Form HUD-9900 Application for Approval as a Housing Counseling Agency

APPLICATION FOR APPROVAL AS A HOUSING COUNSELING AGENCY
OMB Approval No. 2502-0573
(Exp. 1/31/2021)

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

CERTIFICATIONS

Privacy Advisory:

By signing below, the applicant assures and certifies the following:

Authorities: The Office of Housing Counseling is responsible for
administration of the Department’s Housing Counseling Program,
authorized by Section 106 of the Housing and Urban Development
Act of 1968 (12 U.S.C. 1701w and 1701x). New Certification
Requirements Final Rule released December 14, 2016. Section
106 of the Housing and Urban Development Act of 1968 (12
U.S.C. 1701x) (Section 106) was amended by Subtitle D of title
XIV of the Dodd-Frank Wall Street Reform and Consumer
Protection Act (Pub. L. 111–203, 124 Stat. 1376, approved July
21, 2010).
Principal Purpose: The mission of the Office of Housing
Counseling (OHC) is to provide individuals and families with
the knowledge they need to obtain, sustain, and improve their
housing. Agencies that are eligible, meet program requirements,
and provide the information requested on the form HUD-9900
may be approved to provide Comprehensive Housing Counseling
Services that aid in the homeownership process.
Disclosure: The information will not be disclosed outside HUD
without your consent except to civil, criminal, or regulatory
investigations or prosecutions, or to a Member of Congress
or a congressional office in response to an inquiry. All the
information requested on the form HUD-9900 is voluntary.
The information is required to evaluate new applicants against
Housing Counseling Program eligibility requirements only.
If the information is not provided, the agency may not be
considered for approval into HUD’s Housing Counseling Program.
This application is designed to be completed by applicants who are
seeking approval to be a HUD-Approved Housing Counseling
Agency. As of August 1, 2021, housing counseling required by or
provided in connection with HUD programs must only be provided
by HUD certified housing counselors working for participating
agencies approved to provide such housing counseling by HUD’s
Office of Housing Counseling.
Public Reporting Burden for this collection of information
is estimated to be 8 hours 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 agency may not conduct or
sponsor, and a person is not required to respond to a collection
of information unless that collection displays a valid OMB control
number.
This information is collected in connection with HUD’s Housing
Counseling Program and will be used to determine eligibility for
Program participation under Section 106 of the Housing and
Community Development Action of 1968.

CERTIFICATIONS:
I certify that this agency, and HUD program branches, sub-grantees
and/or affiliates, if applicable, will:
1. Administer the housing counseling in accordance with Title VI of the
Civil Rights Act of 1964, Title VIII of the Civil Rights Act of 1968,
Executive Order 11063, Section 504 of the Rehabilitation Act of 1973,
the Age Discrimination Act of 1975; and Title IX of the Education
Amendment of 1972.
2. Provide housing counseling services without sub-agreement with
other agencies for the delivery of any or all parts of the services in
our proposed housing counseling plan as approved by HUD.
3. Represent our clients without any conflict of interest by our agency,
paid and volunteer staff, or board members which might compromise our
ability to represent fully in the best interests of the client in accordance
with HUD 7610.1.
4. Meet all local, State and Federal requirements necessary to provide
our agency’s housing counseling services, including, if applicable,
the management and liquidation services.
5. Comply with the fee guidelines set forth in HUD Handbook 7610.1
and 24 CFR Part 214, if we plan to charge counseling fees.
6. Provide HUD with all required Housing Counseling Program data
and information, in a timely manner, for use by HUD both internally
and externally on HUD’s web listing and other media.
7. Act on our own behalf and are not under the influence, control,
or direction of any outside party such as a landowner, real estate broker,
contractor, builder, lender, or consultant seeking to derive a profit or gain
from our housing counseling program clients.
8. Meet the applicable accessibility requirements of Section 504 of the
Rehabilitation Act of 1973 (29 U.S.C. 794), 24 CFR parts 8 and 9,
and the Americans with Disabilities Act (42 U.S.C. 12101 et seq).
Our facilities provide accessibility features for persons with disabilities
and elderly persons, or we will arrange to meet with each person at an
alternative accessible location or format.
9. Ensure on an on-going basis that no employee, board member,
or partner has been suspended, debarred, or otherwise restricted
under the Department’s or any other federal regulations (see 24 CFR
Part 214).
10.Ensure on an on-going basis that such participants are not indicted for,
or convicted of, a criminal offense that reflects upon the responsibility,
integrity, or ability of the agency to participate in housing counseling
activities. These offenses include criminal offenses that can be prosecuted
at a local, State, or Federal level.
11.Ensure that the agency is not subject to unresolved program approval
requirements outlined in HUD Handbook 7610.1 and 24 CFR Part 214.
12.Ensure that no Grantee nor its Branches and Sub-grantees employs
an individual who has been, convicted of a violation under federal law
relating to an election for Federal office (as defined in Pub. L. 111-203,
124 Stat. 1376 (July 21, 2010)).

