4600.1 REV-1

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CHAPTER 4. APPLICATION REQUIREMENTS

4-1. FILING AN APPLICATION.

A. FHA-approved multifamily mortgagees submit applications

for Conditional or Firm Commitment on behalf of

prospective mortgagors to the HUD Field Office with

jurisdiction. Applications must comply with this

handbook and the Section 232 regulations and include

all required exhibits. An application for Site

Appraisal and Market Analysis (SAMA - new construction

projects) or Feasibility (rehabilitation projects) may

be submitted to the Field Office by the Sponsor.

(See 4-3.)

B. Sections 4-3 through 4-5 list the exhibits for each

stage of new construction processing. Section 4-6

lists them for substantial rehabilitation. Section 4-7

lists them for existing projects insured pursuant to

Section 223(f). The firm commitment stage and exhibits

are mandatory.

4-2. USE OF HUD FORMS. Forms are available from HUD Field

Offices. Xerox copies are acceptable.

SECTION I - NEW CONSTRUCTION/SUBSTANTIAL REHABILITATION

4-3. APPLICATION EXHIBITS - SITE APPRAISAL AND MARKET ANALYSIS

(SAMA).

A. Form
[HUD-92013-NHICF](http://www.hud.gov/utilities/intercept.cfm?/offices/adm/hudclips/forms/files/92013nhi.pdf) -
Application - Project Mortgage

Insurance, (Appendix 2), completed as follows:

1\. Page 1 in its entirety except for Section D;

2\. Page 2, Section G, Item 38, Land (Estimated Market

Price of Site);

3\. Page 3, Sections I (to the extent known) and J.

B. Form HUD-2576-HF - Certificate of Need for Health

Facility and Assurance of Enforcement of State

Standards (Appendix 1). For States without Certificate

of Need, alternate study of market needs and

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4-1 9/92

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4600.1 REV-1

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(4-3) feasibility plus State standards and enforcement

certification (see 2-2B). For board and care

facilities only, a 1616(e) Certification is required,

instead of Certificate of Need or alternative study.

C. Narrative program for design analysis (see paragraph

5-8).

D. Sketch plan of the site showing the development of the

site including: location of proposed buildings,

streets, parking areas and drives, and service and

recreation areas.

E. Evidence of permissive zoning or evidence that needed

rezoning is likely before submission of a firm

commitment application.

F. Location map.

G. Legal description of the property.

H. Documentary evidence of title to the site or a copy of

the site option agreement, contract of sale or other

legal commitment for the site.

I. Form HUD-92010 - Equal Employment Opportunity

certification.

J. Evidence of last arm\'s length sale and price.

K. Form FHA-3433 - Request for Determination of

Eligibility of Nonprofit Sponsor and/or Mortgagor, if

applicable (Appendix 7).

L. Housing Consultant Contract, if applicable.

M. Form HUD-2530 - Previous Participation Certificate, for

all principals, as defined in Handbook 4065.1.

(Appendix 10)

N. Market analysis or feasibility study, if any.

O. Byrd Amendment (lobbying) disclosure forms.

P. Certification of the date the intergovernmental review

was requested and a copy of the SF-424 (Appendix 14)

sent to Single Point of Contact, as required in

paragraph 3-14.

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9/92 4-2

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4600.1 REV-1

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(4-3) Q. Social Security/Employer Identification numbers for the

sponsor, the proposed mortgagor and its principals.

R. Any other information HUD requires in support of the

application.

4-4. APPLICATION EXHIBITS - CONDITIONAL COMMITMENT.

A. Form
[HUD-92013-NHICF](http://www.hud.gov/utilities/intercept.cfm?/offices/adm/hudclips/forms/files/92013nhi.pdf)
completed in its entirety.

B. Residential care facility management experience for at

least one member of the mortgagor group that clearly

demonstrates:

1\. Familiarity with this kind of housing.

2\. Ability to effectively promote prompt market

absorption.

3\. Familiarity with special needs and expectations of

the target occupancy group.

4\. Ability to handle long market absorption periods

and the complex services and expenses of

residential care facilities.

C. Architectural exhibits - schematics (see Chapter 5) and

narrative program for design analysis, if no previous

SAMA (see paragraph 5-12).

D. Form FHA-2013-SUPP - Application - Project Mortgage

Insurance (Supplement to
[HUD-92013-NHICF](http://www.hud.gov/utilities/intercept.cfm?/offices/adm/hudclips/forms/files/92013nhi.pdf)
for each

principal and general contractor, if known).

