Public reporting burden for this collection of information is estimated to average 0.5 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 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.
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). |
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The information contained in this certification is required for the submission of application fees to HUD. The application fee is sent to HUD when the electronic version of the Firm Application is submitted (and project is placed in the queue).
To enter the ORCF Firm Application processing queue, please submit a completed, signed, version of this certification with evidence of payment for the FHA application fee, and your storage medium containing the electronic version of the Firm Application.
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| Project Name |
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| FHA Project Number |
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| Project City |
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Project State |
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| Loan Amount |
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| Indicate the appropriate application queue: |
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| Program Type |
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Complete only for New Construction, Substantial Rehabilitation, Blended Rate or 241a applications given prior ORCF approval. All other loan types are Single Stage only.
Stage |
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Available Queues: Section 223a7; Section 223f Non-Portfolio; Section 223f Portfolio; Other: New Construction, Substantial Rehabilitation, Blended Rate, 241a Supplemental, 223d Operating Loss, 232i Fire Safety Equipment
Application Queue |
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| Tax Credits: The project involves Low Income Housing Tax Credits (LIHTC) or grants. |
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| Additional Comments: Any additional key identifying information that HUD needs to know about or start working on as soon as an application is submitted (e.g. Tribal Notification). |
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| Common Ownership: (Complete only if the project is not part of a medium or large portfolio, but contains common control with other projects to be submitted within the previous or next 18 months or with currently insured 232 Health Care Facilities. Guidance on common control is outlined in HUD HB 4232.1, Section II, Chapter 17.) |
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| Portfolio Name |
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| Portfolio Number |
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| List the projects (project name and FHA #) with common ownership and application submission within the previous or next 18 months: |
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| List the projects (project name and FHA #) with common ownership and currently HUD insured: |
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| Medium/Large Portfolios: (Complete only if the project is part of a medium or large portfolio.) |
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| Portfolio Name |
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| Portfolio Number |
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| List the projects (project name and FHA Number) that are a part of this batch: |
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| Lender Contact information: |
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| Lender Contact Name |
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| Lender Contact Email |
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| Lender Contact Phone |
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Certification:
By signing this certification, I am certifying that to the best of my knowledge each application included in this submittal is completely assembled according to Office of Residential Care Facilities (ORCF) requirements (including any special requirements of the portfolio approval letter, if applicable). |
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| Executed this <<enter date>> day of <<enter month>>, <<enter year>>. |
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<<enter Lender's name here>> |
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| By: |
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Signature |
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(Printed Name & Title) |
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