HUD XXXXX Direct Quarantee Lender's Annual Recertification

OMB Approval No. XXX-XXX

(Expires XX/XX/20XX)

Office of Native American Programs

S ection 184/184A Programs

Direct Guarantee Lender’s Annual Recertification

1. Direct Guarantee (DG) Lender

1a. Official Name

1b. Doing Business as (if applicable)

1c. Legal Structure (e.g., Corporation, S Corporation, Partnership, or Sole Proprietorship)

1d. Tax ID	1e. Approved to Participate in the ☐ Section 184 program ☐ Section 184A program
1f. Date Founded (Month and Year)	1g. Fiscal Year End

1h. Street Address	1i. City	1j. State	1k. Zip Code
1l. Mailing Address – If different (Street Address)	1m. City	1n. State	1o. Zip Code

1p. Phone Number

1q. Email

1r. Website

2. DG Lender Contact

2a. Last Name	2b. First Name	2c. Middle Name
2d. Title	2e. Phone Number	2f. Email

3. Certification and Acknowledgements	Yes	No
3a. Most recent renewal documents from approving or supervising agency/agencies	☐	☐
3b. Statement of Good Standing from the approving or supervising agency(s) dated within 12 months of submission of this recertification	☐	☐
3c. List of all employees (full name, title, NMLS number) who are trained and competent in Section 184 and/or 184A loans	☐	☐
3d. List of all Officers (full name, title, NMLS number, if applicable) involved with Section 184 and/or 184A loans and owners as prescribed in Section 184 Program Guidance	☐	☐
3e. List of all Sponsored Entities currently under contract including principal’s full name, NMLS number, organization address, tax ID, States authorized to originate Section 184 and/or 184A loans, contact person, email address, phone number	☐	☐
3f. List of all DG Lender’s branch offices originating Section 184 and/or Section 184A loans (address, phone, Branch Manager’s full name)	☐	☐
3g. List of all Section 184 and/or Section 184A-approved DG Underwriters (full name, NMLS number, if applicable, FHA-DE Number, if applicable, and Section 184 and/or Section 184A DG Underwriter approval number)	☐	☐
3h. Most recent audited annual financial statements, if not approved under 24 CFR §1005.203	☐	☐

4. Loan Metrics and Performance

4a. Total number of Section 184/184A loans closed in the previous calendar year for each program
4b. Number of Section 184/184A loans closed on Trust land or Hawaiian Home Lands in the previous calendar year
4c. Number of Section 184/184A loans more than 90 days past due for each program

• I certify that I am a corporate officer and/or principal/owner of the above-named DG Lender with the authority to legally bind the lender and to execute these certifications on behalf of the organization.

• I certify that the above-named DG Lender has not been refused a license by any Tribe, State, or Federal entity.

• I certify that the above-named DG Lender is in good standing with any Tribe, State, or Federal entity with which it performs direct guarantee activities.

• I certify that the above-named DG Lender continues to meet the DG program eligibility requirements in accordance with applicable statue and Section 184/184A Program Guidance.

• I certify that the attached list of employees represents employees who are trained and competent to perform their assigned responsibilities in mortgage lending, including origination, servicing, collection, and conveyance activities, and that the above-named lender shall maintain adequate staff and facilities to originate or service mortgages, or both, in accordance with applicable Tribal, Federal, or State requirements, to the extent the DG Lender engages in such activities.

• I certify that the attached list of officers is accurate and certify that all employees who will sign applications for Guaranteed Loans on behalf of the above-named DG Lender shall be corporate officers or shall otherwise be authorized to bind the DG Lender in the origination transaction. The DG Lender certifies that only authorized person(s) report on guarantees, purchases, and sales of guaranteed loans to HUD for the purpose of obtaining or transferring guarantee coverage.

• As a DG Lender with a list of Sponsored Entities attached to this form, I certify the continued eligibility of each of the Sponsored Entities listed.

• I certify that, within a timeframe and form as prescribed by Section 184 Program Guidance, the above-named DG Lender shall provide written notification to HUD on:

1. All changes in the DG Lender or Sponsored Entities’ legal structure, including, but not limited to, mergers, acquisitions, terminations, name, location, control of ownership, and character of business,

2. Staffing changes with senior leadership and approved Section 184/184A underwriters for this DG Lender and its Sponsored Entities; and

3. Any sanctions imposed by another supervising entity.

• I certify knowledge that failure to report changes within the timeframe prescribed in Section 184/184A Program Guidance, may result in sanctions.

• I hereby certify that all 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 applicant, 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.

• I further certify that, upon the submission of this recertification, and with the submission of each loan for a Loan Guarantee or request for Loan Guarantee benefits, the DG Lender has and will comply with the requirements of the Secretary of HUD, which include, but are not limited to, Section 184 and/or Section 184A the Housing and Community Development Act of 1992, as amended (12 U.S.C. §§ 1715z-13a and 1715z-13b), 24 CFR parts 1005 and 1007, and Section 184/184A Program Guidance with regard to maintaining its Section 184/184A DG Lender approval.

5. Authorized DG Lender Official

5a. Last Name

5b. First Name

5c. Middle Name

5d. Title

5e. Signature

5f. Date

Burden Notice: This information is required for the U.S. Department of Housing and Urban Development (HUD) to consider if a Direct Guarantee (DG) Lender is eligible to continue participation in the Section 184 Indian Housing Loan Guarantee (Section 184) program and/or the Section 184A Native Hawaiian Housing Loan Guarantee (Section 184A) program. Public reporting burden for this collection of information is estimated to average 15 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. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions to reduce this burden, to the Reports Management Officer, REE, U.S. Department of Housing and Urban Development, 451 7th Street SW, Room 4176, Washington, DC 20410-5000. When providing comments, please refer to OMB Approval No. 2577-XXXX. HUD may not collect this information, and you are not required to complete this form, unless it displays a valid OMB control number. HUD is authorized to solicit the information requested in the form by virtue of by 12 U.S.C. §§ 1715z-13a and 1715z-13b, and 24 C.F.R. Parts 1005 and 1007. While no assurance of confidentiality is pledged to respondents, HUD generally discloses this data only in response to a Freedom of Information Act request.

Page 1 of 2 Form HUD-5xxxx (02/2024)