E. Financial statements for each principal and general

contractor, if known.

1\. Individuals must submit Form HUD-92417, Personal

Financial and Credit Statement, including criminal

certification on back of form.

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4-3 9/92

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4600.1 REV-1

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(4-4) 2. Partnerships and corporations must submit the

following separate financial statements and

supporting documents for the last 3 years signed

and dated by a senior corporate officer of the

organization (i.e., Chief Executive officer or

Chief Financial Officer):

a\. Balance sheet.

b\. Income and expense statement.

c\. Statement of changes in equity.

d\. Supporting schedules (such as aging of

receivables).

e\. Combined or consolidated statement(s).

f\. Other financial data necessary to determine the

financial responsibility and capacity of the

sponsorship and general contractor (if known).

g\. Criminal certification on the back of Form

HUD-92417.

F. Personal credit reports for each principal and

commercial credit reports for general contractor and

each principal where applicable.

G. Proposed operating budget which shows:

1\. Projected income and expenses for the operation of

the facility.

2\. Projected supplementary budget for the period from

the date of initial occupancy through sustaining

occupancy.

H. Prospective reimbursement rate and percentage of

patient population for each patient type.

\(1\) Private patients with:

\(a\) No insurance coverage or

\(b\) Private insurance coverage.

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9/92 4-4

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4600.1 REV-1

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(4-4) (2) Medicare patients

\(3\) Medicaid patients and

\(4\) Supplemental Social Security (SSI) patients

I. Form HUD-935.2 - Affirmative Fair Housing Marketing

Plan (see Appendix 4 of Handbook 8025.1 REV-1,

Implementation of Affirmative Fair Housing Marketing

Requirements for Multifamily Housing Handbook).

J. Owner/Architect Agreement. (Use AIA Document B181 and

HUD amendments.)

K. Grant and/or loan commitment letter (if applicable).

L. Identity of Interest Forms FHA 3434 and 3435.

(Appendices 8 and 9.)

M. Byrd Amendment (lobbying) disclosure forms.

N. Social Security/Employer Identification numbers for the

sponsor, the proposed mortgagor and its principals.

O. Statement reflecting all debt service requirements for

the project.

P. Current provider agreement for Medicare/Medicaid, if

any.

Q. Items B, E, F, G, H, I, J, K, L, M, N and P in

paragraph 4-3.

R. Revised exhibits for any item submitted at SAMA if

changes warrant a revision.

S. Any other information HUD requires in support of the

application.

4-5. APPLICATION EXHIBITS - FIRM COMMITMENT.

A. Form HUD-92013-NH-ICF completed in its entirety.

B. Current licenses as required by the State and local

jurisdiction.

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4-5 9/92

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4600.1 REV-1

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(4-5) C. Evidence of permissive zoning.

D. Complete construction contract exhibits and narrative

program for design analysis if no previous application

processing. - (See Chapter 5).

E. City/County Health officer\'s approval letter where

private water/sewage treatment systems are provided.

F. Form FHA-2328 - Contractors and/or Mortgagor\'s Cost

Breakdown.

G. Form HUD-92457 - Surveyor\'s Report/Survey Instructions.

H. Management exhibits.

I. Proposed operating budget which shows:

1\. Projected income and expenses for the operation of

the facility.

2\. Projected supplementary budget for the period from

the date of initial occupancy through sustaining

occupancy.

J. Reimbursement rate and percentage of patient population

for each patient type.

\(1\) Private patients with:

\(a\) No insurance coverage or

\(b\) Private insurance coverage.

\(2\) Medicare patients

\(3\) Medicaid patients and

\(4\) Supplemental Social Security (SSI) patients

K. Statement reflecting all debt service requirements of

the project.

L. Items B, F, G, H, I, J, L, M, N, and P in paragraph

4-3.

M. Items D, E, F, I, J, K, L and P in paragraph 4-4.

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9/92 4-6

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4600.1 REV-1

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(4-5) N. Byrd Amendment (lobbying) disclosure forms.

O. Social Security/Employer Identification numbers for the

sponsor, mortgagor entity and its principals.

P. Revised exhibits for any item submitted in previous

stages of processing if changes warrant a revision.

Q. Any other information HUD requires in support of the

application.

4-6. REHABILITATION PROJECTS. Applications proposing

substantial rehabilitation may also be divided into as many

as three stages, although processing can be limited to a

single stage with all required firm commitment exhibits.