Name and Title of Authorized Executive Approved to Legally Bind Agency:
By signing this Application, I certify to the best of
my knowledge and belief that this application is true,
complete, and accurate. I am aware that any false, fictitious,
or fraudulent information, or the omission of any material
fact, may subject me to criminal, civil or administrative
penalties for fraud, false statements, false claims or
otherwise. (U.S. Code Title 18 Section 1001 and Title 31,
Sections 3729 - 3730 and 3801 - 3812).

Signature of person authorized to legally bind entity:

Date Signed:

Warning: Anyone who knowingly or willfully makes false or fraudulent statements or representations in connection with the statements of information
or certifications herein may be subject to criminal and/or civil penalties and may also be subject to administrative action by HUD.
See, e.g., 18 U.S.C. § § 1001, 1010, 1012, 31 U.S.C. § 3801 et seq, 2 C.F.R. Parts 180 and 2424.
Application for Approval as a
Housing Counseling Agency

Page 1 of 10

Form HUD-9900

APPLICANT INFORMATION
Official Name of Agency:

Agency Website Address:

Physical Address
of the Main Office:

City:

State:

Zip Code:

Mailing Address
of the Main Office:

City:

State:

Zip Code:

Executive Director
(ED) Name and Title:

ED Direct Phone Number:

Ext:

ED E-mail:

Ext:

CPM E-mail:

Ext:

POC E-mail:

Counseling Program Manager
(CPM) Name and Title:

CPM Direct Phone Number:
Name of Agency’s Point of Contact
(POC) for this Application:

POC Direct Phone Number:

Name and Title of Authorized Executive Approved to Legally Bind Agency:

Agency Federal Taxpayer Identification Number (TIN):

List any Agency Acronyms, aka, or dba names, if applicable:

Agency Dun and Bradstreet Universal Numbering System (DUNS) Number:

ELIGIBLE ENTITY TYPE
Select one entity that best represents your entity type.
A housing counseling agency must function as a private or public nonprofit organization, or be a unit of general local or state government.

Nonprofit Entities:
1.
2.
3.
4.
5.
6.
7.

Government Entities:

Nonprofit Agency
Intermediary/Collaboration of Entities coming
in as an Intermediary
Multi-State Organization (MSO)
Community Development Corporation (CDC)
Community Housing Development Organization (CHDO)
Nonprofit Instrumentality of Government,
Including IOG University
Nonprofit University

8.
9.
10.
11.
12.
13.
14.
15.
16.

Application for Approval as a
Housing Counseling Agency

Page 2 of 10

State Housing Finance Agency (SHFA)
or State Designated Agency
Public Housing Authority (PHA)
State University
City
County
State
Lead Entity of HOME Consortium
(City & County)
Other Government created Instrumentality
of Government
Other Government/Municipality.
Please indicate other municipality type:

Form HUD-9900

TYPE OF HUD-APPROVED ORGANIZATIONS
Using the list of Entity Types from page 1, please check one box designating
the type of organization for which the agency is seeking approval to become.
National Intermediary Organization (Entity Type 2 only) – Provides, in multiple regions of the United States:
(i) housing counseling services through its branches, sub-grantees and/or affiliates, and (ii) provide training, technical
assistance, oversight, and pass-through funding to its network of branches, sub-grantees and/or affiliates.
Regional Intermediary Organization (Entity Type 2, 11, 12, 13, 14 & 15 only) – Provides, in a generally recognized
region within the United States, such as the Southwest, Mid-Atlantic, New England: (i) housing counseling services
through its branches, sub-grantees and/or affiliates, and (ii) provide training, technical assistance, oversight,
and pass-through funding to its network of branches, sub-grantees and/or affiliates.
Multi-State Organization (MSO) (Entity Type 3 only) – Provides housing counseling and education services through
a main office and branches in two or more states. All branches operate and are identified under main office
tax ID number, and (i) provide training, technical assistance, oversight, and pass-through funding to its branches.
Local Housing Counseling Agency (LHCA) (Entity Type 1, 4, 5, 6, 7, 9, 10, 11, 12, 13, 15, & 16 only) –
Provides housing counseling and education services directly through one location or a main office with one or more branch
offices, in no more than two contiguous states. An exception can be made for a local housing counseling agency that
serves a single metropolitan area covering more than two contiguous states.
State Housing Finance Agencies (SHFAs) (Entity Type 8 only) – Any public body, agency, or instrumentality
created by a specific act of a state legislature empowered to finance activities designed to provide housing and related
facilities through land acquisition, construction, or rehabilitation throughout the entire state.
______________________________________________________________________________________________
List the State(s) and Cities in which your organization provides counseling services in the box below:

