93480-ORCF Schedule B - Schedule of Disbursements

U.S. Department of Housing and Urban Development

See Instructions and Reporting Burden Statement on Page 2.

For the Month and Year of:

,

Date

Check No.

Payee

Purpose

Amount

$

Total Disbursements (enter under line 3 of form HUD-93479-ORCF)

$

OMB Approval No. 2502-0605

(exp. 11/30/2022)

Schedule B

Schedule of Disbursements

See Instructions on Page 2

form HUD-93480-ORCF (06/2019)

Warning: Anyone who knowingly submits a false claim or makes a false statement is subject to criminal and/or civil penalties, including confinement for up to 5 years, fines, and civil and administrative penalties. (18 U.S.C. §§ 287, 1001, 1010, 1012; 31 U.S.C. §3729, 3802).

Office of Residential

Care Facilities

Previous versions obsolete

Page 1 of 2

Instructions for Preparation of Monthly Reports for Establishing Net Income

Authority for the collection of information on this form is contained in 24 CFR, CH 11 (4-1-99 Edition), Section 200.105, Mortgagor Supervi­sion, Page 22. The reporting on HUD-93480-ORCF, Schedule of Disbursements, is sent to the Department of Housing and Urban Development (HUD) on the tenth day of each month by owners or management agents of HUD-insured or Secretary-held properties. The information is used by HUD to assess the need for remedial actions to correct project deficiencies. If information is not collected HUD would not be able to monitor debt collection on HUD-held projects and it would increase the potential for fraud, diversions, defaults, and assignments. The information is not considered sensitive. While no assurances of confidentiality are pledged to respondents, HUD generally discloses this data only in response to a Freedom of Information request.

Previous versions obsolete

Page 2 of 2

form HUD-93480-ORCF (06/2019)

You may attach an internally prepared document of this information, as long as it contains at a minimum, the same information as requested on the form headings. All disbursements from project cash must be shown.

Disbursements should be categorized alphabetically by vendor, and within this categorization, check numbers must be consecutive. Payee and purpose of each disbursement must be identified

One copy of the monthly report forms (forms HUD-93479-ORCF, HUD-93480-ORCF, and HUD-93481-ORCF) is due HUD no later than the tenth of the month following the month of operation covered by the report. All applicable lines should be completed since partial information reduces the usefulness of the reports. The report must be signed by an authorized representative of the management agent or borrower.

Schedule B: Form HUD-93480-ORCF, Schedule of Disbursements

Public reporting burden for this collection of information is estimated to average 1 hour 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. The information is being collected to obtain the supportive documentation that 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. Response to this request for information is required in order to receive the benefits to be derived from the National Housing Act Section 232 Healthcare Facility Insurance Program. 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. While no assurance of confidentiality is pledged to respondents, HUD generally discloses this data only in response to a Freedom of Information Act request.

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File Modified	0000-00-00
File Created	2023-09-03