93480-ORCF Schedule B - Schedule of Disbursements

U.S. Department of Housing and Urban Development

See Instructions and Reporting Burden Statement on back.

For the Month and Year of:

,

Date

Check No.

Payee

Purpose

Amount

$

Total Disbursements (enter under line 3 of form HUD-93479-ORCF)

$

Schedule B

Schedule of Disbursements

OMB Approval No. 2502-XXXX

(exp. mm/dd/yyyy)

Office of Residential

Care Facilities

See Instructions on back

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.

form HUD-93480-ORCF (mm/dd/yyyy)

Page 1 of 2

Previous versions obsolete

Authority for the collection of information on this form is contained in 24 CFR, CH 11 (4-1-99 Edition), Section 200.105, Mortgagor Supervi­sion, Page 22. The reporting on HUD-93480-ORCF, Schedule of Disbursements, is sent to the Department of Housing and Urban Development (HUD) on the tenth day of each month by owners or management agents of HUD-insured or Secretary-held properties. The information is used by HUD to assess the need for remedial actions to correct project deficiencies. If information is not collected HUD would not be able to monitor debt collection on HUD-held projects and it would increase the potential for fraud, diversions, defaults, and assignments. The information is not considered sensitive. While no assurances of confidentiality is pledged to respondents, HUD generally discloses this data only in response to a Freedom of Information request.

Instructions for Preparation of Monthly Reports for Establishing Net Income

Page 2 of 2

Previous versions obsolete

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. HUD 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. 

One copy of the monthly report forms (forms HUD-93479-ORCF, HUD-93480-ORCF, and HUD-93481-ORCF) is due HUD no later than the tenth of the month following the month of operation covered by the report. All applicable lines should be completed since partial information reduces the usefulness of the reports. The report must be signed by an authorized representative of the management agent or borrower.

Schedule B: Form HUD-93480-ORCF, Schedule of Disbursements

You may attach an internally prepared document of this information, as long as it contains at a minimum, the same information as requested on the form headings.All disbursements from project cash must be shown.

Check numbers must be consecutive. Payee and purpose of each disbursements must be identified

form HUD-93480-ORCF (mm/dd/yyyy)