DEFINITIONS
HUD-approved housing counseling agency. Private and public nonprofit organizations that are exempt from taxation under section 501(a),
pursuant to section 501(c) of the Internal Revenue Code of 1996, 26 U.S.C. 501(a) and 501(c) and approved by HUD, in accordance with this
part, to provide housing counseling services to clients directly, or through their branches, sub-grantees, and/or affiliates, and which meet the
requirements set forth in this part.
Unit of general local government. Any city, county, parish, town, township, borough, village, or any other general purpose political
subdivision of a State.
State. Each of the several States, the Commonwealth of Puerto Rico, the District of Columbia, the Commonwealth of the Northern Mariana
Islands, Guam, the Virgin Islands, American Samoa, or any other possession of the United States.

TYPE(S) OF SUPPORT PROVIDED
Check as many boxes that apply to your agency.
Faith-Based Organization. (Faith-based organizations must recognize that their non-discrimination responsibilities
are to not only serve anyone who is eligible for counseling, but also that they must affirmatively conduct outreach and
marketing to those least likely to apply for the services, even if they are not members of the organization’s faith group.)
Organization provides services to migrant farm workers.
Organization provides services in Colonias. (Colonias are rural economically distressed communities located with
150 miles of the US-Mexican border that lack basic infrastructure; running water, electricity, paved roads, etc.)
Organization is designated as a legal service agency.

Application for Approval as a
Housing Counseling Agency

Page 3 of 10

Form HUD-9900

TYPE(S) OF HOUSING COUNSELING SERVICES
Applicant must employ trained staff with experience in the housing counseling services selected below.
Check all housing counseling services for which your agency is seeking HUD-approval.
One-on-One Counseling Types:
Homeless Assistance
Rental Topic
Pre-Purchase/Homebuying
Home Maintenance and Financial Management
for Homeowners (Non-Delinquency Post-Purchase)

Group Education — Agencies providing group education must also provide
one-on-one counseling of the same service type.
Financial literacy workshop, including home affordability, budgeting
and understanding use of credit
Predatory lending, loan scam or other fraud prevention workshop
Fair housing workshop

Resolving or Preventing Mortgage Delinquency
or Default

Homeless prevention workshop

Rental workshop

Reverse Mortgage

Non-delinquency post-purchase workshop, including home maintenance
and/or financial management for homeowners

Pre-purchase homebuyer education workshop

Resolving or preventing mortgage delinquency workshop
Other workshop(s) not listed above

PART 1: APPLICANT CHARACTERISTICS AND COMPLIANCE
The following is a list of requirements that applicant will Self-Certify to and/or be required to provide documentation.

A. NONPROFIT AND TAX EXEMPT / UNIT OF GENERAL LOCAL GOVERNMENT
Nonprofit Entities (Entity type 1-7) must provide all the following:
1.

Provide a legible copy of the document that supports the agency's claim to be a non-profit organization (e.g., 501(c) letter issued by
IRS). The document must include the organization’s official name, physical address, and telephone number of the legal authority that
granted the non-profit status, and

2.

Charter: Submit a copy of the recorded document (e.g., Charter, Articles of Incorporation, By-laws, governing body meeting
minutes, etc.) that specifically authorizes your organization to provide housing counseling, and

3.

The applicant must assure HUD that its branches, sub-grantees and/or affiliates are eligible entities. Provide copies of the documents
that support their claim to be an eligible entity, and if applicable

4.

