Form Hud-9250-Ohf - Funds Authorization Section 242
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1Funds Authorization
U.S. Department of Housing
OMB Approval No. 2502-0602
(Exp. 08/31/2019)
and Urban Development
Section 242
Office of Hospital Facilities
Public reporting burden for this collection of information is estimated to average 1 hour. This includes the time for collecting, reviewing, and reporting
the data. The information is being collected to obtain the supportive documentation which 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. 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.
Warning: Federal law provides that anyone who knowingly or willfully submits (or causes to submit) a document containing any false, fictitious,
misleading, or fraudulent statement/certification or entry may be criminally prosecuted and may incur civil administrative liability. Penalties upon
conviction can include a fine and imprisonment, as provided pursuant to applicable law, which includes, but is not limited to, 18 U.S.C. 1001, 1010,
1012; 13 U.S.C. 3729, 3802, 24 C.F.R. Parts 25, 28 and 30, and 2 C.F.R. Parts 180 and 2424.
Instructions: Indicate the Fund for the request and provide the information for each section as requested.
FHA Project Number:
Mortgage Reserve Fund
Other Reserve Fund (specify
below)
Is this withdrawal request to replace equipment and/or major
Lender Loan Number: (Optional)
components with energy efficient products/systems?
Property Address: (Include City, State, and Zip Code)
Yes
No
To: (Lender) or Servicer
Comments: (Optional)
Amount
This is your authority to release the following amounts from the reserve:
Purpose:
$
$
$
$
$
$
$
$
$
$
Total Amount
$
Check (X) appropriate box:
______________ revealed satisfactory replacement and/or installation.
An inspection made on the date of
(mm/dd/yyyy)
An inspection will be made on the next visit to the property. Satisfactory replacement and/or installation will be determined at that time.
This Office has approved (Check (X) appropriate boxes.) This is your authority to adjust the Reserve requirements accordingly. This authority is
revocable upon written notice from HUD.
A suspension of Deposits to the Reserve from the date of
___________ to the date of
__________
(mm/dd/yyyy)
(mm/dd/yyyy)
A suspension of Deposits to the Reserve as long as a balance of $ _______________
is maintained.
A change in the Scheduled Deposit to the Reserve from $ _______________ to $ ______________ effective the date of
(mm/dd/yyyy)
______________ through the date
________________
(mm/dd/yyyy)
Remarks (optional)
To: ( Borrower)
Name: HUD Authorizing Official: (please type or print)
Signature
City
State
Date (mm/dd/yyyy)
Previous versions obsolete
Page 1 of 1
form HUD-9250-OHF
Rev 9/2016
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