HUD XXXX Tribal Application

OMB Approval No. XXX-XXX

(Expires XX/XX/20XX)

Office of Native American Programs

S ection 184 Program

Tribal Application

1. Tribe

1a. Official Name

1b. Street Address	1c. City	1d. State	1e. Zip Code
1f. Mailing Address – If different	1g. City	1h. State	1i. Zip Code

1j. Phone Number

1k. Email

1l. Website

2.Tribal Contact

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

3. Required Documentation (Check the box to indicate that each required document has been included)

3a. Tribal Resolution indicating the Tribe’s desire to participate in the Section 184 program.	☐
3b. Executive document affirming the Tribal ordinance permitting HUD, USDA, VA, and the Lender and their agent to access mortgage properties for serving-related reasons.	☐
3c. Copies of Tribal laws/ordinances related to:
Leasing	☐
Lien priorities	☐
Eviction	☐
Foreclosure	☐
All cross-referenced ordinances related to the above sections.	☐
3d. Documents executed by the authorized official affirming the requirement of the Tribe’s agreement to enforce lien priority, foreclosure, and eviction laws/ordinances. The Tribe’s non-compliance may result in HUD ceasing to guarantee loans on the Tribe’s land.	☐
3e. Copy of a sample residential lease for Tribal land, if applicable.	☐
3f. Copy of a sample Official Tribal Member Enrollment document provided by the Tribe.	☐
3g. Other:	☐

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 determine the Tribe’s eligibility 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 20 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)