Red line Forms

GOOD NEIGHBOR
NEXT DOOR
Sales Program
Personal Information
Questionnaire

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

OMB Approval No. 2502-0570
(Expires XX/30/20XX)

Warning: Falsifying information on this or any other form of
the 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 Medical Technician.
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 a
nd 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.

Public reporting burden for this collection of information is
estimated to average 5 minutes per response. This includes
the time for collecting, reviewing, and reporting the data.
This information is required to administer the Good Neighbor
Next Door (GNND) 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 GNND
sales program properly to avoid waste, mismanagement and
abuse. This information will be retained by HUD as part of
the property disposition transaction record. Response to this
request for information is required to obtain benefits. Failure
to provide this information could affect your participation in
HUD’s GNND sales program. In accordance with the
Paperwork Reduction Act, HUD may not collect this
information, and you are not required to complete this form,
unless it displays a currently valid OMB control number.

* Required Information
Personal Contact and Employer Information
* First Name

* Middle Name or Initial

* Last Name
* Social Security Number
*Occupation
* Residential Street Address
* City

* Zip Code + Plus4 -

*State

* Home Phone Number
* Current Residence

Own

Rent

Other

* Contact E-Mail Address
* Contact Fax Number
_____________________________________
* Work Phone Number
* Employer/Agency Name
* Employer Street Address
* State

* City

* Zip Code + Plus4 -

* Human Resources/Point of Contact Full Name
* Human Resources/Point of Contact Phone Number
* Human Resources/Point of Contact Fax Number

Clear All

Print
form HUD-9549
(3/2020)