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941-ORCF Lender’s FHA Number Request

ICR 202101-2502-003 · OMB 2502-0605 · Object 107979900.

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Public reporting burden for this collection of information is estimated to average 2 hours. This includes the time for collecting, reviewing, and reporting the data. The information is being collected to obtain the supportive documentation which must be submitted to HUD for approval, and is necessary to ensure that viable projects are developed and maintained. The Department will use this information to determine if properties meet HUD requirements with respect to development, operation and/or asset management, as well as ensuring the continued marketability of the properties. This agency may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB control number.

Warning: Any person who knowingly presents a false, fictitious, or fraudulent statement or claim in a matter within the jurisdiction of the U.S. Department of Housing and Urban Development is subject to criminal penalties, civil liability, and administrative sanctions.






Data must be provided for every field.










Application General Information






Project Name


Borrower Type
*NC = New Construction; SR = Sub. Rehab.; BR = Blended Rate (both NC and Existing); 232(i) = Fire Safety Equipment Type of Project




Current FHA Project #


Loan Amount
Type of Current Loan (if 223a7)


Permanent Interest Rate
Type of Activity (if 223f)




Type of Mortgage Insurance










Project Street Address


Congressional District
Project City




Project State


Project Zip Code






Lender Name


Lender ID #
Lender Contact Name




Lender Contact Email




Lender Contact Phone










Project Characteristics





(Check as applicable)
# of Nursing Home (SNF)
Beds
LIHTC
# of Intermediate Care
Beds
Tax-Exempt Bonds
# of Assisted Living (ALF)
Units
HOME
# of Memory Care
Beds
CDBG
# of Board & Care
Units
Other
# of Independent
Units


# of Other Type Facility
Beds








Projects with Common Control (whether part of a Small, Mid/Size or Large Portfolio)*






Mid/Large size portfolio?
(Requires HUD HQ Review)


Small size portfolio?




Master lease proposed?










Portfolio Name




Portfolio Number




Identify Projects with Common Control by FHA#






* Follow existing Office of Residential Care Facilities (ORCF) Guidance related to what constitutes projects with common control (whether a Small, Mid/ Size, or Large portfolio). It is important to identify related projects so HUD can employ economies of scale in OGC and underwriting reviews.
File Typeapplication/vnd.openxmlformats-officedocument.spreadsheetml.sheet
File Title 941-ORCF Lender’s FHA Number Request
File Modified0000-00-00
File Created0000-00-00