HUD-92090 HUD PAD Authorization

Debt Resolution Program
Preauthorized Debits
HUD PAD Authorization

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

OMB Approval No 2502-0483
(exp. 12/31/2009)

Public reporting burden for this collection of information is estimated to average 15 minutes 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. HUD may not collect this information,
and you are not required to complete this form, unless it displays a currently valid OMB control number.
The Deficit Reduction Act of 1984, P.L. 98-369 (31 U.S.C. 3720) authorizes HUD to collection this information. This information is needed to automatically deduct
payments from the applicant’s bank account. The information is provided on a voluntary basis and will be used by HUD and the financial institution to reduce the
applicant’s debt to the Government. No deduction may be made unless a complete authorization is received.

Important information about HUD PAD
What is HUD PAD? HUD PAD is a convenient method of making monthly payments to HUD. When you select HUD PAD, the amount of your monthly
payment is transferred directly from your financial institution to HUD and credited immediately to your account.
What are financial institutions? Financial institutions include State or Federal Banks, saving and loan associations, mutual savings banks and credit
unions.
How does HUD PAD work? Payments under HUD PAD are made by electronic funds transfer. Shortly before payment is due, HUD will notify your
financial institution of the amount and the due date of the payment. On the due date, that amount will be deducted from your account and
credited to your HUD account.
Do all financial institutions accept HUD PAD? Although the majority of financial institutions accept electronic funds transfer, such as HUD PAD, some
do not. You should contact your financial institution to ask if they will process electronic funds transfer requests for your account before
completing this form.
What are the advantages of HUD PAD? HUD PAD is a convenient, automatic and safe way to make payments. It will save buying stamps and writing
and mailing checks as well as help you avoid penalties due to late or missed payments or lost mail.
What happens if a requested deduction by HUD PAD is not honored by my financial institution? If your financial institution does not honor a
deduction due to insufficient funds, account closed or for any other reason, HUD will either contact you for further information or terminate
HUD PAD. Upon termination HUD will resume normal billing.
Can I cancel HUD PAD? You may cancel HUD PAD at any time by notifying your local HUD office, in writing. Any cancellation shall be effective
only after receipt by HUD and a reasonable opportunity to act upon it.
1. Complete and sign this form. If the account from which payments are to be made is jointly held, all account holders must sign this form.
2. Send us a blank check from your account or a copy of the check and mark it “Void”. The voided check must be forwarded with this authorization
since it contains the financial institution codes needed to establish your records.
3. Return the original and a voided blank check to the local HUD Office which services your account. The carbon should be retained by you.
4. Continue to make your payments when due. You will be notified when your HUD PAD will begin.
Name of Applicant

Social Security No.

Address (number, street, rural route or PO box)

City

Name of Financial Institution

HUD Account No.
State

Zip code

State

Zip Code

Branch Name (if any):

Address of Financial Institution (number, street, rural route or PO box)
Checking Account Number

Telephone No.

Telephone No. of Financial Institution

City
Transit Number: (May be obtained from financial institution).

Monthly Payment Amount

I hereby authorize HUD to start deductions from my account at the financial institution named above.
I understand that:
1.
2.
3.
4.

Each deduction will be in the amount of my monthly payment and shall be made on the 12th of the month.
The amount of the monthly deduction is subject to change and that I will be notified of any change in advance.
This authorization will cover the HUD program participant under the account number shown above unless otherwise specified by me.
This authorization will remain in force until revoked by me and until HUD receives such notice.

Signature of account holder(s), (If account is jointly held, all holders must sign).
Name (print or type)
Signature

Date

Name (print or type)

Date

Signature

Privacy Act Notice – The United States Department of Housing and Urban Development, Federal Housing Administration, is authorized to solicit the information
requested on this form by virtue of Title 12, United States Code, Section 1701 et seq. The Housing and Community Development Act of 1987, U.S.C. 3543
authorizes HUD to collect Social Security Numbers. This information will not be otherwise disclosed or released outside of HUD, except as required and permitted
by law, including routine uses identified in the HUD system of records.
form HUD-92090 (1/2006)