HUD 92001-B Application for Federal Housing Administration (FHA) Bra

Application for Federal Housing Administration (FHA)
Branch Office Approval
U.S. Department of Housing and Urban Development

OMB Approval Number 2502-0005
exp. 10/31/2014

Lender Name:
DBA name(s), if applicable.
10 Digit FHA ID Number

NMLS Number of Branch Office

Geographic Address

County:

TAX ID

Mailing Address (if different)

Phone:

Fax: :

Web Site:
eMail:
Type of
Traditional
Nontraditional
Direct Lending
Number of Employees:
Branch
Branch
Name:
SSN:
Manager
eMail:
Name:
Contact Person
Phone:
Fax:
Certifications. You must provide a detailed explanation for any certification where you mark the “No” box. The explanation must
be on the applicant’s letterhead, and must be dated and signed by the same person who signs this application.
1. I certify I am a corporate officer and/or principal/owner of the above-named lender with
the authority to legally bind the lender and to execute these certifications on behalf of
the lender.
2. I certify this branch office meets all HUD/FHA requirements

Yes

Yes

No

3. I certify that the staff of this branch office are employees of the lender which will pay all
operating costs of the branch office including compensation of all employees
3. I certify that the lender has approval from the appropriate regulatory authority for any
DBA name listed on this application.
4. I certify that the branch fee has been paid.

Yes

No

Yes

No

Yes
Yes

No

5.

I hereby certify that all of the information I have provided on this form and in any accompanying
documentation is true and accurate to the best of my knowledge and belief. I acknowledge that
if I knowingly have made any false, fictitious, or fraudulent statement, representation, or
certification on this form or on any accompanying documents, I, as well as the lender, may be
subject to administrative action, as well as civil and criminal penalties, including fines and/or
imprisonment, under applicable federal law, including but not limited to 18 U.S.C. §§1001, 1010,
and 1012, and 31 U.S.C. §§3729 and 3802.

Name (Printed):

Title:

Signature

Date

Send the executed application form 92001-B and all required exhibits to one of the following addresses.
US Mail
Dept of HUD
FHA Lender Approval & Recertification Division
451 7th Street, S.W., Room B133/P3214
Washington, DC 20410

Overnight Delivery
Dept of HUD
FHA Lender Approval & Recertification Division
490 L’Enfant Plaza East, SW, Suite 3214
Washington, DC 20024
Form HUD-92001-B (08/10)
Page 1 of 2

Public Reporting Burden for this collection of information is estimated to average 30 minutes per response, including the time for searching existing
data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The information requested on
this form is required by 24 CFR Part 202, HUD Handbook 4060.1 or HUD Handbook, 4700.2. The information collected assists FHA in determining
which lenders should be approved to participate in the FHA single and multifamily insurance programs. It is used to help FHA minimize its risk in
insuring single family and multifamily mortgages. Applicants are not required to respond to this collection of information unless a currently valid
approved OMB control number is displayed on the form.
Privacy Act Statement. Branch Manager’s name and Social Security Numbers are requested in order for the Department to obtain positive
identification of branch manager and will be used solely to determine the eligibility of the branch manager to be an officer of the lender. The
Department is authorized to request this information by Executive Order 9397 and it will not be disclosed outside the Department without prior
consent except as required or permitted by law. The Social Security Numbers are provided to HUD on a voluntary basis. Failure to provide this
information could cause delay in processing of the applications. While no assurances of confidentiality are pledged to respondents, HUD generally
discloses this data only in response to a Freedom of Information Act request

Warning: It is a crime to knowingly make false statements to the United States on this or
any other similar form. Penalties upon conviction can include a fine and imprisonment. For
details, see: Title 18 U.S. Code, Sections 1001 and 1010.

Form HUD-92001-B (08/10)
Page 2 of 2