HUD-9906-P Intermediary, State Housing Finance Agency, and Multi-St

OMB Number: 2502-0621
Expiration Date: 06/30/2023

Intermediary, State Housing Finance Agency,
and Multi-State Organization Application
Form HUD-9906-P (3/2023)
Burden Statement:
Public reporting burden for this collection of information is estimated to average 40 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. The information is being collected for a housing counseling agency to participate in HUD’s Housing Counseling program
and is required to obtain or retain benefits. No confidentiality is assured. The information will be used by HUD to ensure that Counselors
provide guidance and advice to help families and individuals improve their housing conditions and meet the responsibilities of tenancy
and homeownership. Counselors also help borrowers avoid predatory lending practices, such as inflated appraisals, unreasonably high
interest rates, unaffordable repayment terms, and other conditions that can result in a loss of equity, increased debt, default, and
foreclosure. This agency may not collect this information, and you are not required to complete this form, unless it displays a valid OMB
control number.

I/We, the undersigned, certify under penalty of perjury that the information provided below is true and correct.
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, 1014; 31 U.S.C. §3729, 3802).

I agree to the above certification statement.

form HUD-9906-P (3/2023)

CHART A2 – INTERMEDIARY, SHFA, OR MSO CHARACTERISTICS
A) Name of Applicant
B) Location City

State

C) Agency’s HUD Housing Counseling (HCS) Number

If the Applicant's main office provides direct housing counseling activities, the main office must be included in the list of
subgrantees and branches in the Chart A2 Supplement (Excel). All Intermediary, SHFA, and MSO Applicants must fill out
and submit the Chart A2 Supplement (Excel) with their branch and/or subgrantee information. Enter the totals from that
chart here.
The Applicant must remember to attach their Chart A2 Supplement (Excel) to their grants.gov application.
D
E
F
G
H
I
J
K
L
M
N
O1
O2
O3
P1
P2

# of Branches of an Intermediary, MSO, or SHFA
# of Subgrantees of an Intermediary, MSO, or SHFA
Number of Housing Counselor Full-Time Equivalents
Number of HECM Roster Reverse Mortgage Counselor Full-Time Equivalents
Number of Default Counselor Full-Time Equivalents to Provide Reverse Mortgage/HECM
Default Counseling during Grant Period
Formal Housing Counseling Training
HUD-Certified Housing Counselors on Staff
Adopted National Industry Standards
Issued Client Exit Surveys
Issued Follow-Up Client Surveys
Pulled Credit Reports as Part of Housing Counseling Follow-Up Prior to the Termination
of Counseling
Opportunity Zones (preference points) – Not Applicable
Promise Zones (preference points)
Historically Black Colleges and Universities (preference points)
% of Award Applicant intends to Allocate to itself
% of Award Applicant intends to Allocate to its Branches and Subgrantees

Q) Maximum Grant Request.
R) Seeking Reimbursement for Program Costs Incurred Prior to the Period of Performance.

Instructions: Enter the total number of subgrantees and/or branches that will provide housing counseling services in the
modes below.
S
T
U
V

Counseling/Group Education to be Provided in Person
Counseling/Group Education to be Provided via Telephone or Video (interactive)
Counseling/Group Education to be Provided over the Internet (asynchronous, self-guided
courses)
Counseling/Group Education to be Available in Multiple Languages

form HUD-9906-P (3/2023)

CHART B2 – LEVERAGING
Applicants with leveraged funds must fill out and attach their Chart B Supplement (Excel) to their grants.gov application.
Failure to complete and submit this form may result in loss of points.

form HUD-9906-P (3/2023)

CHART C2 – VULNERABLE POPULATIONS
The Applicant must complete Fields A through I of the chart below to demonstrate how the Applicant will affirmatively
further fair housing, advance racial equity, provide access to clients with disabilities and limited English proficiency, inform
clients of lead-based paint hazards, and provide emergency preparedness and/or disaster recovery activities.