Nonprofit Instrumentality of Gov’t (IOG), IOG Universities Entities ONLY must provide the following: In addition to providing
items 1, 2 & 3, these entities must also provide the following supporting documentation of an IOG:

•

ESTABLISHMENT — Must have been established by a governmental body or with governmental approval or under special law
to serve a particular public purpose or designated as an instrumentality by law (statute or court opinion), and

•

a. ORGANIZATIONAL — Majority of governing board and/or principal CONTROL officers named or approved by
governmental body/officials, or

•
•

b. OPERATIONAL — Government body approves all major decisions CONTROL and/or expenditures, or
c. FINANCIAL — Government body provides funds through CONTROL direct appropriations/grants/loans,
with related controls applicable to all activities of entity.
OR

Government Entities (Entity type 8-16) must provide all the following:
1.

Provide the document giving authority to operate as a unit of general local government, and

2.

Provide the document giving authority to specifically provide housing counseling services as proof of authorization, and if applicable

3.

Gov’t Created Instrumentality of Gov’t (IOG) Entities ONLY: In addition to providing items 1 & 2, these entities must also
provide the following supporting documentation of an IOG:

•

ESTABLISHMENT — Must have been established by a governmental body or with governmental approval or under special law
to serve a particular public purpose or designated as an instrumentality by law (statute or court opinion), and

•

a. ORGANIZATIONAL — Majority of governing board and/or principal CONTROL officers named or approved by
governmental body/officials, or

•
•

b. OPERATIONAL — Government body approves all major decisions CONTROL and/or expenditures, or
c. FINANCIAL — Government body provides funds through CONTROL direct appropriations/grants/loans,
with related controls applicable to all activities of entity.

Application for Approval as a
Housing Counseling Agency

Page 4 of 10

Form HUD-9900

B. CONFLICT OF INTEREST AND DISCLOSURE STATEMENT
Nonprofit Entities and Government Entities (Entity type 1-16) must provide all the following:
1.

Provide a document that identifies any other jobs or activities apart from the housing counseling agency,
an employee, volunteer or board member of the agency performs that could result in a potential conflict of interest
as identified in HUD Handbook 7610.1, and

2.

Provide a list of additional housing programs or activities, other than housing counseling services, that your agency,
branches, sub-grantees and/or affiliates offer including such programs as administering down payment assistance programs, developing housing projects, managing apartment buildings, rehabilitating and reselling HUD homes and selling real estate. Provide the office location for each additional program referenced, and

3.

Provide a copy of the agency Conflict of Interest Policy and Procedures involving personnel and board members, and

4.

Provide a copy of the Disclosure Statement(s) provided to clients that explicitly describes the various types of services or products provided by the agency and any financial relationships as identified in HUD Handbook 7610.1.
Disclosure must clearly state that the “client is not obligated to receive, purchase or utilize any other services offered
by the organization or its exclusive partners, in order to receive housing counseling services”.

C. SCREENING FOR INELIGIBLE PARTICIPANTS

Nonprofit Entities and Government Entities (Entity type 1-16) must provide all the following:
1.

Complete form HUD-9900a, New Application-Board and Housing Counseling Program Staff List Attachment.
List all counseling staff working in the housing counseling program, all current Board Members, supervisors and housing
counselors, and

2.

For each individual listed, provide the agency office, the agency physical address, state their position title, length of
employment, the name of board member’s employer and title, their duties, if staff member is full-time or part-time,
paid or a volunteer and provide their physical home addresses, a contact telephone number, and

Self-Certification: Applicants unable or unwilling to self-certify will result in rejection of their application.
By checking this box, the Authorized Executive certifies that the agency has vetted all housing counseling
program related staff including, agency directors, board members, partners, officers, principals and employees
at all locations, including employees of branches, sub-grantees and/or affiliates listed in items #2 above and
confirm that they are not suspended, debarred, or otherwise restricted; Indicted for or convicted of a criminal
offense; Subject to unresolved findings as a result of HUD or other governmental audit or investigation,
including any state & federal tax liens without a repayment plan in place, as per described in 24 CFR 214.103
(c)(1)(2)(3). If needed, please refer to the “Learn More” section of the Housing Counseling Agency Eligibility
Tool for information on Ineligible Participants: https://www.hudexchange.info/programs/housing-counseling/
housing-counseling-agency-eligibility-tool
Self-Certification: Applicants unable or unwilling to self-certify will result in rejection of their application.
By checking this box, the Authorized Executive certifies that this entity is in compliance with other HUD
program(s) for which the applicant is currently a participant.
a.

