Comprehensive Listing of Transactional Documents for Mortgagors, Mortgagees and Contractors

Forms and Documents

Document Name	Status
Form 91710-ORCF Transactional Documents for Mortgagees and Contractors Form	Unchanged
83C (2502-0605-ORCF).doc Justification for No Material/Nonsubstantive Change	2017-08-14
Supporting Statement A2.doc Supporting Statement A	2014-05-06

IC Document Collections

IC ID	Document Title	Status
204773	Transactional Documents for Mortgagees and Contractors Form	Unchanged

ICR Details

OMB Control No: 2502-0605	ICR Reference No: 201708-2502-001
Status: Historical Active	Previous ICR Reference No: 201308-2502-009
Agency/Subagency: HUD/OH	Agency Tracking No:
Title: Comprehensive Listing of Transactional Documents for Mortgagors, Mortgagees and Contractors
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  Yes
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/30/2017
	Date Received in OIRA: 08/14/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2017	12/31/2017	12/31/2017
Responses	20,322	0	20,322
Time Burden (Hours)	44,221	0	44,221
Cost Burden (Dollars)	0	0	0

---

Abstract: Information provided includes documents comprising the application for FHA mortgage insurance of residential care facilities, and for servicing of the mortgages. The information is submitted from HUD-approved mortgagees, sponsors, mortgagors and contractors. The included documents are necessary for the application, review, commitment, initial/final endorsement, administration, servicing, technical oversight and audit of the Office of Residential Care Facilities projects pursuant to FHA programs 232, 241, 223(f) and 223(a)(7).

---

Authorizing Statute(s): US Code: 12 USC 1715n Name of Law: Misc Housing Insurance
   US Code: 12 USC 1713 Name of Law: Rental Housing Insurance
   US Code: 12 USC 1701 Name of Law: Rental Supplement Payments
   US Code: 12 USC 1715 Name of Law: Housing for Moderate and Displaced Families
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
2502-AJ05	Final or interim final rulemaking	77 FR 55120	09/07/2012

