HUD-9250-OHF Funds Authorizations

Funds Authorization Section 242

U.S. Department of Housing and Urban Development Office of Hospital Facilities

OMB Approval No. 2502-0602 (Exp. 05/31/2016)

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: Federal law provides that anyone who knowingly or willfully submits (or causes to submit) a document containing any false, fictitious, misleading, or fraudulent statement/certification or entry may be criminally prosecuted and may incur civil administrative liability. Penalties upon conviction can include a fine and imprisonment, as provided pursuant to applicable law, which includes, but is not limited to, 18 U.S.C. 1001, 1010, 1012; 13 U.S.C. 3729, 3802, 24 C.F.R. Parts 25, 28 and 30, and 2 C.F.R. Parts 180 and 2424.

Instructions: Indicate the Fund for the request and provide the information for each section as requested.

Mortgage Reserve Fund

Other Reserve Fund (specify below)

FHA Project Number:      

Is this withdrawal request to replace equipment and/or major components with energy efficient products/systems?

Yes No

Lender Loan Number: (Optional)      

Property Address: (Include City, State, and Zip Code)

     

     

To: (Lender) or Servicer      

Comments: (Optional)      

This is your authority to release the following amounts from the reserve:

Purpose:

Amount

     

$     

     

$     

     

$     

     

$     

     

$     

     

$     

     

$     

     

$     

     

$     

     

$     

Total Amount

$     

Check (X) appropriate box:

An inspection made on the date of (mm/dd/yyyy)  ______________  revealed satisfactory replacement and/or installation.

An inspection will be made on the next visit to the property. Satisfactory replacement and/or installation will be determined at that time.

This Office has approved (Check (X) appropriate boxes.) This is your authority to adjust the Reserve requirements accordingly. This authority is revocable upon written notice from HUD.

A suspension of Deposits to the Reserve from the date of (mm/dd/yyyy)  ___________  to the date of (mm/dd/yyyy)  __________ 

A suspension of Deposits to the Reserve as long as a balance of $ _______________  is maintained.

A change in the Scheduled Deposit to the Reserve from $  _______________  to $ ______________  effective the date of (mm/dd/yyyy)  ______________  through the date (mm/dd/yyyy)  ________________    

Remarks (optional)

     

To: ( Borrower)

     

     

Name: HUD Authorizing Official: (please type or print)

     

Signature

City

     

State

  

Date (mm/dd/yyyy)

     

Previous versions obsolete Page 2 of 2 form HUD-9250-OHF