HUD 92001-C Application for Conversion of Existing FHA Lender

Application for Conversion of Existing Federal Housing Administration (FHA) Lender Approval Type U.S. Department of Housing and Urban Development

OMB Approval Number 2502-0005 Exp. 05/12/2012

Section 1: Approved Lender Information
Lender Name      
FHA Title II ID Number (if applicable):      				FHA Title I ID Number (if applicable)      
Loan Correspondent Conversions Only		10 Digit FHA ID Number of Sponsor: Title II:       Title I:      
Contact Person	Name      			eMail      		Phone      		Fax      
Affiliation with Home Builder Yes No If yes, Name:       Tax ID:      				Minority/Women-Owned Business (Optional) Minority-Owned Women-Owned Minority-Owned/Women-Owned
All Applicants must make sure that its lender information listed in the lender approval section of their FHA Connection Account is current because that information will be used for reviewing the conversion application.
All Applicants must provide the following information below for all officers, directors, partners, managers and owners. Please indicate which officer will be in charge of the day-to-day operations of the applicant’s planned FHA operations. Attach a separate sheet for any additional persons or owning entities
Name of Person or Owning Entity			Title (If Applicable)		Officer in Charge?		Social Security or TAX ID Number		Percent Ownership
     			     				     		     
     			     				     		     
     			     				     		     
     			     				     		     
     			     				     		     
     			     				     		     
     			     				     		     
     			     				     		     
     			     				     		     

Section 2: FHA Lender Approval Being Requested

Nonsupervised Loan Correspondent Nonsupervised Lender

Supervised Loan Correspondent Supervised Lender

Section 3: List of Supplemental Information Required for Conversion Applications

Supplemental information must be submitted with form HUD-92001-C to demonstrate that an applicant meets FHA requirements for the conversion requested. Details about each item are in HUD Handbooks 4060.1 and 4700.2 and subsequent Mortgagee Letters and Title I Letter are available at: http://www.hud.gov/offices/adm/hudclips/ Check the appropriate box to indicate that each required document has been included with the application package		To Nonsupervised Loan Correspondent	To Nonsupervised Lender	To Supervised Lender	To Supervised Loan Correspondent
1	Audited Financial Report
2	Funding Program
3	Copy of Fidelity Bond
4	Copy of Errors & Omissions Insurance
5	Combination Sponsor/Funding Letter
6	Certification that all FHA Insured loans held or serviced have been transferred to another FHA lender that is approved to hold and service FHA insured loans.

Section 4: Certifications and Acknowledgments: Check the appropriate box next to each certification and/or acknowledgment. You must provide a detailed explanation for any certification where you mark the “No” box. The explanation must be on the lender’s letterhead, and must be dated and signed by the same person who signs this application.

