HUD-94196 Application for Benefits and Fiscal Data in Support of F

Application for Benefits and Fiscal Data
in Support of Final Claim Settlement
Housing Finance Agency
Risk-Sharing

OMB Approval #2502-0500
(exp. XX/XX/XXXX)

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

Instructions: See HUD Handbook 4590.1 for instructions on how to prepare this Form and Schedules A through F. Send original and two
copies of this Form and Schedules A through F, together with required supporting documentation to: U.S. Department of Housing and Urban
Development, Multifamily Claims Branch, HFFMC, Washngton, DC 20410-8000.
1. Date Form Prepared

2. Project Name and Location

4. HFA Name, Address and Telephone

3. FHA Project Number

5. Servicer Name, Address and Telephone

(

)

6. HFA Tax Identification Number

(

7. HFA HUD Mortgage Number

8. Date to Which Interest Collected

9. Date of Default

12. Date Receiver Appointed (if applicable)

13. Date Receiver Discharged (if applicable) 14. Date Property Acquired

16. Method of Acquisition

Foreclosure

)

10. Date Election to Acquire

11. Date Foreclosure Started

15. Date Property Sold

17. Method of Disposition

Deed-in-Lieu

Negotiated Sale

Competitive Bid

Part I
A. Amount of Initial Claim Payment
Part II – Disbursements
A. Outstanding Advances for:
1. Taxes, Ground Rents, Water Charges, etc., (Schedule A, Col. 5, total in parentheses) $ _______________________
2. Property Insurance (Schedule A, Column 6, total in parentheses)
$ _______________________
Total Outstanding Lender Advances (Sum of Lines A1 and 2)
B. Reasonable Expenses for Protection and Preservation of the Property (Schedule D, Col. 3)
C. Total Foreclosure and Acquisition Costs (Schedule D, Column 5)
D. Repairs to the Property (Schedule D, Column 6)
E. Disposition Expenses (Schedule D, Column 7)
F. HFA Debenture Interest
Total Disbursements (Sum of Lines II.A through II.F)
Part III – Deductions
A. Funds in Escrow:
1. Mortgage Insurance Premiums (Schedule A, Column 4)
$ _______________________
2. Taxes, Ground Rents, Water Charges, etc., (Schedule A, Column 5)
$ _______________________
3. Hazard Insruance Premiums (Schedule A, Column 6)
$ _______________________
4. Reserve for Replacements (Schedule A, Column 10)
$ _______________________
5. Other (Schedule A, Column 7 plus Schedule E Balance)
$ _______________________
Total Funds in Escrow (Sum of Lines A1 through 5 above)
B. Net Income Received from Property:
1. Total Collections (Schedule B, Column 7)
$ _______________________
2. Operating Expenses (Schedule C, Column 5)
$ _______________________
Net Income (Line B1 minus Line B2)
C. Funds Received on Account of Mortgagor (Schedule A, Column 12)
D. Net Sales Proceeds (Schedule F)
E. HFA Debenture Interest
Total Deductions (Sum of Lines III.A through III.E)
Part IV
Total Claim (Part I plus Part II minus Part III)

Not Sold
$ _______________________

$ _______________________
$ _______________________
$ _______________________
$ _______________________
$ _______________________
$ _______________________
$ _______________________

$ _______________________

$ _______________________
$ _______________________
$ _______________________
$ _______________________
$ _______________________
$ _______________________

To the best of my knowledge, all the information stated herein, as well as any information provided in the accompaniment herewith, is true and accurate.
Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)
HFA Name, Address and Telephone

Previous editions are obsolete

Title and Signature of Authorized Official

Page 1 of 2

Date Signed

form HUD-94196 (12/97)
ref Handbook 4590.1

Instructions for Completing Application for Benefits and Fiscal Data
in Support of Final Claim Settlement Housing Finance Agency Risk-Sharing
A. Overview. This form summarizes all of the components of the
claim except accrued interest. HUD will compute accrued interest at the time of claim settlement. This Form and Schedules A
through F capture the information required by 24 CFR 266.644
through 650. Prepare this Form only after Schedules A through
F have been completed.

4. Lines IIIA through D will be derived from the appropriate
supporting schedules as indicated on the front of the Form.
Line IIIE is the amount of HFA Debenture interest accrued
but not paid to HUD from the anniversary date of the last HFA
Debenture interest payment to the date the form is prepared.
This amount will be adjusted at the time of claim settlement
to the date of claim settlement in accordance with 24 CFR
266.650(g).

B. Steps to Complete Form.
1. Complete Blocks 1 through 17 as applicable. If the HFA has
retained a Servicer and the Servicer is filing the claim both
Blocks 4 and 5 must be completed. If there is no servicer
Block 5 may be omitted.
2. Line IA is the amount of funds received for the initial claim
payment.
3. Lines IIA through E will be derived from the appropriate
supporting Schedules as indicated on the front of the Form.

5. Calculate Total Disbursements (Line II) and Total Deductions (Line III).
6. Calculate the Total Claim (Line I plus Line II minus Line III).
7. Sign and date the Form. Be sure to include the title of the
signing official and telephone number so HUD can contact
that person if necessary.

Line IIF is the amount of HFA Debenture interest paid to HUD
up to the date the form is prepared.

Previous editions are obsolete

Page 2 of 2

form HUD-94196 (12/97)
ref Handbook 4590.1