Form HUD-92541 – Fill Out and Use This PDF

Phone Number

2)If participating, is the community in good standing with the National Flood Insurance Program (NFIP)?

3)If "Yes" to item 1.A. above, attach:

(i)A Letter of Map Amendment (LOMA) or;

(ii)A Letter of Map Revision (LOMR) or;

(iii)A signed Elevation Certificate documenting that the lowest floor (including basement) is built in compliance with

24 CFR 200.926d(c)(4).

,VWKHSURSHUW\ORFDWHGZLWKLQD&RDVW%DUULHU5HVRXUFH6\VWHP&%56",I\HVWKHSURSHUW\LVLQHOLJLEOHIRU)+$LQVXUHGILQDQFLQJ B. Noise. Is the property located within 1000 feet of a highway, freeway, or heavily traveled road?

(i)Within 3000 feet of a railroad?

(ii)Within one mile of a civil airfield or 5 miles of a military airfield?

C. Runway Clear Zones / Clear Zones. Is the property within 3000 feet of a civil or military airfield?

(i)If "Yes," is the property in a Runway Clear Zone / Clear Zone?

D. Explosive /Flammable Materials Storage Hazard. Does the property have an unobstructed view or located within 2000 feet of any facility handling or storing explosive or fire prone materials?

E. Toxic Waste Hazards. Is the property within 3000 feet of a dump, landfill or site recognized on a EPA Superfund National Priority List (NPL) or equivalent State list?

F. Foreseeable Hazards or Adverse Conditions.

1)Does the site have any rock formations, high ground water levels, inadequate surface drainage, springs, sinkholes, etc.?

2)Does the site have unstable soils (expansive, collapsible, or erodible)?

3)Does the site have any excessive slopes?

4)Does the site have any earth fill?

(i)If "Yes," will foundations, slabs, or flatwork rest on the fill?

If you marked "Yes" to any of the above questions in item "F," attach a copy of all State licensed engineers' (soils and structural) reports, designs, and/or certifications to demonstrate compliance with HUD requirements ensuring structural soundness of the improvements and the health and safety of the occupants.

Refer to HUD Handbook 4145.1, HUD Handbook 4140.3 and HUD Handbook 4000.1.

HUD Label Number(s):

Builder or Builder's Agent: I hereby certify that the site analysis information above is true and accurate to the best of my knowledge and belief and that the plans and specifications were designed to mitigate any foreseeable hazards or adverse conditions. On all properties eligible for maximum LTV financing, I further certify that I have personally reviewed the plans, specifications, and site information submitted herewith . Based upon my review, I hereby certify that such plans, specifications comply with the applicable building codes specified above as well as complying with the HUD construction requirements listed above. An "X" marked in the blank by each numbered item indicates that provisions from the marked code apply.

d. I certify that I will comply with the following: (a) Carry out an affirmative program to attract all minority and majority groups to the housing for initial sale or rental. Such a program shall typically involve publicizing to minority persons the availability of housing opportunities regardless of race, color, religion, sex, handicap, familial status or national origin, through the type of media customarily utilized by the applicants; (b) Maintain a nondiscrimination hiring policy in recruiting from both minority and majority groups;

(c)Instruct all employees and agents in writing and orally in the policy of nondiscrimination and fair housing; (d) &onspicuously

display the Fair Housing Poster in all Sales Offices, include the Equal Housing Opportunity logo, slogan and statement in all printed material used in connection with sales, and post in a prominent position at the project site a sign which displays the Equal Opportunity logo, slogan or statement, as listed in 24 CFR 200.620 and appendix to subpart M to part 200. I understand that I am obliged to

develop and maintain records on these activities, and to make them available to HUD upon request.

Builder: I hereby certify that the site analysis information is true and accurate to the best of my knowledge and belief. I further certify that on all properties eligible for maximum LTV financing, the plans and specifications submitted herewith have been reviewed by the individual signing above and that the individual has the knowledge and experience necessary to determine whether such plans and specifications comply with the HUD/FHA requirements set forth at 24 CFR 200.926d and with other applicable HUD requirements as determined in accordance with 24 CFR 200.926(d)(1) and (2). Any subsequent changes to these plans and specifications shall comply with the aforementioned requirements. Upon sale or conveyance of the property, the undersigned will promptly furnish to the lender a Warranty of Completion of Construction, form HUD-92544 on all properties eligible for maximum LTV financing.

“I, the undersigned, certify under penalty of perjury that the information provided above is true and correct.

WARNING: Anyone who knowingly submits a false claim, or makes false statements is subject to criminal and civil penalties, including confinement for up to 5 years, fines, and civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729)”

This form must be complete and legible and must be reproduced to include all three pages.

Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. 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.

Executive Order 11988 and HUD environmental regulations (24 CFR Part 51) require builders who build newly constructed properties to ensure that the property is not affected by: flood hazards, noise, runway clear zones, explosive/flammable materials storage hazards, toxic waste hazards, and other foreseeable hazards that may affect the site.

HUD requires this information to determine whether the site/location factors would adversely affect the dwelling or homeowner. A response is required whenever a builder builds new properties. Confidentiality is not applicable.

Instructions for Builder's Certification, form HUD-92541