(A) Affirmatively Furthering Fair Housing. You must provide a brief description of how you will carry out your proposed activities in a
manner that affirmatively furthers fair housing in compliance with the Fair Housing Act and its implementing regulations. For
example, you could describe how you will address disparities in access to opportunity for protected class groups or foster and
maintain compliance with civil rights and fair housing laws by educating low and moderate-income families about their rights (limit
2,000 characters).
Note: any actions taken in furtherance of this section must be consistent with federal nondiscrimination requirements. Failure to
submit this narrative is a non-curable deficiency which may result in applicants being deemed ineligible.

(B) Affirmative Marketing. You must submit a narrative demonstrating that the housing, services, or other benefits provided under
this grant will be affirmatively marketed broadly throughout the local area and nearby areas to any demographic groups that would
be unlikely or least likely to apply absent such efforts. Such demographic groups may include, for example, Black and Brown
persons or communities, individuals with limited English proficiency, individuals with disabilities, or families with children. Such
activities may include outreach through community contacts or service providers or at community centers serving the target
population; and marketing on websites, social media channels, television, radio, and print media serving local members of the
targeted group. Documentation for this factor consists of a narrative describing the activities that will fulfill the factor requirements.
(limit 1,000 characters).
Note: Failure to submit this narrative is a non-curable deficiency which may result in applicants being deemed ineligible.

form HUD-9906-P (3/2023)

(C) Advancing Racial Equity. In accordance with Executive Order 13985, Executive Order On Advancing Racial Equity and Support
for Underserved Communities Through the Federal Government, and federal fair housing and civil rights laws, you must submit a
narrative demonstrating the following:
-You analyzed the racial composition of the persons or households who are expected to benefit from your proposed grant
activities;
-You identified any potential barriers to persons or communities of color equitably benefiting from your proposed grant activities;
-You detailed the steps you will take to prevent, reduce, or eliminate these barriers; and
-You have measures in place to track your progress and evaluate the effectiveness of your efforts to advance racial equity in
your grant activities. (limit 1,000 characters).
Note: any actions taken in furtherance of this section must be consistent with federal nondiscrimination requirements. Failure to
submit this narrative is a non-curable deficiency which may result in applicants being deemed ineligible.

(D) Experience Promoting Racial Equity. Describe your past experience and resources to effectively address the needs of
underserved communities. This may include, but is not limited to:
• experience working directly with historically underserved neighborhoods when designing, planning, or implementing programs
and activities;
• experience building community partnerships with grassroots and resident-led organizations;
• experience designing or operating programs that have provided tangible reductions in racial disparities; or
• having staff with lived experience and/or expertise to provide services in a culturally competent way. (limit 1,000 characters).

(E) Persons with disabilities. Describe how programs and activities will be accessible to persons with disabilities and identify policies
and procedures for providing reasonable accommodations. (limit 1,000 characters).

form HUD-9906-P (3/2023)

(F) Limited English proficiency. Describe what steps will be taken to ensure people with limited English proficiency (LEP) will have
meaningful access to programs and activities. (limit 1,000 characters).

(G) Lead-based paint. Describe how counselors will inform clients of hazards of lead-based paint in homes (limit 1,000 characters).

(H) Emergency preparedness and/or disaster recovery. Indicate any emergency preparedness and/or disaster recovery activities in
which the Applicant participates with the options below.
1) Applicant provides emergency preparedness workshops.
2) Applicant provides disaster recovery workshops.
3) Counselor discusses emergency recovery topics and resources during one-on-one counseling.
4) Counselor discusses disaster recovery topics and resources during one-on-one counseling.
5) Counselors participate in emergency preparedness and/or disaster recovery trainings.
6) Applicant entered into an agreement outlining mutual emergency and services with community partner.
7) Other – Provide a brief description below.

