Funds Authorizations 9250 (Page 2 of 2) in pdf

U.S. Department of Housing

OMB Approval No. 2502-0555

Funds Authorizations

(exp. 09/30/2016)

and Urban Development

Office of Housing

Federal Housing Commissioner

Instructions: Indicate the Fund for the request and provide the information for each section as requested.

Owners/Agents must also submit the following with this form:

(1) A narrative providing a detailed description of the work performed or to be performed;

(2) Copies of paid invoices if the withdrawal request is for reimbursement for work that has been performed;

(3) If a bid exceeds $25,000 than copies of bids may required. Please refer to HUD Handbook 4350.1 Chapter

detailed guidance;

(4) Mortgagor Certification (refer to HUD Handbook 4350.1, REV-1); and,

(5) A list of appliances and/or major components that will be replaced along with a notation of whether or not the

replacement items will be energy efficient products. If replacement items are not energy efficient products, the

owner/agent must provide a justification.

Public reporting burden for this collection is estimated to average 30 minutes per response, including the time for

reviewing instructions, searching existing data sources, gathering and maintaining data needed, and completing and

reviewing the collection of information. This information is required to obtain is required to obtain benefits. HUD may not

collect this information, and you are not required to complete this form, unless it displays a currently valid OMB control

number.

The regulations at 24 CFR Part 880.601 and 24 CFR Part 880.602 authorizes the Secretary of the Department of

Housing and Urban Development to effectively monitor withdrawals from the Reserve for Replacements and/or Residual

Receipts Funds. This information collection sets forth the information that must be reviewed and approved by HUD in

order to withdraw funds from these accounts. While no assurances of confidentiality are pledged to respondents, HUD

generally discloses this data only in response to a Freedom of Information Act request.

Mortgagee: Retain this record for three years.

Page 2

form HUD-9250

Distribution: One copy to Mortgagor and HUD files.

Ref. Handbook 4350.1, REV-1

1/2008

Funds Authorizations 9250 Page 2