OMB Control No:  2502-0605ICR Reference No: 
201210-2502-009 
Status:  Historical ActivePrevious ICR Reference No:   
Agency/Subagency:  HUD/OHAgency Tracking No:  
Title:  Comprehensive Listing of
Transactional Documents for Mortgagors, Mortgagees and
Contractors 
Type of Information Collection:  New
collection (Request for a new OMB Control Number)Common Form ICR:   Yes 
Type of Review Request:  Regular 
OIRA Conclusion Action:  Approved
without changeConclusion Date:  03/04/2013 
Retrieve
Notice of Action (NOA) Date Received in OIRA: 
11/21/2012 
Terms of Clearance:  The submission
process for this collection requires at least one hard copy from
the respondent(s) in addition to an electronic copy. During the
review process, HUD committed to making an effort to switch to an
electronic submission process to the greatest extent feasible.
Accordingly, this collection is being approved for one year in
order to monitor the submission process associated with this
collection. 
  
Inventory as of this Action 
Requested 
Previously Approved 
 
Expiration Date 03/31/2014 
36 Months From Approved 
 
Responses 20,322 
0 
0 
 
Time Burden (Hours) 44,966 
0 
0 
 
Cost Burden (Dollars) 0 
0 
0 
 
 
Abstract:  Information provided includes
documents comprising the application for FHA mortgage insurance of
residential care facilities, and for servicing of the mortgages.
The information is submitted from HUD-approved mortgagees,
sponsors, mortgagors and contractors. The included documents are
necessary for the application, review, commitment, initial/final
endorsement, administration, servicing, technical oversight and
audit of the Office of Residential Care Facilities projects
pursuant to FHA programs 232, 241, 223(f) and 223(a)(7). 
 
Authorizing Statute(s):   US Code:
12
USC 1701  Name of Law: Rental Supplement Payments12
USC 1715  Name of Law: Housing for Moderate and Displaced
Families12
USC 1715n  Name of Law: Misc Housing Insurance12
USC 1713  Name of Law: Rental Housing Insurance 
Citations for New Statutory
Requirements:  None 
 
Associated Rulemaking
Information  
RIN: Stage of Rulemaking: Federal Register Citation: Date:  
2502-AJ05 
Final or interim final rulemaking 
77 FR
55120 09/07/2012 
 
 
Federal Register Notices &
Comments  
60-day Notice: Federal Register Citation: Citation Date:  
  
77 FR
26304 05/03/2012 
 
30-day Notice: Federal Register Citation: Citation Date:  
77 FR
69870 11/21/2012 
 
Did the Agency receive public comments on
this ICR?  
Yes  
 
Number of Information Collection (IC) in this
ICR:  1  
IC Title 
Form No. 
Form Name 
 
