HUD XXXX Tribal Annual Recertification

OMB Approval No. XXX-XXX

(Expires XX/XX/20XX)

O ffice of Native American Programs

Section 184 Program

Tribal Annual Recertification

1. Tribe

1a. Official Name

1b. Street Address

1c. City

1d. State

1e. Zip Code

1f. Mailing Address (if different)

1g. Phone Number

1h. Email

1i. Website

2. Tribal Contact

2a. Last Name	2b. First Name	2c. Middle Name
2d. Title	2e. Phone Number	2f. Email

3. Certifications	Status	Status	Status
Documents	No changes since the last HUD approval	Changed and previously approved by HUD	Changed and not yet approved by HUD*
3a. Section 184 Residential Lease or other legal instrument property interest from Tribe to borrower	☐	☐	☐
3b. Leasing Ordinances	☐	☐	☐
3c. Lien Priority Ordinances	☐	☐	☐
3d. Foreclosure Ordinances	☐	☐	☐
3e. Eviction Ordinances	☐	☐	☐
3f. Sample Official Tribal Enrollment Document	☐	☐	☐
3g. Other	☐	☐	☐

*For any changes made and not yet approved by HUD, please include the updated documents with this certification for HUD’s review and approval.

I, the undersigned, certify under penalty of perjury that the information provided above is true, correct, and accurate. WARNING: Anyone who knowingly submits a false claim or makes a false statement is subject to criminal and/or civil penalties, including confinement for up to 5 years, fines, and civil and administrative penalties. (18 U.S.C. §§ 287, 1001, 1010, 1012, 1014; 31 U.S.C. §§ 3729, 3802).

4. Authorized Tribal Official

4a. Last Name

4b. First Name

4c. Middle Name

4d. Title

4e. Signature

4f. Date

Burden Notice: This information is required for the U.S. Department of Housing and Urban Development (HUD) to allow for a Tribe to continue to participate in the Section 184 Indian Housing Loan Guarantee (Section 184) program. Public reporting burden for this collection of information is estimated to average 10 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 1 of 1 Form HUD-5xxxx (02/2024)