Provide a list of the other HUD program(s) in which you are currently participating, the name of the HUD
program Point of Contact (POC) and contact information.
OR

Check this box if the Applicant does not participate in any Other HUD programs.

Application for Approval as a
Housing Counseling Agency

Page 5 of 10

Form HUD-9900

D. HOUSING COUNSELING WORK PLAN
Nonprofit Entities and Government Entities:
1.

All Entity types must provide a Housing Counseling Work Plan that includes the components listed in
HUD Handbook 7610.1 for approval.

2.

National/Regional Intermediaries, MSO and SHFA (Entity type 2, 3, 8, 11, 12, 13, 14, & 15)
Agencies that provide direct housing counseling services must address all items below in their work plan.
Intermediaries/MSO and State Housing Finance Agencies (SHFA) may provide a brief summary for items a-l
and attach individual work plans of their branches, sub-grantees and/or affiliates.
a.

Target Community

b.

Housing Needs and Problems

c.

Affirmatively Furthering Fair Housing

d.

Description of Services, for each service checked within the “Type of Housing Counseling Services”
section and include a list of zip codes where the agency, branches, sub-grantees and/or affiliates
provide these services

e.

Homeownership Counseling and Home Inspection

f.

Impact and Scope of One-on-One Counseling Services

g.

Formats for Delivery of Services

h.

Client Follow-up

i.

Fee Structure

j.

Non-English or Limited English Proficiency

k.

Marketing and Outreach

l.

Supervisory Monitoring/Quality Control Plan

Parent Agency Oversight Activities:
National/Regional Intermediaries, MSO and SHFA Oversight Activities (Entity type 2, 3, 8, 11, 12, 13, 14, & 15)
All applicants seeking approval as an Intermediary Organization (National Intermediary or Regional Intermediary),
MSO or SHFA, as indicated within the Type of HUD-Approved Organization on page 2, must provide the following:
1.

Provide the parent agency’s policy and procedures on oversight activities pertaining to their branches, sub-grantees and/or
affiliates.

2.

Provide a Quality Control Plan for network management that addresses the following policy and procedures:
a.

Providing training and technical assistance,

b.

Performing oversight and monitoring,

c.

Monitoring financial performance, including issuing or administering the use of pass-through funding,

d.

Performing accounting of administrative costs,

e.

Ensuring compliance with federal regulations, including 24 CFR 214, the HUD Handbook 7610.1, applicable grant
agreement, OMB Circulars A-110 and A-133, and other federal guidelines.
https://www.hudexchange.info/resource/5189/oversight-agency-toolkit-quality-control/

3.

Intermediaries/MSO/SHFA with branches, sub-grantees and/or affiliates must include each office HUD ID Number(s) (if
applicable), branch telephone numbers, physical addresses and housing counseling program staff names and positions.

4.

Information on Developing a Housing Counseling Agency Work Plan and a sample copy is available at:
https://www.hudexchange.info/resources/documents/Developing-Housing-Counseling-Work-Plan-HUD-Approval.pdf

Application for Approval as a
Housing Counseling Agency

Page 6 of 10

Form HUD-9900

PART 2: EXPERIENCE
A. COMMUNITY BASE
Nonprofit Entities (Entity type 1-7) must provide all the following:
1.

Self-Certify to the following:
Self-Certification: Applicants unable or unwilling to self-certify will result in rejection of their application.
By checking this box, the Authorized Executive certifies that this entity has one year experience administering
a housing counseling program AND that the agency, branches, sub-grantees and/or affiliates have functioned
for at least one year in the geographical area(s) as described within the agency work plan, and

2.

Provide a HUD-9902 that quantifies the households the agency provided counseling and education services to during
the past 12-month period, and

3.

Nonprofit entities that oversee any branches, sub-grantees and/or affiliates must provide written
agreements which delineate the responsibilities of the main office, branches, sub-grantees and/or affiliates.
If applicable, provide a copy of these written agreements.

Government Entities (Entity type 8-16) must provide all the following:
1.

Self-Certify to the following:
Self-Certification: Applicants unable or unwilling to self-certify will result in rejection of their application.
By checking this box, the Authorized Executive certifies that this entity has one year experience administering
a housing counseling program AND that the agency, branches, sub-grantees and/or affiliates have functioned
for at least one year in the geographical area(s) as described within the agency work plan, and

2.

