HUD-50131-A Request for Section 184A Case Number

OMB Approval No.
(exp. )

Request for Section 184A Case Number
HUD Office of Native American Programs
Section 184A Loan Guarantee Program
Request for Case Number
(Email to Claudine Allen, HUD Honolulu at claudine.c.allen@hud.gov)

Lender Name:
Lender EIN Number /

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Lender Contact Name:
Lender Telephone Number:

Email:

Purpose of Loan (check one):
Acquisition:

Refinance:

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/ Acquisition of Existing Home

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/ Streamline with appraisal

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/ Acquisition/Rehab of Existing Home

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/ Streamline without appraisal

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/ Acquisition – Less than 1 yr old

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/ New – Less than 1 year old

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/ Credit Qualifying with cash out

Construction:

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/ Credit Qualifying with no cash out

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/ Credit Qualifying with escrow

/ Single Close Proposed

Please Check one: /

/ Direct Guarantee or /

/ HUD Underwritten

Borrower’s Name:
Co-Borrower’s Name:
Property Street Address or TMK#:
Street
City
HI

State

Zip code

Proposed Mortgage Amount $

To be completed by HUD:
184A Case Number:

Form HUD-50131-A (date)

OMB Approval No.
(exp. )

Privacy Act Statement. This statement is provided pursuant to the Privacy Act of 1974, 5 USC § 552a. The
authority for collecting personally identifiable information (PII) in the Regulatory Consistency
Communication Board (RCCB) Electronic Feedback Form is based in Section 313 of Public Law 112-95.
Public reporting burden for this collection of information is estimated to average .1 hours per response,
including the time for reviewing instructions, searching existing data sources, gather and maintaining the
data needed, and completing and reviewing the collection of information. HUD may not collect this
information, and you are not required to complete this form, unless it displays a currently valid OMB
control number.
This information is required in order for an eligible homebuyer to obtain a benefit and for HUD to
administer the Loan Guarantee Program for low-income Native Americans, Alaska Natives, and native
Hawaiians (24 CFR Parts1000 and 6000). The requested information is necessary to determine the income
and credit worthiness of low income homebuyers. If HUD did not collect this information, it would
prevent HUD from guaranteeing mortgages to eligible homebuyers. While no assurances of confidentiality
are pledged to respondents, HUD generally discloses this data only in response to a Freedom of
Information request.

Form HUD-50131-A (date)