Form Hud-92563 - Fee Or Roster Designation / Form Va 26-6681 - Application For Fee Personnel Designation
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1
2Fee or Roster Designation
HUD OMB Approval No. 2502-0538
Check One
U.S. Department of Housing
(exp. 4/30/2003)
and Urban Development (HUD)
Application for
Department of Veterans Affairs (VA)
Fee Personnel Designation
Respondent Burden: Public reporting burden for this collection of information is estimated to average 30 minutes per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and reviewing the collection of information. These agencies may
not conduct or sponsor, and a respondent is not required to respond to this collection of information unless that collection displays a valid OMB Control Number.
If you have comments regarding this burden estimate or any other aspect of this collection, call 1-800-827-1000 for mailing information on where to send your comments.
Privacy Act Statement: The information you provide will enable the designated agency to determine whether you qualify for designation in the position for
which you are applying. The information will not be disclosed outside the designated agency without your consent except to verify its accuracy and, when
relevant to civil, criminal, or regulatory investigations and prosecutions, including the routine uses identified in VA system of records, 17 VA 26, Loan Guaranty
Fee Personnel and Program Participant Records, published in the Federal Register. It will not be otherwise disclosed or released outside of the designated
agency except as required and permitted by law. The Department of Housing and Urban Development (HUD) is authorized to collect this information by Title
I, Section 1 of the National Housing Act (Pub. L. 479, 48 Stat. 1246, 12 U.S.C., 1701 et seq.). The Housing and Community Development Act of 1987, 42 U.S.C.
3543 authorizes HUD to collect the SSN. The Department of Veterans Affairs (VA) is authorized to collect this information by Chapter 37, Title 38 U.S.C.
Penalty: The provision of the SSN to the VA is voluntary; the provision of the SSN to HUD is mandatory. Failure to provide any of the requested information
could affect the decision to approve your application since this decision will be made only on the basis of available information we currently have on record.
This may result in a delay in the processing of your application.
Instructions: Please use typewriter or print clearly. This application is to be submitted to HUD only after the appraiser is State licensed or certified to appraise
and has passed the HUD/FHA Appraisal Examination. Mail the completed form to the VA Regional Office or the HUD Homeownership Center (HOC) having
supervision over the area in which you intend to operate. HUD/FHA appraisers may ascertain an appraiser's FHA roster status from HUD's web site at:
If this application is to be submitted to the VA, an executed VA Form 26-6684, Statement of Fee Appraisers or Compliance Inspectors must be attached.
Designation being applied for:
Appraiser Real Estate
Compliance Inspector
HUD required / VA Voluntary
1. Name of Applicant (first-middle-last)
2. Date of Birth (mm/dd/yyyy) 3. Social Security Number
Male
3a. Sex
(1)
Female
(2)
4. Residence Address (number and street or rural route, city or P.O., county, State, zip code)
5. Telephone Number (include area code)
3b. Race
(1) White Non-Hispanic
(2) Black Non-Hispanic
(3) American Indian /
Alaskan Native
6. Business Address (Address where field reviews are to be sent)
7. Business Phone (include area code)
(4) Asian / Pacific Islander
(5) Hispanic
(7) Hispanic Black
(8) Asian Indian American
8. Present Occupation
9. Name and Address of Present Employer
10. Education
No. of Years
High School
a.
College
b.
Degree(s) Awarded
c.
(If applicable)
11. Special Education or Training, Vocational, Business, or Special courses (Enter course and school name and location)
For HUD/FHA Appraisal Examination Information (Enter city, State, and date (mm/dd/yyyy) of Examination; attach a copy of the certification.)
12. Professional Organizations of which you are a member
13. Registration/License Information (Attach copy(ies) of appraisal license)
Kind
Registration/License No.
State Where Issued
Expiration Date
(mm/dd/yyyy)
Have you been previously approved
14a.
14b. Office Name & Address
14c. Dates of Fee Activity for VA or HUD
by VA or HUD for a Fee Position?
From: (mm/dd/yyyy)
To: (mm/dd/yyyy)
Yes
(If “Yes,” complete Items 14b & 14c)
No
15. Geographic Area(s) of Practice (List your appraisal area(s), e.g., Albany, NY; Ft. Worth, TX; Cleveland, OH; etc.)
All previous editions are obsolete
Page 1 of 2
form VA 26-6681
form HUD-92563 (5/2000)
ref Handbooks 4150.2 & 4905.1
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