Transactional
Documents for Mortgagees and Contractors 9001e-ORCF, 9001f-ORCF, 9001g-ORCF, 9001h-ORCF, 9001i-ORCF,
91125-ORCF, 91127-OCRF, 91129-ORCF, 92408-ORCF, 92412-ORCF,
92441-ORCF, 92441a-ORCF, 92442-ORCF, 92452-ORCF, 92452A-ORCF,
90020-ORCF, 92322-ORCF, 91117-ORCF, 91725CERT-ORCF, 91725INST-ORCF,
92325-ORCF, 2-ORCF, 91110-ORCF, 91112-ORCF, 91126-ORCF, 91708-ORCF,
91710-ORCF, 92070 - ORCF, 92223-ORCF, 92466A-ORCF, 92576A-ORCF,
94000-ORCF, 94001-ORCF, 93332-ORCF, 93481-ORCF, 93486-ORCF,
95379-ORCF, 9443-ORCF, 91128-ORCF, 92414-ORCF, 92464-ORCF,
92476-ORCF, 92476B-ORCF, 9001-ORCF, 9001a-ORCF, 9001b-ORCF,
9001c-ORCF, 9001d-ORCF, 9003-ORCF, 9002-ORCF, 9004-ORCF, 9005-ORCF,
9005a-ORCF, 9006-ORCF, 9007-ORCF, 9007a-OCRF, 9008-ORCF, 9009-ORCF,
9444-ORCF, 90010-ORCF, 90011-ORCF, 90025-ORCF, 90025a-ORCF,
92211-ORCF, 92331-ORCF, 92333-ORCF, 92335-ORCF, 92337-ORCF,
92339-ORCF, 92340-ORCF, 9445-ORCF, 90012-ORCF, 90013-ORCF,
90014-ORCF, 90015-ORCF, 90016-ORCF, 90017-ORCF, 90018-ORCF,
90019-ORCF, 90022-ORCF, 91118-ORCF, 91130-ORCF, 92434-ORCF,
92479-ORCF, 92456-ORCF, 92554-ORCF, 93305-ORCF, 92450-ORCF,
9442-ORCF, 91123-ORCF, 91124-ORCF, 92023-ORCF, 92415-ORCF,
92455-ORCF, 91725-ORCF, 941-ORCF, 2205a-ORCF, 9839-ORCF,
90024-ORCF, 91111-ORCF, 91116-ORCF, 93480-ORCF, 91119-ORCF,
92264a-ORCF, 92323-ORCF, 92420-ORCF, 92466-ORCF, 9250-ORCF,
9250A-ORCF, 92117-ORCF, 92228-ORCF, 92266-ORCF, 92417-ORCF,
93333-ORCF, 93479-ORCF 
Lender Narrative 
Operating Loss Loan  ,   Lease Addendum  ,  
Subordination,
Non-Disturbance and Attornment Agreement  ,   Survey Instructions and
Borrowers Certification  ,   Surplus Cash Note  ,  
Certification for
Submission of Electronic Firm Application  ,   Instructions to Guide for
Opinion of Borrowers and Operators Counsel  ,   Guide for Opinion of Operators
Counsel, and Certification  ,   Request for Waiver of Housing
Directive  ,   Lenders FHA Number Request 
,   Borrowers
Certificate of Actual Cost  ,   Management Certification
-Residential Care Facility  ,   Addendum to Operating Lease 
,   Schedule of
Facilities Owned, Operated or Managed  ,   Consolidated Certifications 
Contractor  ,   Auditor Certification  ,
  Borrower's
Certification - Completion of Critical Repairs  ,  
Building Code
Certification  ,   Lenders Certificate  ,
  Completion of
Assurance  ,   Subordination Agreement
Financing  ,   Healthcare Regulatory Agreement
 Borrower  ,   Certificate of Need, (CON), for
Health Facility and Assurance of Enforcement of State Standards 
,   Security
Instrument/ Mortgage/Deed of Trust  ,   Healthcare - Facility Note 
,   Funds
Authorization  ,   Borrower Certification and
Request Detail  ,   Borrowers Certification- Full
or Partial Completion of Non-Critical Repairs  ,   Model Form - Bill of Sale  ,
  Application for
Transfer of Physical Assets  ,   Personal Financial and Credit
Statement  ,   Certification of Exigent Health
& Safety (EH&S) Issues  ,   Certification of Physical
Condition Compliance  ,   Schedule B - Schedule of
Disbursements  ,   Computation of Surplus Cash,
Distributions and Residual Receipts  ,   Memo Requesting Post-Commitment
Early Start of Construction  ,   Design Professionals
Certification of Liability Insurance  ,   Operator Security Agreement 
,   Healthcare
Regulatory Agreement  Operator  ,   Monthly Report for Establishing
Net Income  ,   Schedule C - Schedule of
Accounts Payable  ,   Design Architects
Certification  ,   Forecasted Staffing
Schedule  ,   Financial Statement
Certification-General Contractor  ,   Lender Certification for New
Construction, Cost Certifications  ,   Request for Final Endorsement
of Credit Instrument  ,   HUD Amendment to AIA Document
B108  ,   Escrow Agreement for Working
Capital  ,   Request for Permission to
Commence Construction  ,   Building Loan Agreement  ,
  Building Loan
Agreement Supplemental  ,   Maximum Insurable Loan  ,
  Accounts
Receivable Financing Certification  ,   Intercreditor Agreement  ,
  Estoppel
Certificate  ,   Guide for Opinion of Borrowers
Counsel  ,   Exhibit A to Opinion of
Borrowers Counsel - Certification  ,   Contact Sheet  ,  
Refund Request for
Overpayment of Firm Application Exam Fee  ,   Financial Statement
Certification-Borrower  ,   Agreement for Payment of Real
Property Taxes  ,   Residual Receipts Note
(Nonprofit Borrowers)  ,   Construction Contract  ,
  Performance Bond
- Dual Obligee  ,   Payment Bond  ,  
Request for Endorsement
of Credit Instrument & Certificate of Lender, Borrower &
General Contractor  ,   Escrow Agreement for Incomplete
Construction  ,   Off-Site Bond  Dual
Obligee  ,   Supplementary Conditions of the
Contract for Construction  ,   Agreement and Certification 
,   HUD
Representatives Trip Report  ,   Minor Movable Equipment Escrow
Agreement  ,   Initial Operating Deficit
Escrow Calculation  ,   Lender Narrative  Blended Rate
2 Stage, Final Firm Submission  ,   Master Lease Addendum  ,
  Cross-Default
Guaranty of Subtenants  ,   Master Lease Subordination,
Non-Disturbance and Attornment Agreement  ,   Guide for Opinion of Master
Tenants Counsel  ,   Healthcare Regulatory Agreement
 Master Tenant  ,   Master Tenant Estoppel
Certificate  ,   Master Tenant Security
Agreement  ,   Certification of Outstanding
Obligations - Section 232/223(f)  ,   Consolidated Certifications 
Lender  ,   Consolidated Certifications 
Borrower  ,   Consolidated Certifications 
Principal of Borrower  ,   Consolidated Certifications 
Operator  ,   Consolidated Certifications -
Parent of the Operator  ,   Consolidated Certifications 
Management Agent  ,   Escrow Agreement For Latent
Defects  ,   Request for Approval of
Advance/Release of Escrow Funds  ,   Escrow Agreement for
Non-critical, Deferred Repairs  ,   Escrow Agreement For Operating
Deficits  ,   Lender Narrative  Section
232/223(a)7 Refinance  ,   Addendum to Underwriting
Narrative  Project Capital Needs Assessment (PCNA)  ,  
Addendum to
Underwriting Narrative  ALTA/ACSM Land Title Survey  ,  
Addendum to
Underwriting Narrative  Environmental  ,   Addendum to Underwriting
Narrative  Other Eligible Existing Indebtedness  ,  
Addendum to
Underwriting Narrative  Principal of the Borrower  ,  
Addendum to
Underwriting Narrative  Operator  ,   Addendum to Underwriting
Narrative  Management Agent  ,   Addendum to Underwriting
Narrative  Transfer of Physical Assets  ,   Addendum to Underwriting
Narrative  Accounts Receivable (AR) Financing  ,  
Lender
Narrative-Section 232/223(f) Refinance  ,   Lender Narrative  Section
232/241(a)  ,   Lender Narrative  New
Construction Single Stage  ,   Lender Narrative  New
Construction 2 Stage, Initial Firm Submission  ,   Lender Narrative  New
Construction 2 Stage, Final Firm Submission  ,   Lender Narrative  Substantial
Rehabilitation Single Stage  ,   Lender Narrative  Substantial
Rehabilitation 2 Stage Initial Firm Submission  ,  
Lender Narrative
Substantial Rehabilitation 2 Stage, Final Firm Submission  ,
  Lender Narrative
 Existing Buildings with New Construction Blended Rate Single
Stage  ,   Lender Narrative - Fire Safety
Equipment Installation, without Existing HUD-Insured Mortgage  ,
  Lender Narrative
Supplement  Cost Certification  ,   Lender Narrative - Fire Safety
Equipment Installation, with Existing HUD-Insured Mortgage  ,
  Lender Narrative
 Existing Buildings with New Construction Blended Rate 2 Stage,
Initial Firm Submission  
 