Provide a HUD-9902 that quantifies the households the agency provide counseling and education services to during
the past 12-month period, and

3.

Government Entities overseeing branches, sub-grantees and/or affiliates must provide written agreements
which delineate the responsibilities of the main office, branches, sub-grantees and/or affiliates.
If applicable, provide a copy of these written agreements.

B. KNOWLEDGE OF HUD PROGRAMS AND LOCAL HOUSING MARKET

Nonprofit Entities and Government Entities (Entities 1-16) must provide all the following:
1.

Self-certify to the following:

Self-Certification: Applicants unable or unwilling to self-certify will result in rejection of their application.
By checking this box, the Authorized Executive certifies that the housing counseling staff possesses knowledge
of HUD and other state and local housing counseling programs available to the community, consolidated plans,
and the local housing market.

Application for Approval as a
Housing Counseling Agency

Page 7 of 10

Form HUD-9900

PART 3: RESOURCES
A. FUNDING EVIDENCE
All Nonprofit Entities, SHFA, PHA, & State Universities (Entity type 1, 2, 3, 4, 5, 6, 7, 8, 9, 10) must provide
all the following:
1.

Provide a copy of their independent audited financial statement completed within the last two years and letters of
funding showing written commitment from sources for the initial 12 month period as a HUD approved housing
counseling agency.

2.

Submit a copy of your current annual housing counseling budget. Include income and expenses associated with your
housing counseling program.

Cities, Counties, State, Lead Entity of a Consortium, Other Gov’t IOG, Other Municipalities (Entity type 11, 12, 13,
14, 15, 16) ONLY must provide all the following:
1.

Self-certify to the following:
Self-Certification: Applicants unable or unwilling to self-certify will result in rejection of their application.
By checking this box, the Authorized Executive certifies that they have sufficient funds to cover the costs of
operating the housing counseling program during the initial 12 months of approval.

B. STAFF
Nonprofit Entities and Government Entities (Entity type 1-16) must provide all the following:
1.

Self-certify to the following:
Self-Certification: Applicants unable or unwilling to self-certify will result in rejection of their application.
By checking this box, the Authorized Executive certifies that the agency employs staff trained in housing
counseling AND at least half the counselors have at least 6 months of experience in the job they will perform
in the agency’s housing counseling program, and
The agency must submit a list of the housing counselor(s) and their evidence of passing HUD Housing Counselor
Certification Examination. (For example, submit a copy of email from hudhousingcounselors.com that the counselor
passed the certification examination.)
a. Self-certify to the following:
Self-Certification: *Self-certification number one alpha (1a.) will become effective on or after the final
compliance date for Housing Counselor Certification and will supersede self-certification number one listed above.
Applicants unable or unwilling to self-certify will result in rejection of their application.
By checking this box, the Authorized Executive certifies that the agency employs individuals who will provide
one-on-one housing counseling and/or oversee group education at its main office, branches, sub-grantees and/
or affiliates that have passed the HUD Housing Counselor Certification Examination and are trained in the job
that they will perform in the agency’s housing counseling program, and

2.

Self-certify to the following:
Self-Certification: Applicants unable or unwilling to self-certify will result in rejection of their application.
By checking this box, the Authorized Executive certifies that the agency has a written supervisory monitoring
plan and quality control compliance procedures established for monitoring the work of housing counselors by
reviewing client files with the housing counselor to determine the adequacy and effectiveness of the housing
counseling.

Application for Approval as a
Housing Counseling Agency

Page 8 of 10

Form HUD-9900

C. LANGUAGE SKILLS
Nonprofit Entities and Government Entities (Entity type 1-16) must provide all the following:
1.

Self-certify to the following:
Self-Certification: Applicants unable or unwilling to self-certify will result in rejection of their application.
By checking this box, the Authorized Executive certifies that the agency has housing counselors who are fluent
in the language of the clients they serve, or the housing counseling agency uses the services of an interpreter, or
the agency refers the client to another agency that can meet the client’s needs.

D. COMMUNITY RESOURCES
Nonprofit Entities and Government Entities (Entity type 1-16) must provide all the following:
1.

Self-certify to the following:
Self-Certification: Applicants unable or unwilling to self-certify will result in rejection of their application.
By checking this box, the Authorized Executive certifies that the housing counseling agency has established
working relationships with private and public community resources to which it can refer clients who may need
help the agency cannot offer.

