Hud Xxxxx

OMB Approval No. XXX-XXX

(Expires XX/XX/20XX)

Office of Native American Programs

S ection 184 Program

Borrower’s Authorization of Tribal Notification

1. Section 184 Case Number

2. Direct Guarantee Lender

2a. Name

2b. Loan Number

2c. Land Type

3. Borrower(s)

3a. Borrower’s Last Name or Tribe/Entity	3b. First Name	3c. Middle Name
3d. Co-Borrower Last Name	3e. First Name	3f. Middle Name

4. Property

4a. Street Address

4b. City

4c. State

4d. Zip Code

5. Servicer

5a. Name

5b. Contact’s Last Name

5c. First Name

5d. Middle Name

5e. Contact’s Phone Number

5f. Contact’s Email

5g. Street Address

5h. City

5i. State

5j. Zip Code

6. Tribe

6a. Official Name

7. Tribal Contact

7a. Last Name

7b. First Name

7c. Middle Name

7d. Phone Number

7e. Email

☐ I/We, the Borrower(s), authorize the DG Lender and/or Servicer, and any successor Holder, Lender and Servicer, to notify my Tribe if I default on my Section 184 mortgage. For Missed Payments: The DG Lender and/or Servicer, and any successor Holder, Lender and/or Servicer, shall provide notification to the Tribe between the 31^st and the 46^th day following the date the first missed payment was due. For Other Defaults Under the Mortgage: The DG Lender and/or Servicer, and any successor Holder, Lender and/or Servicer, shall provide notification to the Tribe no earlier than 30 days and no later than 60 days after the borrower’s default. Notification may include disclosure of relevant information about the Borrower(s)’s default status and any actions taken by the DG Lender and/or Servicer, and any successor Holder, Lender and Servicer, to remedy the default.

☐ I/We, the Borrower(s), do not authorize the Holder, DG Lender nor Servicer to notify my Tribe if I default on my Section 184 mortgage.

8. Borrower

8a. Borrower’s Signature	8b. Date
8c. Co-Borrower’s Signature	8d. Date

I hereby certify that the borrower(s) named selected their preferred option and signed this document in my presence.

9. Witness

9a. Last Name

9b. First Name

9c. Middle Name

9d. Phone

9e. Signature

9f. Date

Burden Notice: This information is required for the U.S. Department of Housing and Urban Development (HUD) to verify that the Section 184 Indian Housing Loan Guarantee (Section 184) Direct Guarantee (DG) Lender provided the borrower with the opportunity for the lender to notify the borrower’s Tribe in the event the borrower defaults on the mortgage. Public reporting burden for this collection of information is estimated to average 3 minutes per response, including the time for searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions to reduce this burden, to the Reports Management Officer, REE, U.S. Department of Housing and Urban Development, 451 7th Street SW, Room 4176, Washington, DC 20410-5000. When providing comments, please refer to OMB Approval No. 2577-XXXX. HUD may not collect this information, and you are not required to complete this form, unless it displays a valid OMB control number. HUD is authorized to solicit the information requested in the form by virtue of 12 U.S.C. § 1715z-13a and 24 C.F.R. Part 1005. While no assurance of confidentiality is pledged to respondents, HUD generally discloses this data only in response to a Freedom of Information Act request.

Page 2 of 2 Form HUD-5xxxx (02/2024)