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 55282	09/10/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 11114	02/27/2014
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Transactional Documents for Mortgagees and Contractors	91725INST-ORCF, 92325-ORCF, 2-ORCF, 91110-ORCF, 91112-ORCF, 9443-ORCF, 91128-ORCF, 92414-ORCF, 92464-ORCF, 92476-ORCF, 92476B-ORCF, 91126-ORCF, 91708-ORCF, 91710-ORCF, 92070 - ORCF, 92223-ORCF, 92466A-ORCF, 92576A-ORCF, 94000-ORCF, 94001-ORCF, 93332-ORCF, 93481-ORCF, 93486-ORCF, 95379-ORCF, 9001-ORCF, 9001a-ORCF, 9001b-ORCF, 9001c-ORCF, 9001d-ORCF, 9003-ORCF, 9002-ORCF, 9004-ORCF, 9005-ORCF, 9005a-ORCF, 9006-ORCF, 9007-ORCF, 9007a-OCRF, 9008-ORCF, 9009-ORCF, 9444-ORCF, 90010-ORCF, 90011-ORCF, 90025-ORCF, 90025a-ORCF, 92211-ORCF, 92331-ORCF, 92333-ORCF, 92335-ORCF, 92337-ORCF, 92339-ORCF, 92340-ORCF, 9445-ORCF, 90012-ORCF, 90013-ORCF, 90015-ORCF, 90016-ORCF, 90017-ORCF, 90018-ORCF, 90019-ORCF, 90022-ORCF, 91118-ORCF, 91130-ORCF, 92434-ORCF, 92479-ORCF, 92456-ORCF, 92554-ORCF, 93305-ORCF, 92450-ORCF, 9442-ORCF, 91123-ORCF, 91124-ORCF, 92023-ORCF, 92415-ORCF, 90014-ORCF, 92455-ORCF, 91725-ORCF, 941-ORCF, 2205a-ORCF, 9839-ORCF, 90024-ORCF, 91111-ORCF, 91116-ORCF, 91117-ORCF, 91119-ORCF, 92264a-ORCF, 92323-ORCF, 92420-ORCF, 92466-ORCF, 9250-ORCF, 9250A-ORCF, 92117-ORCF, 92228-ORCF, 92266-ORCF, 92417-ORCF, 93333-ORCF, 93479-ORCF, 93480-ORCF, 9001e-ORCF, 9001f-ORCF, 9001g-ORCF, 91725CERT-ORCF, 9001h-ORCF, 9001i-ORCF, 91125-ORCF, 91127-OCRF, 91129-ORCF, 92408-ORCF, 92412-ORCF, 92441-ORCF, 92441a-ORCF, 92442-ORCF, 92452-ORCF, 92452A-ORCF, 90020-ORCF, 92322-ORCF	Residual Receipts Note (Nonprofit Borrowers) ,   Lease Addendum ,   Surplus Cash Note ,   Maximum Insurable Loan ,   Operator Security Agreement ,   Subordination Agreement Financing ,   Healthcare Regulatory Agreement – Borrower ,   Healthcare Regulatory Agreement – Operator ,   Certificate of Need, (CON), for Health Facility and Assurance of Enforcement of State Standards ,   Security Instrument/ Mortgage/Deed of Trust ,   Healthcare - Facility Note ,   Funds Authorization ,   Borrower Certification and Request Detail ,   Financial Statement Certification-Borrower ,   Borrower’s Certification- Full or Partial Completion of Non-Critical Repairs ,   Agreement for Payment of Real Property Taxes ,   Model Form - Bill of Sale ,   Application for Transfer of Physical Assets ,   Personal Financial and Credit Statement ,   Certification of Exigent Health & Safety (EH&S) Issues ,   Certification of Physical Condition Compliance ,   Monthly Report for Establishing Net Income ,   Master Lease Addendum ,   Cross-Default Guaranty of Subtenants ,   Master Lease Subordination, Non-Disturbance and Attornment Agreement ,   Guide for Opinion of Master Tenant’s Counsel ,   Healthcare Regulatory Agreement – Master Tenant ,   Master Tenant Estoppel Certificate ,   Master Tenant Security Agreement ,   Certification of Outstanding Obligations - Section 232/223(f) ,   Consolidated Certifications – Lender ,   Consolidated Certifications – Borrower ,   Consolidated Certifications – Principal of Borrower ,   Consolidated Certifications – Operator ,   Consolidated Certifications - Parent of the Operator ,   Consolidated Certifications – Management Agent ,   Consolidated Certifications – Contractor ,   Auditor Certification ,   Certification for Submission of Electronic Firm Application ,   Borrower's Certification - Completion of Critical Repairs ,   Building Code Certification ,   Lender’s Certificate ,   Completion of Assurance ,   Schedule B - Schedule of Disbursements ,   Schedule C - Schedule of Accounts Payable ,   Computation of Surplus Cash, Distributions and Residual Receipts ,   Memo Requesting Post-Commitment Early Start of Construction ,   Design Professional’s Certification of Liability Insurance ,   Design Architect’s Certification ,   Forecasted Staffing Schedule ,   Financial Statement Certification-General Contractor ,   Lender Certification for New Construction, Cost Certifications ,   Request for Final Endorsement of Credit Instrument ,   HUD Amendment to AIA Document B108 ,   Escrow Agreement for Working Capital ,   Request for Permission to Commence Construction ,   Building Loan Agreement ,   Building Loan Agreement Supplemental ,   Construction Contract ,   Performance Bond - Dual Obligee ,   Payment Bond ,   Request for Endorsement of Credit Instrument & Certificate of Lender, Borrower & General Contractor ,   Escrow Agreement for Incomplete Construction ,   Off-Site Bond – Dual Obligee ,   Supplementary Conditions of the Contract for Construction ,   Agreement and Certification ,   HUD Representative’s Trip Report ,   Minor Movable Equipment Escrow Agreement ,   Initial Operating Deficit Escrow Calculation ,   Escrow Agreement For Latent Defects ,   Request for Approval of Advance/Release of Escrow Funds ,   Escrow Agreement for Non-critical, Deferred Repairs ,   Escrow Agreement For Operating Deficits ,   Lender Narrative – Section 232/223(a)7 Refinance ,   Addendum to Underwriting Narrative – Project Capital Needs Assessment (PCNA) ,   Addendum to Underwriting Narrative – ALTA/ACSM Land Title Survey ,   Addendum to Underwriting Narrative – Environmental ,   Addendum to Underwriting Narrative – Other Eligible Existing Indebtedness ,   Addendum to Underwriting Narrative – Principal of the Borrower ,   Addendum to Underwriting Narrative – Operator ,   Addendum to Underwriting Narrative – Management Agent ,   Addendum to Underwriting Narrative – Transfer of Physical Assets ,   Addendum to Underwriting Narrative – Accounts Receivable (AR) Financing ,   Lender Narrative-Section 232/223(f) Refinance ,   Lender Narrative – Section 232/241(a) ,   Lender Narrative – New Construction Single Stage ,   Lender Narrative – New Construction 2 Stage, Initial Firm Submission ,   Lender Narrative – New Construction 2 Stage, Final Firm Submission ,   Lender Narrative – Substantial Rehabilitation Single Stage ,   Lender Narrative – Substantial Rehabilitation 2 Stage Initial Firm Submission ,   Lender Narrative Substantial Rehabilitation 2 Stage, Final Firm Submission ,   Lender Narrative – Existing Buildings with New Construction Blended Rate Single Stage ,   Lender Narrative - Fire Safety Equipment Installation, without Existing HUD-Insured Mortgage ,   Lender Narrative Supplement – Cost Certification ,   Lender Narrative - Fire Safety Equipment Installation, with Existing HUD-Insured Mortgage ,   Lender Narrative – Operating Loss Loan ,   Lender Narrative – Existing Buildings with New Construction Blended Rate 2 Stage, Initial Firm Submission ,   Lender Narrative – Blended Rate 2 Stage, Final Firm Submission ,   Accounts Receivable Financing Certification ,   Intercreditor Agreement ,   Estoppel Certificate ,   Guide for Opinion of Borrower’s Counsel ,   Exhibit A to Opinion of Borrower’s Counsel - Certification ,   Instructions to Guide for Opinion of Borrower’s and Operator’s Counsel ,   Guide for Opinion of Operator’s Counsel, and Certification ,   Request for Waiver of Housing Directive ,   Lender’s FHA Number Request ,   Borrower’s Certificate of Actual Cost ,   Management Certification -Residential Care Facility ,   Contact Sheet ,   Subordination, Non-Disturbance and Attornment Agreement ,   Survey Instructions and Borrower’s Certification ,   Refund Request for Overpayment of Firm Application Exam Fee ,   Addendum to Operating Lease ,   Schedule of Facilities Owned, Operated or Managed

---

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	20,322	20,322	0	0	0	0
Annual Time Burden (Hours)	44,221	44,221	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The actual form changes have not affected the burden reporting. Corrections were made to burden hour calculation, due to errors found in prior publications. The errors have been corrected.

---

Annual Cost to Federal Government: $1,581,864

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  Yes

Description/Changes for Common Form Usage: 

Approved RCFs using this ICR

Agency/Sub Agency	RCF ID	RCF Title	RCF Status	IC Title

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 08/14/2017

---