90029-ORCF 232 Healthcare Portal Access

Comprehensive Listing of Transactional Documents for Mortgagors, Mortgagees and Contractors

90029_orcf_Final_Clean

Transactional Documents for Mortgagees and Contractors

OMB: 2502-0605

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Healthcare Portal Access Form

Section 232


U.S. Department of Housing

and Urban Development

Office of Residential

Care Facilities

OMB Approval No. 2502-0605

(exp. 03/31/2018)

Public reporting burden for this collection of information is estimated to average 0.5 hour(s). 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. 


SECTION 1a: Access Status

Create New

Change Existing

Delete


SECTION 1b: Access Type

Lender Account Manager

Backup Account Manager

SECTION 2: User Information

Last Name:      

First Name:      

E-mail Address:      

Telephone Number:      

Time Zone:


Office Address:                        

Street City State Zip Code

Status: Lender HUD Employee Other (Please explain)

SECTION 3: Servicer’s Name

Name:


SECTION 4: Acceptable Use and Password Policy Acceptance


Password Policy has been reviewed and accepted

[see – Password Policy in the 232 HUD Healthcare Portal Instructional Manual]


Acceptable Use Policy has been reviewed and accepted

[see – Acceptable Use Policy in the 232 HUD Healthcare Portal Instructional Manual]


SECTION 5: Authorized Signatures



User Signature:


     



     


Print

Signature

Date


Authorizer Signature:

     


     


Print

Signature

Date

I hereby certify that all the information stated herein, as well as any information provided in the accompaniment herewith, is true and accurate.




























For official use only:


Requester’s Username:


Access completed by:

Date: _______/______/______


Notes:











Instructions for Completing the HUD Healthcare Access Form:


Section 1a: Access Status

Select the functions (Create, Change, or Delete) which reflect the status of which the

user requests. NOTE: The delete function will eliminate all access to the HHcP.


Section 1b: Access Type

Select the type of access of which the user requests (LAM – Lender Account Manager

– an individual who has access to the entire Lender portfolio and who may grant

others access accordingly, BAM – Backup Account Manager – an individual who has

access to the entire Lender portfolio as a backup to the LAM, and who may grant

others access accordingly.


Section 2: User Information

The following are required fields. PLEASE complete them all.

Last Name

Please PRINT the user’s Last name.

First Name

Please PRINT the user’s First Name.

E-mail Address

Please include your Brown box number.

Telephone Number

Please PRINT your telephone number, including the area code.

Time Zone

Please select your time zone.

Office Address

Please provide your office address, to include the street, city, state and zip code.

Status

Please select your current status, if it’s “Other”, please provide a brief explanation of your status.


Section 3: Lender’s Information

The following are required fields. PLEASE complete them all.

Name

Please PRINT the name of the Servicer you are representing.


Section 4: Policy Acceptance

All approved individuals who use the HHcP are obligated to be familiar with those policies regulating their access and use. This is especially true for those handling sensitive and/or confidential information. Indicate in the provided spaces that you have reviewed and agree to the listed policies located in the HHcP Instructional Manual.


Section 5: Authorized Signatures

All individuals requesting access to this account as a LAM or BAM must print, sign and date the form and obtain the signature of the Authorized Lender Representative, prior to receiving access to the HHcP.

Questions?

If you have questions about filling out this form, direct them to [email protected].


Previous versions obsolete Page 6 of 6 form HUD-90029-ORCF (03/2018)

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleRequest to Access the HUD Healthcare Portal
AuthorH47700
File Modified0000-00-00
File Created2021-01-13

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