U.S. Department of Housing
Credit Application for
OMB Approval No. 2502-0328
(exp. 1/31/2003)
and Urban Development
Manufactured (Mobile) Home
Office of Housing
This application is submitted to obtain credit under the provisions of Title I of the National Housing Act. Please answer all questions.
Public reporting burden for this collection of information is estimated to average 0.5 hour 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. 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.
Privacy Act Statement: The Department of Housing and Urban Development (HUD) is authorized to collect this information by Title I, section 2 of the
National Housing Act (12 U.S.C. 1703), and to obtain and verify your Social Security Number (SSN) by section 165 of the Housing and Community
Development Act of 1967 (42 U.S.C. 3543). You must provide all of the information requested. This information will be used to determine your
creditworthiness and to assist HUD in accounting for and monitoring the use of Title I funds. Your SSN is a unique identifier which may be used to conduct
computer matches to verify the information you provide. This information may be given to Federal, State, or local agencies when relevant to civil, criminal,
or regulatory investigations or prosecutions. It will not be otherwise disclosed or released outside of HUD or the lending institution which will provide the
loan funds, except as required or permitted by law. Failure to provide any of the requested information may result in delay or rejection of your application.
General Information: You are required to answer the questions on sex, race and ethnic background. Your answers are needed to determine the
characteristics of Title I program beneficiaries, and willl not affect consideration of your application. By providing this information, you will assist us in
ensuring that this program is administered in a nondiscriminatory manner. If you feel you have been discriminated against and you want to report it, the
Fair Housing and Equal Opportunity Hotline Number is (800) 424-8590.
This information is being collected to permit more efficient risk management of the Title I loan portfolio as well as facilitate claims processing for loan defaults.
The information provides a more comprehensive basis for evaluating Title I lender underwriting practices and thereby improving risk management of the loan
portfolio and also enhances management’s ability to determine appropriate policy changes affecting the Title I portfolio as a whole. Responses are required
in order to obtain benefits. No assurance of confidentiality is provided.
I/We hereby apply for a loan of $
(
) to be repaid in
months Date
net
Yes
No
1. Do you have any past due obligations owed to or insured by any agency of the Federal Government? (check the appropriate box)
(If the answer is "Yes," you are not eligible to apply for an FHA Title I loan until the existing debt has been brought current.)
2. Have you any other application for an FHA Title I loan pending at this time?
Yes
No
3. Are there any unsatisfied judgments against you?
Yes
No
If "Yes," with whom? (Name and address)
4. Have you been declared bankrupt in the last seven years?
Yes
No
Explain any "Yes" answers to items 3 and 4.
5a. Applicant(s)
5b. Co-Applicant
Name of Applicant
Name of Co-Applicant
Social Security Number
Telephone Number
Social Security Number
Telephone Number
Present Address
How Long
Present Address
How Long
Previous Address
How Long
Previous Address
How Long
Married
Separated
Married
Separated
Marital Status
Marital Status
Unmarried
Unmarried
(including Single, Divorced, Widowed)
(including Single, Divorced, Widowed)
Sex
Date of Birth
Number of Dependents
Sex
Date of Birth
Number of Dependents
Male
Female
Male
Female
White
Black
White
Black
Check Applicable Box
1
2
Check Applicable Box
1
2
American Indian or
Asian or
Hispanic
American Indian or
Asian or
Hispanic
3
4
5
3
4
5
Alaska Native
Pacific Islander
Alaska Native
Pacific Islander
Name & Address of Nearest Relative Not Living With You
Name & Address of Nearest Relative Not Living With You
Relationship
Telephone Number
Relationship
Telephone Number
6. Applicants' Bank Account
Name & Address of Bank or Branch
Yes
Savings
No
Checking
7. Other Income Source Indicate source of income and amount per week or month.
Note: Income from alimony, child support, or separate maintenance income need not be reported unless you will rely upon it as a basis for undertaking or repaying this loan.
Source
Amount
Source
Amount
$
per
$
per
Source
Amount
Source
Amount
$
per
$
per
Source
Amount
Source
Amount
$
per
$
per
Previous editions are obsolete.
Page 1 of 2
ref Handbook 4700.1
form HUD-56001-MH (5/93)