90024-ORCF Contact Sheet

Contact Sheet Section 232

U.S. Department of Housing and Urban Development Office of Residential Care Facilities

OMB Approval No. 9999-9999 (exp. mm/dd/yyyy)

Public reporting burden for this collection of information is estimated to average 1 hour. This includes the time for collecting, reviewing, and reporting the data. The information is being collected to obtain the supportive documentation which must be submitted to HUD for approval, and is necessary to ensure that viable projects are developed and maintained. The Department will use this information to determine if properties meet HUD requirements with respect to development, operation and/or asset management, as well as ensuring the continued marketability of the properties. This agency may not collect this information, and you are not required to complete this form unless it displays a currently valid OMB control number. 

Warning: Any person who knowingly presents a false, fictitious, or fraudulent statement or claim in a matter within the jurisdiction of the U.S. Department of Housing and Urban Development is subject to criminal penalties, civil liability, and administrative sanctions. 

For Use in all Section 232 Projects

Project Name:
New FHA Project Number:			Old FHA Project Number:

(if applicable)

Project

Site Address:
CMS* Number: (if applicable) ____________________________________________________ *Center for Medicaid and Medicare Services Contact for ORCF* Appraiser/Inspector To Coordinate On-Site Visits and Repair Inspections: *Office of Residential Care Facilities
Contact Name/Title:
Site Contact Phone:
Contact Email
Site Contact (i.e. Administrator, Manager if different than above)
Contact Name/Title:
Site Contact Address:
Site Contact Phone:
Contact Email:

Lender

Firm Name:
Mortgagee No:
Address:
Underwriter Contact
Underwriter Phone:
Underwriter Email:

Servicing Lender

Firm Name:
Address:
Contact Name
Contact Phone:
Contact Email

Lender’s Counsel

Firm Name:
Address
Contact Name:
Contact Phone:
Contact Email:

Borrower

Legal Name:
Address:
Contact Name:
Annual FYE Date:		EIN: (Employee ID Number)
Contact Phone:
Contact Email:

Borrower’s Counsel

Firm Name:
Address:
Contact Name:
Contact Phone
Contact Email:

Operator (Lessee) (if applicable)

Legal Name:
Address:
Contact Name
Annual Fiscal Yr. End:		EIN:
Contact Phone:
Contact Email:

Management Agent (if applicable)

Legal Name:
Address:
Contact Name:
Annual Fiscal Yr. End:		EIN:
Contact Phone:
Contact Email:

Title Company

Firm Name:
Address:
Contact Name:
Contact Phone:
Contact Email:

Bonding Company (if applicable)

Firm Name:
Address:
Contact Name:
Contact Phone:
Contact Email:

General Contractor (if applicable)

Firm Name:
Address:
Contact Name:
Contact Phone:
Contact Email:

Design Architect (if applicable)

Firm Name:
Address:
Contact Name:
Contact Phone:
Contact Email:

Supervisory Architect (if applicable)

Firm Name:
Address:
Contact Name:
Contact Phone:
Contact Email:

Additional Participants

(Include Accounts Receivable Lender, if applicable)

Firm Name:
Address:
Contact Name:
Contact Phone:
Contact Email:

Additional Participants

Firm Name:
Address:
Contact Name:
Contact Phone:
Contact Email:

Previous versions obsolete Page 5 of 5 form HUD-90024-ORCF (mm/dd/yyyy)