HUD-94195 Mortgagee's Application for Initial Claim Payment

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

Mortgagee's Application
for Initial Claim Payment
Housing Finance Agency
Risk-Sharing

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

Instructions: Prepare this form in four parts (original and 3 copies) and submit original and 2 copies along with the Payment Information Form
to:
U.S. Department of Housing and Urban Development
Multifamily Claims Branch, HFFMC
Washington, DC 20410-8000
Mortgagee/Servicer should retain 1 copy.
The claim will be paid in cash in accordance with 24 CFR 266.626 and 628. Blocks 1 through 6 must be completed. If the note has not been
finally endorsed for insurance, complete Block 7. If the Housing Finance Agency (HFA) has retained a servicer and that servicer is filing the
claim, Blocks 8, 9, and 11 must be completed. If the HFA is filing the claim omit Blocks 9 and 11. Please be sure to include telephone numbers
in the event HUD officials need additional information of clarification.
If the default is cured after this form is sent to HUD and prior to the payment of the initial claim, the HFA must notify HUD by telefax immediately
at (202) 619-8259, that the claim is being withdrawn (24 CFR 266.632).
The HFA must use the proceeds of the initial claim payment to retire any bonds serving the mortgage within 30 calendar days after the payment.
Any excess funds resulting from the retirement of the bonds shall be returned to HUD within 30 calendar days of the initial claim payment (24
CFR 266.628(a) (3)). Form HUD-94193 will be used for this purpose.
1. FHA Project Number

4. Default Date

2. Name and Location of Project

5. Unpaid Principal Balance as of Default Date

3. Date of this Notice

6. Mortgage Interest Rate

$
8. HFA Name, Address and Zip

%
Tax Identification Number (HFA)

10. Signature, Title and Telephone of HFA Official

7. Undisburse Mortgage Proceeds

$

9. Servicer's Name, Address and Zip

11. Signature, Title and Telephone of Servicer

(

)

(

)

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)

Previous editions are obsolete

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form HUD-94195 (12/97)
ref Handbook 4590.1