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GOOD NEIGHBOR
NEXT DOOR
Sales Program –
Firefighter/Emergency
Medical Technician

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

Public reporting burden for this collection of information is estimated
to average 5 minutes per response, including the time for reviewing
instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the
collection of information. This information 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.
This information is required in order to administer the Good Neighbor
Next Door Sales Program (24 CFR Part 291, Subpart F) and to
determine and document eligibility to participate in the program. This
is an electronic form to be completed online. The form will be
automatically converted to a print form for the selected participant’s
signature as a record for compliance enforcement. If this information
were not collected, HUD would not be able to administer the Good
Neighbor Next Door Sales Program properly to avoid waste,
mismanagement, and abuse. The information will be retained by the
Department as part of the transaction record for a property disposition
action. Failure to provide this information could affect your participation
in HUD’s Good Neighbor Next Door Sales program.

OMB Approval No. 2502-0570
(Expires XX/XX/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 and 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.

Firefighter/Emergency Medical Technician Pre-Qualification Questionnaire
1. Are you employed full-time as a firefighter or emergency medical technician by a fire department or
YES
emergency medical services responder unit of the Federal Government, a state, unit of general local
government, or an Indian tribal government serving the community, neighborhood, or jurisdiction of the
unit of general local government, or Indian tribal government where the home is located?
(NOTE: Your employer will be required to certify that this statement is correct.)

NO

2. Have you previously purchased a home through the Good Neighbor Next Door Sales Program
or its predecessor program, the Officer Next Door or Teacher Next Door Sales Program?
3. Have you owned any residential real property within the previous 12 months prior to
submitting a bid?
4. Has your spouse owned any residential real property within the previous 12 months
prior to submitting a bid?
5. By proceeding to submit a bid you certify to the following:
• You will live in the HUD home as your sole residence for the 36 month owner-occupancy term.
• Your good faith intention to continue employment as a firefighter/emergency medical technician for at least one year after
date of closing.
• You will sign a second mortgage and note for the amount of the discount from the list price of the property you are awarded.
• You do not and have not owned any residential real property for the calendar year preceding the date you are
submitting this offer.
You
will not purchase or accept any residential real property prior to the date you close on the purchase of a home
•
if your offer is accepted?

•

You will certify initially and once annually that you have continuously occupied and are occupying the HUD home you purchased.

I certify that the answers supplied to this eligibility questionnaire are true and correct.

Signature

SSN:

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Date:

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form HUD-9549-C
(3/2020)