 
 
ICR Summary of Burden 
  
Total Approved 
Previously Approved 
Change Due to New Statute 
Change Due to Agency Discretion 
Change Due to Adjustment in
Estimate 
Change Due to Potential Violation of
the PRA 
 
Annual Number of Responses 
20,322 
0 
0 
20,322 
0 
0 
 
Annual Time Burden (Hours) 
44,966 
0 
0 
44,966 
0 
0 
 
Annual Cost Burden (Dollars) 
0 
0 
0 
0 
0 
0 
 
Burden increases because of Program Change due to Agency
Discretion:  Yes 
Burden Increase Due to:  Miscellaneous
Actions 
Burden decreases because of Program Change due to Agency
Discretion:  No 
Burden Reduction Due to:  
Short Statement:  The Commissioner has directed
that the control, management operations, and oversight of the
Section 232 Program be transferred from the Office of Multifamily
Housing Programs to the Office of Healthcare Programs. Therefore,
all forms related to that program have been eliminated from
Multifamily submissions and will become the responsibility of the
Office of Healthcare Programs. Also, on September 7, 2012, Office
of Residential Care Facilities (ORCF) published a final rule on
Strengthening Accountability in the Section 232 Healthcare Facility
Insurance Program. This rule was designed to improve the efficiency
of and enhance the risk management of the Section 232 program. 
Annual Cost to Federal Government: 
$1,581,864 
Does this IC contain surveys, censuses, or employ
statistical methods?  No 
Is the Supporting Statement intended to be a Privacy
Impact Assessment required by the E-Government Act of 2002? 
No 
Is this ICR related to the Affordable Care Act [Pub. L.
111-148 & 111-152]?  No 
Is this ICR related to the Dodd-Frank Wall Street Reform
and Consumer Protection Act, [Pub. L. 111-203]?  No 
Is this ICR related to the American Recovery and
Reinvestment Act of 2009 (ARRA)?  No 
Is this ICR related to the Pandemic Response? 
Uncollected 
Agency Contact:  Nicole Hendrich 202
402-6856 
 
Common Form ICR:   Yes 
Description/Changes for Common Form
Usage:   
Approved RCFs using this ICR  
Agency/Sub Agency 
RCF ID 
RCF Title 
RCF Status 
IC Title