HUD 9549-E Verificaiton of Participant Employment

Employer Verification of
Participant Employment
Property Disposition Program
Good Neighbor Next Door Sales Program

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

Public reporting burden for this collection of information is estimated to
average 5 minutes per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining
the data needed, and completing and reviewing the collection of
information. This information is required to obtain benefits. HUD may not
collect this information, and you are not required to complete this form,
unless it displays a currently valid OMB control number.
This information is required in order to administer the Good Neighbor
Next Door Sales Program (24 CFR Part 291, Subpart F) and to
determine and document eligibility to participate in the program. If this
information were not collected, HUD would not be able to administer the
Good Neighbor Next Door Sales Program properly to avoid waste,
mismanagement, and abuse. The information will be retained by the
Department as part of the transaction record for a property disposition
transaction. Failure to provide this information could affect your
employee’s participation in HUD’s Good Neighbor Next Door Sales
program.
Warning: Falsifying information on this or any other form of the

OMB Approval No. 2502-0570
(exp. 04/30/2014)

Department is a felony. It is punishable by a fine not to exceed $250,000
and/or a prison sentence of not more than two years. Failure to adhere to
the residency and resale requirements may result in administrative
sanctions being taken against the Law Enforcement Officer, Teacher or
Firefighter/Emergency Responder.
Privacy Act Notice – The United States Department of Housing and
Urban Development, Federal Housing Administration, is authorized to
solicit the information requested on this form by virtue of Title 12, United
States Code, Section 1701 et seq. The Housing and Community
Development Act of 1987, U.S.C. 3543 authorized HUD to collect
Employer ID and/or Social Security Numbers. These numbers are used
to provide information to the IRS regarding payment of commissions or
other fees. HUD may also disclose this information to Federal, State,
and local agencies when relevant to civil, criminal, or regulatory
investigations and prosecutions. It will not be otherwise disclosed or
released outside of HUD, except as required and permitted by law.
Failure to provide the Employer ID Number or Social Security Number
could affect your participation in HUD’s Property Disposition Program.

To the employer:
The individual named below has represented to the U.S. Department of Housing and Urban Development that he/she is
employed by your agency in one of the capacities identified below. The information must be verified by your agency as a
prerequisite to participation in the Good Neighbor Next Door Sales Program. Please check the appropriate box provided
below, sign/date where indicated and forward this form in the enclosed pre-addressed envelope. Participation in the
Good Neighbor Next Door Sales Program by the named individual is dependent on receipt of this Verification from your
agency.
Agency's Certification of Employment
I hereby certify that
Name:
Address:
Is employed by the below-named agency and is: (check the appropriate box)

Case #:

a Law Enforcement Officer who, for purposes of GNND Sales Program, is defined as an individual who is employed
full-time by a Federal, State, county, or municipal government and is sworn to uphold, and make arrests for violations
of, Federal, State, county, or municipal law; or
a Teacher, who, for purposes of the GNND Sales Program, is defined as an individual employed full time by a state
accredited public school or private school, as a classroom teacher in grades pre-K through 12 and that this agency
serves students from the school district or, in the case of a private school, from the area serving the above listed
address.
a firefighter/emergency responder who, for the purposes of the GNND Sales Program, is defined as an individual who
is employed full-time as a firefighter or emergency medical technician by a fire department or emergency medical
services responder unit of a federal, state, or general local government, or an Indian tribal government serving the
above listed address:
Print or type your name
Print or type your title
Agency Name
Agency Address
Telephone Number
Your signature
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ref. Handbook 4310.5

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form HUD-9549-E