E. FACILITIES
Nonprofit Entities and Government Entities (Entity type 1-16) must provide all the following:
1.

Self-certify to the following:
Self-Certification: Applicants unable or unwilling to self-certify will result in rejection of their application.
By checking this box, the Authorized Executive certifies that the housing counseling facilities of the agency
main office, its branches, sub-grantees and/or affiliates meet all the following criteria:
a. Have a clearly identified office with space available for housing counseling services and operate
during normal business hours and offer extended hours when necessary;
b. Provide privacy for in-person counseling and confidentiality of client records;
c. Provide accessibility features or make alternative accommodations for persons with disabilities, and

2.

In addition to the Self-Certification, applicants must provide the following:
a.
b.
c.
d.
e.
f.
g.

3.

List of the agency offices including the official name, physical addresses and zip codes of the agency main office,
and the offices of all branches, sub-grantees and/or affiliates.
Mailing address for each location, if different from the physical address.
Telephone number(s) for each location including toll-free if available.
Name, title, and telephone number of the person in charge of the housing counseling program at each location.
Indicate for each location if the agency owns or rents the facility. If owned, provide proof of ownership.
If the facility is rented, provide a copy of your signed lease agreement, MOU, or in-kind letter.
Indicate for each location whether your agency shares any part of its facility with any other organizations and if so,
identify the organizations and explain the relationship that exists between your agency and those organizations.
List accessibility features for each location and/or alternate accommodations to serve disabled and elderly client that
have special needs, and

Provide color digital photos from each location documenting the following. Label each photo for each location:
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.

Front of building.
Agency signage (on building and/or agency entrance).
Hours of operation sign.
Internal and external accessibility features for handicapped or elderly clients.
Private one-on-one counseling and group meeting space.
Lobby & receptionist area.
Each counselor office.
Secure file cabinets and storage areas for active and closed files.
Fair Housing Sign visibly located in the office.
Fee structure sign, if applicable.

Application for Approval as a
Housing Counseling Agency

Page 9 of 10

Form HUD-9900

PART 4: SYSTEMS
A. RECORD KEEPING AND REPORTING
Nonprofit Entities and Government Entities (Entity type 1-16) must provide all the following:
1.

Self-certify to the following:
Self-Certification: Applicants unable or unwilling to self-certify will result in rejection of their application.
By checking this box, the Authorized Executive certifies that the agency has an established system of recordkeeping
that is in compliance with HUD Handbook 7610.1, 24 CFR 214, and applicable grant agreements.

B. CLIENT MANAGEMENT SYSTEM (CMS)
Nonprofit Entities and Government Entities (Entity type 1-16) must:
Select one of the Options and Self-Certify to the option that applies to your organization:
OPTION 1:
1.

Self-certify to the following:
Self-Certification: Applicants unable or unwilling to self-certify will result in rejection of their application.
By checking this box, the Authorized Executive certifies that the agency has a compliant Client Management System
in use that satisfies HUD’s requirements and interfaces with HUD’s database to download required information into
HUD’s Housing Counseling System (HCS), and

2.

Provide the name of your CMS:

OR
OPTION 2:
1.

Self-certify to the following:
Self-Certification: Applicants unable or unwilling to self-certify will result in rejection of their application.
By checking this box, the Authorized Executive certifies that the agency has a CMS in use but that it does not interface
with HUD’s databases for downloading required information into HUD’s Housing Counseling System (HCS).
To fundamentally comply with 24 CFR 214.103(f): CMS, the agency agrees to and certifies that they will input
data manually into the Housing Counseling System (HCS), and

2.

Self-certify to the following:
Self-Certification: Applicants unable or unwilling to self-certify will result in rejection of their application.
By checking this box, the Authorized Executive certifies that the agency agrees that until a compliant CMS is in place,
the agency will utilize a system for the collection and reporting of client level information, including but not limited to,
financial and demographic data, counseling services provided, and outcomes data. The system must also provide the
counseling agency with the tools necessary to track and manage all counseling and educational activities associated
with each client, and

3.

Self-certify to the following:
Self-Certification: Applicants unable or unwilling to self-certify will result in rejection of their application.
By checking this box, the Authorized Executive certifies that within their initial one year of approval, the agency agrees
to modify their current CMS to be HUD compliant, or acquire a compliant CMS from the list of approved CMS Vendors.

Application for Approval as a
Housing Counseling Agency

Page 10 of 10

Form HUD-9900