	1. I certify I am a corporate officer and/or principal/owner of the above-named lender with the authority to legally bind the lender and to execute these certifications and acknowledgments on behalf of the lender.				Yes
	2. I certify the lender is not subject to any assessments or contingent liabilities not disclosed in its financial statements.				Yes No
3. I certify any required application fee has been paid					Yes No
	4. I certify that neither the lender nor any of its principals, partners, officers, individuals serving on its board of directors, managers, supervisors, loan originators, loan processors, loan underwriters, individuals acting as authorized signatories or other employees are:
	(a) Suspended, debarred, under a limited denial of participation (LDP), or otherwise restricted under Part 25 of Title 24 of the Code of Federal Regulations, 2 Code of Federal Regulations, Part 180 as implemented by Part 2424, or any successor regulations to such parts, or under similar provisions of any other Federal or State agencies;				Yes No
	(b) Under indictment for, have been convicted of, or charged with a felony offense that reflects adversely upon the lender’s integrity, competence or fitness to meet the responsibilities of a FHA approved lender;				Yes No
	(c) Subject to unresolved findings contained in a Department of Housing and Urban Development or other governmental audit, investigation, or review;				Yes No
	(d) Engaged in business practices that do not conform to generally accepted practices of prudent lenders or that demonstrate irresponsibility, including, but not limited to, failure to satisfy debts due and owing to FHA/HUD, or associating or affiliating, for the purpose of conducting mortgage business, with a person or entity previously sanctioned/fined by HUD;				Yes No
	(e) Convicted of, or has pled guilty or nolo contendre (“no contest”) to, a felony related to participation in the real estate, mortgage loan, or financial services industry— (1) During the 7-year period preceding the date of the application for licensing and registration; or (2) At any time preceding such date of application, if such felony involved an act of fraud, dishonesty, breach of trust, or money laundering;				Yes No
	(f) In violation of provisions of the S.A.F.E. Mortgage Licensing Act of 2008 (12 U.S.C. 5101 et seq.) or any applicable provision of state law;				Yes No
	(g) In violation of any other requirement established by the Secretary;				Yes No
	(h) Currently or presently suspended, terminated, debarred, sanctioned, fined, convicted, denied approval, or subject to a license/approval revocation by any federal, state, or local government agency, or a government-related entity, where the action is related to the responsibilities that are commensurate with those of the financial services industry; and				Yes No
	(i) Currently involved in a proceeding or subject to an investigation that could result, or has resulted, in suspension, fine, debarment, or other sanction by a federal, state, or local government agency, conviction in a criminal matter, bankruptcy or loss of fidelity insurance or errors and omissions insurance coverage.				Yes No
	5. I certify that no mortgage insurance companies, secondary marketing agencies, warehouse lenders, or broker/dealers have denied the lender approval in the past three years from the date of these certifications.					Yes No
	6. I certify the lender, its principals, partners, officers, and/or directors, have not been subject to any past or present action by HUD, VA, Fannie Mae, Freddie Mac, or other government-related entity in which there has been a request to repurchase a loan or to indemnify the entity against loss.				Yes No
	7. I certify the lender is not currently subject to, previously been, or is proposed for regulatory or supervisory action by any regulatory entity. Regulatory actions include, but are not limited to, supervisory agreements, cease and desist orders, notices of determination, notices of proposed actions, formal memoranda of understanding, informal memoranda of understanding, unresolved audits, revocation of license(s) and investigations. Supervisory actions include, but are not limited to, the appointment of a trustee, receiver, conservator, or managing agent.				Yes No
	8. I acknowledge on behalf of the lender, its continuing obligation to notify HUD’s Lender Approval and Recertification Division, in writing, within 5 days of any change to the information or documentation provided in connection with this application for approval while the lender’s application is pending review.				Yes
	9. I certify that neither the lender nor any of its owners, principals, officers, managers or supervisors have been involved, through ownership or otherwise, with a previously defaulted Ginnie Mae issuer(s), an FHA-approved mortgagee that was subject to action by the Mortgagee Review Board, and/or an entity subject to a civil or criminal action by federal or state law enforcement.				Yes No
	10. I certify that, upon the submission of this application, and with its submission of each loan for insurance or request for insurance benefits, the lender has and will comply with the requirements of the Secretary of Housing and Urban Development, which include, but are not limited to, the National Housing Act (12 U.S.C. § 1702 et seq.) and, HUD’s regulations, FHA handbooks, mortgagee letters, and Title I letters and policies with regard to using and maintaining its new FHA lender approval type.				Yes
	11. I acknowledge on behalf of the lender, its continuing obligation to notify HUD’s Lender Approval and Recertification Division, in writing, within 10 days of issuance of any notice (or proposed notice) of violation, revocation, sanction, suspension, or any other administrative action/proceeding initiated by a state or federal regulatory entity.				Yes
	I hereby certify that all of the information I have provided on this form and in any accompanying documentation is true and accurate to the best of my knowledge and belief. I acknowledge that if I knowingly have made any false, fictitious, or fraudulent statement, representation, or certification on this form or on any accompanying documents, I, as well as the lender, may be subject to administrative action, as well as civil and criminal penalties, including fines and/or imprisonment, under applicable federal law, including but not limited to 18 U.S.C. §§1001, 1010, and 1012, and 31 U.S.C. §§3729 and 3802.
	Name (Printed):      		Title:      
	Signature:			Date:
	Send the executed application form 92001-C and all required exhibits to one of the following addresses.
	US Mail Dept of HUD FHA Lender Approval & Recertification Division 451 7th Street, S.W., Room B133/P3214 Washington, DC 20410	Overnight Delivery Dept of HUD FHA Lender Approval & Recertification Division 490 L’Enfant Plaza East, SW, Suite 3214 Washington, DC 20024

Public Reporting Burden for this collection of information is estimated to average 1.0 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 requested on this form is required by 24 CFR Part 202, HUD Handbook 4060.1or HUD Handbook 4700.2. The information collected assists FHA in determining which lenders should be approved to participate in the FHA single and multifamily insurance programs. It is used to help FHA minimize its risk in insuring single family and multifamily mortgages. Applicants are not required to respond to this collection of information unless a currently valid approved OMB control number is displayed on the form.

Privacy Act Statement. Names and Social Security Numbers are requested in order for the Department to obtain positive identification of the applicant’s officers, directors, stockholders and employees who have authority to obligate the applicant. The information requested will be used solely to determine the eligibility of the individuals to participate in the Department’s mortgage insurance programs. The Department is authorized to request this information by Executive Order 9397 and it will not be disclosed outside the Department without prior consent except as required or permitted by law. The Social Security Numbers are provided to HUD on a voluntary basis. Failure to provide this information could cause delay in processing of the applications. While no assurances of confidentiality are pledged to respondents, HUD generally discloses this data only in response to a Freedom of Information Act request

Warning: It is a crime to knowingly make false statements to the United States on this or any other similar form. Penalties upon conviction can include a fine and imprisonment. For details, see: Title 18 U.S. Code, Sections 1001 and 1010.

Form HUD-92001-C (10/09)

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