A. Feasibility Stage. In addition to the items required

in 4-3, B, C, E, F, G, H, I, J, K, L, M, N, O, and Q,

submit the following:

1\. Form HUD-92013-NH-ICF completed in its entirety.

2\. Current licenses as required by the State and local

jurisdiction.

3\. Current provider agreement for Medicare/Medicaid,

if any.

4\. Survey or site plan.

5\. Drawings or sketches of existing project layout

(floor plans and layouts in enough detail for

review).

6\. City/County Health Officer\'s report/clear report

where private water/sewage treatment system

contemplated.

7\. Description of proposed rehabilitation (work

write-up), showing the nature of the improvements for

each basic element of the project (e.g., roof,

exterior walls, porches and steps, interior walls,

ceilings and floors, kitchen and bathroom

facilities, mechanical equipment, landscape, etc.).

If alteration of existing building elevations,

floor plans or layouts is proposed, provide

sketches showing the post-rehabilitation changes.

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4-7 9/92

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4600.1 REV-1

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(4-6) 8. Brief description of proposed post-rehabilitation

management policies and procedures.

9\. Latest State medical/personal care facility

agency(s) report on the project\'s operation.

10\. Copies of all Medicare and Medicaid audits with:

\(1\) Outstanding findings and/or;

\(2\) Repayment schedule for over-reimbursement in

previous years.

11\. Any other information HUD requires in support of

the application.

B. Conditional Commitment Stage. Same as requirements in

4-4 except submit items 1, 2, 3, 8, 9 and 10 in

paragraph 4-6A. The architectural and cost exhibits

must include:

1\. Detailed work write-up defining the specific nature

and extent of the improvements. Use Outline

Specification Form HUD-5087.

2\. Schematic drawings reflecting all proposed.

modifications and additional work.

3\. Cost breakdown showing the estimated cost of each

of the improvements described in the work write-up.

C. Firm Commitment Stage. Same as requirements of 4-5

except that the architectural exhibits must include the

final work write-up and drawings and specifications, if

required. Items 1, 2, 3, 8, 9, and 10 in paragraph

4-6A must also be submitted.

SECTION II - EXISTING PROJECTS

4-7. APPLICATION EXHIBITS.

A. Form HUD-92013-NH-ICF - Application - Project Mortgage

Insurance (Appendix 2) completed in its entirety.

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9/92 4-8

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4600.1 REV-1

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(4-7) B. Form HUD-2576-HF-Certificate of Need for Health

Facilities and Assurance of Enforcement of State

Standards (Appendix 1). For States without

certificates of need, alternate study of market needs

and feasibility (see paragraph 3-2B). For board and

care facilities only a Section 1616(e) Certification

(see paragraph 2-2B2) is required.

C. Current licenses as required by the state and local

jurisdiction and latest State residential care facility

agency(s), report of project\'s operation.

D. Current provider agreement for Medicare/Medicaid.

E. Residential care facility management experience for at

least one member of the mortgagor group that clearly

demonstrates:

a\. Familiarity with proposed operation.

b\. Ability to effectively maintain high occupancy

rates.

c\. Familiarity with special needs and expectations of

the target occupancy group.

d\. Ability to handle complex services and expenses of

residential care facilities.

F. Board and Care facilities that have contact with local

and State agencies must submit letters of understanding

regarding the subsidized amount, e.g., Offices of

Aging, (Older Americans Act) or Departments of Social

Services.

G. A legal description of the property.

H. Form HUD-92457 - Surveyor\'s Report/Survey Instructions

and \"as built\" survey showing all improvements

(including any additions) on the site and a Surveyor\'s

Certificate. At the time of application, the survey

submitted need not be current; however, a current

survey and certificate must be submitted prior to

closing (see paragraph 5-7D).

I. Certificate of Occupancy or Final Inspection Report, if

available, or statement with from the jurisdiction with

authority recognizing conforming use.

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4-9 9/92

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4600.1 REV-1

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(4-7) J. Municipal code violations report or clear report, and

fire marshall\'s report/clear report, or municipal

letter advising nonparticipation.

K. One set of as-built drawings, if available.

L. Sponsor\'s:

1\. Repair list and any available drawings and

specifications of the proposed repairs,

replacements and improvements.

2\. Preliminary schedule for completion of repairs

after loan closing, if applicable; schedule of

delayed/interrupted occupancy or income, if

applicable.

M. Narrative program for design analysis (see paragraph

5-8).

