Form HUD 9549-A HUD 9549-A Officer Pre-Qualificaiton Questionnaire

GOOD NEIGHBOR U.S. Department of Housing OMB Approval No. 2502-XXXX

NEXT DOOR and Urban Development (Expires xx/xx/xxxx)

Sales Program – Office of Housing

Officer Federal Housing Commissioner

Public reporting burden for this collection of information is estimated to average 2 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. This information is required to obtain benefits. HUD may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB control number.

This information is required in order to administer the Good Neighbor Next Door Sales Program (24 CFR Part 291, Subpart F) and to determine and document eligibility to participate in the program. This is an electronic form to be completed online. The form will be automatically converted to a print form for the selected participant’s signature as a record for compliance enforcement. If this information were not collected, HUD would not be able to administer the Good Neighbor Next Door Sales Program properly to avoid waste, mismanagement, and abuse. The information will be retained by the Department as part of the transaction record for a property disposition action. Failure to provide this information could affect your participation in HUD’s Good Neighbor Next Door Sales program.

Warning: Falsifying information on this or any other form of the Department is a felony. It is punishable by a fine not to exceed $250,000 and/or a prison sentence of not more than two years. Failure to adhere to the residency and resale requirements may result in administrative sanctions being taken against the Law Enforcement Officer, Teacher or Firefighter/Emergency Responder.

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 authorized HUD to collect Employer ID and/or Social Security Numbers. These numbers are used to provide information to the IRS regarding payment of commissions or other fees. HUD may also disclose this information to Federal, State, and local agencies when relevant to civil, criminal, or regulatory investigations and prosecutions. It will not be otherwise disclosed or released outside of HUD, except as required and permitted by law. Failure to provide the Employer ID Number or Social Security Number could affect your participation in HUD’s Property Disposition Program.

Officer Pre-Qualification Questionnaire

	YES	NO
1. Are you employed full-time as a law enforcement officer by a law enforcement agency of the federal government, a state, unit of general local government, or an Indian tribal government.
2. In carrying out such full-time employment, are you sworn to uphold, and make arrests for violations of, Federal, state, county, or municipal law? (NOTE: Your employer will be required to certify that this statement is correct.)
3. Have you previously purchased a home through the Good Neighbor Next Door Sales Program or its predecessor program, the Officer Next Door or Teacher Next Door Sales Program?
4. Have you owned any residential real property within the calendar year previous to the date you are submitting this offer?
5. Has your spouse owned any residential real property within the calendar year previous to the date you are submitting this offer?
6. By proceeding to submit a bid you certify to the following: You will live in the HUD home as your sole residence for the 3-year owner-occupancy term. You will sign a second mortgage and note for the amount of the discount from the list price of the property you are awarded. You do not and have not owned any residential real property for the calendar year preceding the date you are submitting this offer. You will not purchase or accept any residential real property prior to the date you close on the purchase of a home if your offer is accepted? Your good faith intention to maintain employment as a law enforcement officer for the first year of occupancy of the home you purchase You will certify initially and once annually that you have continuously occupied and are occupying the HUD home you purchased.

I certify that the answers supplied to this eligibility questionnaire are true and correct.

S ignature SSN: Date

form HUD-9549-A

(8/8/2006)