HUD 4755 HEROS Access Authorization Form

OMB Approval No. 2506-0202

(exp. 4/30/2024)

HEROS Access Authorization Form

U.S. Department of Housing and Urban Development

This system is to be used by local, state, and tribal governments, sub-recipients, applicants, and third-party providers who wish to submit information to be used in the completion of Environmental Review Records under 24 CFR Parts 50 and 58 via HUD’s HUD Environmental Review Online System (HEROS). HUD uses this information to approve requests for access to HEROS. The information collected is required to gain access to HEROS so that respondents can complete HUD Environmental Review Records, to obtain and/or retain benefits. The information collected will not be held confidential. The public reporting burden for this collection of information is estimated to average six minutes per response. 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.

Environmental review preparers and certifiers who work at organizations outside of HUD may register for HEROS access using this form. You will receive an email confirmation with login instructions after you register for access. Click here to complete access form in DocuSign.

For questions regarding this form, please submit a question through Ask a Question by selecting "My question is related to Environmental Review and HEROS" - https://www.hudexchange.info/program-support/my-question/

First Name
Last Name
City
State
Work Email Address
Work Phone Number
Will you use HEROS to prepare or approve environmental reviews for the Community Project Funding (CPF) Program?		- Yes - No
Do you already have a HUD-issued B or C ID? - If you already have Integrated Disbursement and Information System (IDIS) access, your ID will be the letter B or C followed by 5 digits. For example, B12345 or C12345.		- Yes - No / I don’t remember
B or C ID number (if applicable)		B or C ID:
Do you already have HEROS access?		- Yes - No
Five-digit PIN (if no B or C ID) - The PIN is any 5 numbers of your choosing and is used for setting up your initial password. - Your PIN is also used for password resets. You may select any PIN if it is 5 digits long. - PINs must be a combination other than 12345.		PIN:
What type of organization do you work for? - Please note: State Agencies acting as HUD are NOT eligible for HEROS access at this time.	- Tribal Government – Responsible Entity - City, State, or Local Government - Responsible Entity Other listed below: - Consultant (An organization hired to help prepare environmental reviews on behalf of a grantee or HUD) - Lender - Nonprofit - Public Housing Authority - Tribally Designated Housing Entity (TDHE) - Other Non-Re Recipient Other Name:

Responsible Entities (RE) - What is the name of your Responsible Entity?			Name of RE:
Partner Users - What is the name of your organization? - For which HUD program do you anticipate completing your FIRST environmental review in HEROS? --- When you are granted HEROS access, you may work on environmental reviews for a variety of HUD programs. - Who is legally responsible for and finalizes HUD environmental reviews for your organization? --- Please note: While partner users can assist with the preparation of the environmental review, only HUD or a Responsible Entity can finalize the review.						Name:
						HUD Program(s): - 202 Program - CDBG - Community Project Funding - FHA Multifamily - HOME - Office of Native American Programs - PIH Capital Fund - RAD - Section 232 - SHOP / VHRM - Other -Other Name:
						Legal Responsibility: - A Responsible Entity - HUD - Both
Part 58 Reviews - Are you an Authorized Officer for certifying the Request for Release of Funds (for non-RE recipients)? - What is the name of the Responsible Entity that completes your environmental reviews? --- The Responsible Entity is the unit of general local, state, or tribal government that is legally responsible for completing the environmental review. If your organization works with multiple REs, please submit an access request for ONE RE using this form, then submit an Ask A Question requesting access to additional REs at (https://www.hudexchange.info/program-support/my-question/). - Is the Responsible Entity for your environmental reviews a Tribe?						Are you an AO: - Yes - No
						Name of RE:
						Is the RE a Tribe: - Yes - No
Part 50 Reviews - What is the name of your HUD contact for environmental reviews? --- The HUD contact is the HUD staff assigned to your environmental review and receives all environmental review documents. Examples: CPD Rep, Underwriter, Appraiser, Transaction Manager, or Engineer.						Name of HUD Contact:
Part 50 and Part 58 Reviews - What is the name of your HUD contact for environmental reviews? --- The HUD contact is the HUD staff assigned to your environmental review and receives all environmental review documents. Examples: CPD Rep, Underwriter, Transaction Manager, or Engineer. - What is the name of the Responsible Entity who completes your environmental reviews? --- The Responsible Entity is the unit of general local, state, or tribal government that is legally responsible for completing the environmental review. If your organization works with multiple REs, please submit an access request for ONE RE using this form, then submit an Ask A Question requesting access to additional REs at (https://www.hudexchange.info/program-support/my-question/). - Are you an Authorized Officer for certifying the Request for Release of Funds (for non-RE recipients)? - Is the Responsible Entity who completes your environmental reviews a Tribe?						Name of HUD Contact:
						Name of RE:
						Are you an AO: - Yes - No
						Is the RE a Tribe: - Yes - No
HEROS Privileges - Do you prepare environmental reviews for your organization? --- An environmental review preparer can view, edit, and create environmental reviews in HEROS. - Do you approve environmental reviews for your organization? --- An environmental review approver has the authority to sign the environmental review record. HUD recommends but does not require that this be the Certifying Officer. - Are you a Certifying Officer? --- The Certifying Officer signs the Request for Release of Funds and Certification and takes legal responsibility for the environmental review. This role may only be filled by the Certifying Officer or their designee. The Certifying Officer is not required to have access to HEROS, although they are welcome to request access. Alternatively, the Certifying Officer may sign a hard copy of the relevant document that can then be uploaded to HEROS. Please note that if someone other than the highest-level official is acting as Certifying Officer, a record of the delegation of signatory authority should be kept on file. The delegation of authority does not have to be submitted to HUD. - Do you need HEROS Administrator privileges? --- HEROS Administrators have privileges to update contact information for users within their organization. They also have privileges to re-assign environmental reviews in HEROS for their organization. This person should have authorization for this privilege from the Certifying Officer. A record of the authorization should be kept in the local files. Note that an organization may appoint more than one HEROS Administrator.							Prepare Environmental Reviews: - Yes - No
							Approve Environmental Reviews: - Yes - No
							Are you a Certifying Officer: - Yes - No
							Do you need HEROS Admin privileges: - Yes - No
Tribes - In which Region (ONAP Area Office) is your Tribe located?		- Alaska - Eastern Woodlands		- Northern Plains - Northwest	- Southern Plains - Southwest
What is the name of your Tribe?	Alaska: Eastern Woodlands: Northern Plains: Northwest: Southern Plains: Southwest:
Public Housing Authority (PHA) Code:

User Signature:

I/We, the undersigned, certify under penalty of perjury that the information provided above 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).

Previous editions are obsolete. 3 HUD form 4755