N. Project Financial Statements.

Balance sheets, statements of income and expenses and

\"Statement of Changes in Financial Position\" on the

facility for the last 3 years prior to submission of

the application. The latest year\'s statement must be

audited by an IPA or CPA having no identity of interest

with the mortgagor or management agent (i.e., no

business or other relationship except for performance

of the audit, systems work, and/or tax preparation. If

the latest audit is more than 3 months old, it must be

supplemented by an owner-certified year-to-date balance

sheet and operating statement.

O. Monthly Resident Roster/Accommodation Charges

disclosing the following information:

1\. Patient room/accommodation number and type (e.g.,

room 204, single occupancy room or 1 BR). All

patient rooms/accommodations must be listed,

whether they are vacant or occupied.

2\. Occupant name. (\"Vacant\" is entered where there is

not an occupant.)

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9/92 4-10

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4600.1 REV-1

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(4-7) 3. Bed/accommodation charge. The monthly charge being

paid by the occupant and amount in arrears, if any,

is to be shown. If the accommodation is occupied

on a nonpaying basis, zero is entered.

4\. Date of first occupancy. (The date that the

occupant first occupied the accommodation.)

5\. Remarks. (Indicate \"U\" to denote an unfurnished

accommodation or \"F\" to denote a furnished

accommodation.)

6\. The owner\'s signature and certification attesting

that the resident roster is correct.

P. A brief description of the management program

addressing the relationship between the owner and the

management agent/operator (including any delegations of

authority) and revenue collection and maintenance

procedures. Operating handbooks may be submitted

provided all of the above items are addressed.

Q. A copy of the proposed management agreement and

management fee. (A copy of any existing management

agreement must also be submitted.)

R. Form HUD-2530, Previous Participation Certification

(Appendix 10) on all principals as defined on Handbook

4065.1.

S. In purchase transactions, a statement, certified to be

true and correct by the seller, purchaser and previous

lender, disclosing all identities of interest that

exist or will exist between any and all parties

involved in the proposal, including the previous and

proposed lender(s).

T. A statement reflecting the balance in all existing

escrow accounts, including the reserve fund for

replacements, if any.

U. Form HUD-92417, Personal Financial and Credit Statement

on the sponsor(s) or any individual who will provide

funds to meet the cash requirements.

V. A copy of the documentation creating the mortgagor

entity.

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4-11 9/92

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4600.1 REV-1

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(4-7) W. For purchase transactions, a copy of the purchase

agreement certified to be true and correct by the

seller and purchaser disclosing: (a) all assets and

liabilities to be transferred with the sale; (b)

whether or not the seller will make the repairs; and,

if so, (c) whether or not the cost of the required

repairs is included in the purchase price.

X. For refinancing transactions, a statement by the

mortgagor listing all outstanding obligations (payoff

balances, including prepayment penalties, if

applicable) whether secured or unsecured. (The

statement must contain the following language: \"I

hereby certify that the above constitutes all secured

and unsecured obligations against this project,\" and

must be signed by the mortgagor.)

Y. Title report which discloses all liens, secured

transactions, former owners and dates of transfers for

a 3-year period prior to the submission of the

application.

Z. Management Agent/Operator Entity Profile.

AA. Proposed operating budget which shows:

1\. Projected income and expenses for the operation of

the facility.

2\. Projected supplementary budget for the period from

the date of initial occupancy through sustaining

occupancy.

BB. Form HUD-9447 - Unit Vacancy and Resident Turnover

Report for the last 2 years (Appendix 11).

CC\. Form HUD-9448 - Resident Accounts Receivable and

Delinquency Analysis Report (Appendix 12). Include

accounts receivable for the last 2 years and a

delinquency analysis (aging of accounts receivable) for

the most recent fiscal period.

DD. Latest state medical/personal care facility agency(s)

report on the project\'s operation.

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9/92 4-12

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4600.1 REV-1

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(4-7) EE. Reimbursement rate and percentage of patient population

for each patient type.

1\. Private patients with:

a\. No insurance coverage or

b\. Private insurance coverage.

2\. Medicare patients

3\. Medicaid patients and

4\. Supplemental Social Security (SSI) patients

FF. Copies of all Medicare and Medicaid audits with:

1\. Outstanding findings and/or:

2\. Repayment schedule for over-reimbursement in

previous years.

GG. Statement reflecting all debt service requirements of

the project.

HH. Provider Agreement with reimbursement agency

(Medicaid).

II\. Byrd Amendment (lobbying) disclosure forms.

JJ. Social Security/Employer Identification numbers for the

sponsor, mortgagor entity and its principals.

KK. Such other information as HUD may require in support of

the application.

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4-13 9/92