Form HUD-9250 - Funds Authorization

Funds Authorizations

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

OMB Approval No. 2502-0555 (exp. 07/31/2013)

For Instructions, Public Burden Statement, and Privacy Act requirements: See Page 2.
Reserve for Replacements Fund	Residual Receipts Fund	Project Number:      
Is this withdrawal request to replace appliances and/or major components with energy efficient products/systems? Yes No		Mortgagee Loan Number: (Optional)      
		Property Address: (Include City, State, and Zip Code)            
To: (Mortgagee)                  		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 so long as a balance of $     ___ is maintained. A change in the Monthly Deposit to the Reserve from $      ___ to $     ___ effective the date of (mm/dd/yyyy)       through the date (mm/dd/yyyy)      
Remarks (optional)      
To: (Mortgagor/Managing Agent)                        		Name of Hub Director or Program Center Director: (please type or print)      
		Signature
		City      	State   	Date (mm/dd/yyyy)      

Instructions: Indicate the Fund for the request and provide the information for each section as requested. Owners/Agents must also submit the following with this form:

1. A narrative providing a detailed description of the work performed or to be performed;

2. Copies of paid invoices if the withdrawal request is for reimbursement for work that has been performed;

3. If a bid exceeds $25,000 than copies of bids may required. Please refer to HUD Handbook 4350.1 Chapter detailed guidance;

4. Mortgagor Certification (refer to HUD Handbook 4350.1, REV-1); and,

5. A list of appliances and/or major components that will be replaced along with a notation of whether or not the replacement items will be energy efficient products. If replacement items are not energy efficient products, the owner/agent must provide a justification.

Public reporting burden for this collection is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining data needed, and completing and reviewing the collection of information. This information is required to obtain 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.

The regulations at 24 CFR Part 880.601 and 24 CFR Part 880.602 authorizes the Secretary of the Department of Housing and Urban Development to effectively monitor withdrawals from the Reserve for Replacements and/or Residual Receipts Funds. This information collection sets forth the information that must be reviewed and approved by HUD in order to withdraw funds from these accounts. While no assurances of confidentiality are pledged to respondents, HUD generally discloses this data only in response to a Freedom of Information Act request.

Mortgagee: Retain this record for three years. Distribution: One copy to Mortgagor and HUD files.

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form HUD-9250 Ref. Handbook 4350.1, REV-1 1/2008