9250 Funds Authorization

Funds Authorizations

OMB Approval No. 2502-0555
(exp. 2/29/2020)

U.S. Department of Housing
and Urban Development
Office of Housing
Federal Housing Commissioner

For Instructions, Public Burden Statement, and Privacy Act requirements: See Page 2.
Reserve for
Residual Receipts Fund
Replacements Fund
Is this withdrawal request to replace appliances and/or major
components with energy efficient products/systems?

Project Number:
Mortgagee Loan Number: (Optional)
Property Address: (Include City, State, and Zip Code)

Yes

No

To: (Mortgagee)

Comments: (Optional)

This is your authority to release the following amounts from the reserve:
Purpose:

Amount

Total Amount

$
$
$
$
$
$
$
$
$
$
$

0.00

Check (X) appropriate box:
An inspection made on the date of (mm/dd/yyyy) _________ revealed satisfactory replacement and/or installation.
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 (mm/dd/yyyy) __________ to the date of (mm/dd/yyyy) __________
A suspension of Deposits to the Reserve so long as a balance of $__________ is maintained.
A change in the Monthly Deposit to the Reserve from $ ________ to $_______ effective the date of (mm/dd/yyyy) _________
through the date (mm/dd/yyyy) __________
Remarks (optional)

To: (Mortgagor/Managing Agent)

Name of Hub Director or Program Center Director: (please type or print)
Signature
City

Mortgagee: Retain this record for three years.
Distribution: One copy to Mortgagor and HUD files.

Page 1

State

Date (mm/dd/yyyy)

form HUD-9250
Ref. Handbook 4350.1, REV-1
1/2008

Funds Authorizations

U.S. Department of Housing
and Urban Development
Office of Housing
Federal Housing Commissioner

OMB Approval No. 2502-0555
(exp. 09/30/2016)

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.
Distribution: One copy to Mortgagor and HUD files.

Page 2

form HUD-9250
Ref. Handbook 4350.1, REV-1
1/2008