941-ORCF Lender’s FHA Number Request

Lender’s FHA Number Request Section 232

U.S. Department of Housing and Urban Development Office of Residential Care Facilities

OMB Approval No. 9999-9999 (exp. mm/dd/yyyy)

Public reporting burden for this collection of information is estimated to average .5 hours. 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: Any person who knowingly presents a false, fictitious, or fraudulent statement or claim in a matter within the jurisdiction of the U.S. Department of Housing and Urban Development is subject to criminal penalties, civil liability, and administrative sanctions. 

Data must be provided for every field.

Project Name:	     
Type of Project:	223f; 232NC, 223a7, 232SR, 223d, 241a, 232BR, or 232i*.
Current FHA Project Number:	Not Applicable or XXX-XXXXX
If 223a7, type of current loan?	223f; 232NC, 232SR, 223d, 241a, or 232i*.
Type of Activity (if 223f):	Refinance / Purchase
Type of Mortgage Insurance:	Insurance Upon Completion or Insured Advances
Mortgagor Type:	Profit / Nonprofit
Mortgage Amount:	$     
Permanent Interest Rate:	     
Mortgagee ID Number:	     
Mortgagee Name:	     
# of Nursing Home (SNF):	      Beds
# of Intermediate Care:	      Beds
# of Assisted Living (ALF):	      Units
# of Memory Care:	      Beds
# of Board & Care:	      Units
# of Independent:	      Units
# of Other Type Facility:	      Beds
Project Street Address:	     
Project City:	     
Project State:	     
Project Zip Code:	     
Project’s Congressional District:	     
Check all that apply:	LIHTC Tax-Exempt Bonds
	HOME CDBG HOPE VI
Mortgagee Contact Name:	     
Mortgagee Contact Email:	xx@xx
Mortgagee Contact Phone:	xxx-xxx-xxxx
The below questions pertain only to projects with Common Control (whether part of a Small, Mid/Size or Large Portfolio)**
Is this a Mid/Large size Portfolio Project (requiring HUD HQ’s Review)?	No Yes
Is this a small size portfolio?	No Yes
Is a master lease proposed?	No Yes
Identify a name for the portfolio	     
Identify projects with Common Control by FHA #	     

* NC = New Construction; SR = Sub. Rehab.; 232(i) = Fire Safety Equipment; BR = Blended Rate (both NC and Existing)

** Follow existing Office of Residential Care Facilities (ORCF) Guidance related to what constitutes projects with common control (whether a Small, Mid/ Size, or Large portfolio). It is important to identify related projects so HUD can employ economies of scale in OGC and underwriting reviews.

Previous versions obsolete Page 2 of 2 form HUD-941-ORCF (mm/dd/yyyy)