(I) Describe how the Applicant implements the emergency preparedness and/or disaster recovery activities as indicated in Field H
(limit 1,000 characters).

form HUD-9906-P (3/2023)

CHART D2 – OVERSIGHT ACTIVITIES
1.

2.

Enter the number of subgrantees/branches (from 0 to a maximum of 5) for which the Applicant will
conduct a performance review during the grant period of performance using the HUD-9910 form.
The Applicant must share the results of these reviews with HUD.

$

Enter the number of subgrantees/branches for which oversight and quality control activities will be performed during the
grant performance period as part of the proposed work plan.
a.

Train and provide technical assistance to subgrantees/branches.

$

b.

Monitor, evaluate and verify quality of services provided by subgrantees/branches.

$.

c.

i.

Verify subgrantees/branches are conducting supervisory monitoring of the housing counseling
program.

$

ii.

Subgrantee is HUD-approved or, if not directly HUD-approved, Applicant verifies that subgrantee
meets HUD approval standards.

$

iii.

Monitor the grant funded work of subgrantees/branches to verify compliance with HUD grant
agreement requirements and progress in meeting projections.

iv.

Identify and rectify service delivery deficiencies and non-compliance issues.

Process subgrantees’ and branches’ disbursements under the grant:
Review disbursement supporting documentation, including personnel activity reports
(or other personnel expense documentation that satisfies 2 CFR 200.430(i) requirements),
invoices, client file lists, or similar forms of documentation.

$
$

$

form HUD-9906-P (3/2023)

CHART E2 – USE OF FUNDS
The Applicant must fill out and attach Chart E (Excel) to their grants.govapplication. Failure to complete and submit this
form may result in loss of points.

form HUD-9906-P (3/2023)

CHART F2 – HISTORICALLY BLACK COLLEGES AND UNIVERSITIES, TRIBAL COLLEGES AND UNIVERSITIES, AND OTHER MINORITY
SERVING INSTITUTIONS (MSI)
Applicants applying for this funding initiative must complete the following questions. Applicants must also submit proof of status as an HBCU or other MSI, and/or if
applicable, a letter certifying the partnership between the housing counseling agency and the HBCU or other MSI (see NOFO Section V(B)(4) for more details).
A1) Applicant is an HBCU or other MSI.
A2) Applicant is partnering with an HBCU or other MSI.
B) How many housing counseling clients does the Applicant and/or its partner plan to serve with this funding during the period of performance?
C1) Indicate the total award amount requested to provide services for this purpose.
C2) Complete the table below as appropriate for the Applicant and/or the Applicant’s network. The Applicant may provide a separate attachment if more space is needed.

Name of Housing Counseling Agency and HCS ID

Name of Partner HBCU or other MSI;
City, State;
Contact Name, Email Address

Allocation Amount ($)

(state “N/A” if subgrantee or branch is an HBCU or other MSI)

form HUD-9906-P (3/2023)

D) To support the grant amount being requested, describe the following in Fields 1 through 7. If Applicant or its network is partnering with multiple HBCUs or other MSIs, the
Applicant should provide information for no more than three partnerships (limit 2,000 characters for each question).
1. A description of the proposed eligible activities and major tasks required to successfully implement the proposed initiative.

2. Describe the extent to which there is a need to fund the proposed initiative and the importance of meeting the need(s).

3. Relevant experience and capacity of the Applicant, its staff, and HBCU or other MSI partners.

form HUD-9906-P (3/2023)

4. How the Applicant will measure outcomes on its target population.

5. How the Applicant proposes to integrate the institution’s students and faculty into proposed activities.

6. Community involvement in implementation of the program and how the institution will expand its role in target community.
form HUD-9906-P (3/2023)

7. The other resources that support or fund Applicant’s existing housing counseling related partnerships with HBCUs or other MSIs. Include the dollar amounts of support
provided in the description of the resources, if applicable.

form HUD-9906-P (3/2023)