide to the lender, along with other required loan application documents, a statement
that the nonprofit is requesting a refinancing of its guaranteed loan. The nonprofit should also document that
the funds from the original loan were used to carry out eligible activities described in 24 CFR Part 573 of the
HUD regulations [See also page 5 above for list of Eligible Activities].

form HUD-40076-LGA (2/2006)

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OMB # 2506-0159
(Exp. 5/31/2008)

Financial Institution - Information to HUD
Section 4 Loan Guarantee Recovery Fund
The following information is to be submitted by the Financial Institution from whom the nonprofit is seeking a
loan to be guaranteed by HUD.
1. A statement that the organization is regulated by the FDIC, the Office of Thrift Supervision, Credit Union
Administration or the U.S. Comptroller of the Currency.
2. The Nonprofit/Church's application documents.
3. A narrative of the underwriting standards used to review the Nonprofit's loan request that includes an
analysis of the Nonprofit organization's ability to pay debt service and the value of the collateral assigned or
pledged as security for the repayment of the loan. (In connection with a refinancing, advise HUD of any
premium or discount that will be assessed in connection with the refinancing);
4. The term of the loan (up to 20 years): _________________________
5. The interest rate to be charged: ______________________________
6. Any fees to be charged: ____________________________________
7. The percent of the loan HUD is to guarantee: ___________________

Statement of Eligibility of Financial Institution
To be submitted by the Financial Institution

The ______________________________________ is a financial institution as defined by 24 CFR Section
573.2, which is regulated by the FDIC, the Office of Thrift Supervision, Credit Union Administration or
the U.S. Comptroller of the Currency.
Signature:
Name:
Title:

Date: ________________________

form HUD-40076-LGA (2/2006)

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OMB # 2506-0159
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Application for
Federal Assistance

1. Type of Submission
Application

Preapplication

U.S. Department of Housing
and Urban Development

OMB Approval No.2501-0017
(exp. 03/31/2005)

2. Date Submitted

4. HUD Application Number

3. Date and Time Received by HUD 5. Existing Grant Number
6. Applicant Identification Number

7. Applicant's Legal Name

8. Organizational Unit

9. Address (give city, county, State, and zip
code)
A. Address:
B.
City:
C.
County:
D.
State:
E. Zip Code:

10. Name, title, telephone number, fax number, and e-mail of the
person to be contacted on matters involving this application
(including area codes)
A. Name:
B. Title:
C. Phone:
D. Fax:
E. E-mail:
12. Type of Applicant (enter appropriate letter in box)

11. Employer Identification Number (EIN)

A. State
B. County
C. Municipal

13. Type of Application
New

Continuation

Renewal

E. Interstate
F. Intermunicipal

I. University or College
J. Indian Tribe
K. Tribally Designated Housing
Entity (TDHE)
L. Individual
M. Profit Organization
N. Non-profit

G. Special District

O. Public Housing Authority

Revision D. Township

If Revision, enter appropriate letters in
box(es)
A. Increase Amount B. Decrease Amount C. Increase
Duration
D. Decrease Duration E. Other (Specify)

15. Catalog of Federal Domestic Assistance (CFDA)
Number
1 4 --Title:
Component Title:
17. Areas affected by Program (boroughs, cities,
counties, States,
Indian Reservation, etc.)

H. Independent School
P. Other (Specify)
District
14. Name of Federal Agency
U.S. Department of Housing and Urban Development
16. Descriptive Title of Applicant's Program

form HUD-40076-LGA (2/2006)

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18a. Proposed Program start 18b. Proposed Program
date
end date

19a. Congressional Districts of 19b. Congressional Districts of
Applicant
Program
20. Estimated Funding: Applicant must complete the Funding Matrix on Page 2.
21. Is Application subject to review by State Executive Order 12372 Process?
A. Yes
This preapplication/application was made available to the State Executive Order 12372 Process for review on:
Date__________
B. No
Program is not covered by E.O. 12372
Program has not been selected by State for review.
22. Is the Applicant delinquent on any Federal
No
debt?
Yes If "Yes," explain below or attach an
explanation.

Form HUD-424 (01/2003)
Ref. OMB Circular A-102

form HUD-40076-LGA (2/2006)

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