Form Hud 92456 PDF Details

Form HUD 92456 is a form that can be used to request an extension of the time period for mortgaging a property. The form is used to ask for an extension from the date by which the mortgage must be repaid. This can be used in cases where there are extenuating circumstances that have prevented the borrower from repaying the mortgage on time. The form must be submitted before the original due date, and a written explanation must also be included detailing why an extension is needed. There are certain conditions that must be met in order to qualify for an extension, and it is important to discuss your situation with a qualified legal professional before submitting this form. Submitting this form without meeting all of the qualifications could result in penalties or even foreclosure. With careful planning, however, using Form HUD 92456 can provide some much-needed breathing room when facing difficult financial circumstances.

Form NameForm Hud 92456
Form Length7 pages
Fillable fields0
Avg. time to fill out1 min 45 sec
Other namesrevelant, atrisk, 2014, hud acceptable forms of identification

Form Preview Example

Semi-Annual Performance Report

Multifamily Housing

Service Coordinator Program

U.S. Department of Housing

OMB Approval

and Urban Development


Office of Housing

(exp. 11/30/2016)

Federal Housing Commissioner


Public reporting burden for this collection of information is estimated to average 4 hours per response, including the time f or 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 control number.

Instructions: See pages 3 - 5 for detailed instructions.

1. R eporting Period

2. Service Coordinator Information


Oct. 1

- Mar 1, 20___


Email address:

Phone w/ area code:

Number of weekly hrs at project:

Apr. 1

- Sept. 30, 20___





Hire date: _____/_____/__________


3.S ource of funds for S ervice Coordinator

Debt Service Savings

Grant­ Provider #

4.Project Information

Project Name

Street Name, City, S tate, and Zip code

(check all that apply)

Residual Receipts

Section 236 Excess Income

Project Rental Assistance Project (PRAC)

Section 8 Operating Funds

# of Units

# of Residents


5. People S erved

a.R esident Age R anges



Age 18­61 (i.e., non­elderly people w/disabilities)

Age 62­80

Age 81­95

Over 96







b. R esidents' Functional S tatus



Number SC Assisted During



Number of Project Residents


% of Total

Reporting Period


Frail Elders

At Risk Elders


All others


c.Neighbors S erved

Number of low­income elderly or people with disabilites who live in the neighborhood and whom you assisted during the reporting the period.

d. First Timers

Number of individuals whom you assisted for the first time during this reporting period.

New move ins

Neighborhood residents

All other project residents

Page 1 of 7

Form HUD 92456 2/2014

6. Type of Service Coordination Performed (click on title for Glossary of Service Types)

(For each service, provide the number of project and neighborhood residents whom you assisted and number of contacts you made.

Count the individuals only once, but provide the total number of contacts for each individual.


# Individuals

# Contacts



















Case Management






Conflict Resolution






Crisis Intervention/



Support Counseling












Fair Housing and Civil



Rights Assistance








Family Support







General Info/Referral








Health Care Services






Home Management












Isolation Intervention







# Individuals

# Contacts

Legal Assistance

Lease Education


Mental Health Services

Monitoring Services


Resident Councils

Substance Abuse

Tax Preparation S ervices

Transfer to Alternative




Other (specify)

7. Aging in Place Statistics for Residents Who Moved Out of the Project During the R eporting Period.

Move-Out Reasons

This Reporting Period

Last Reporting Period


Number of residents who died

Number of residents who moved to a higher level of care

Number of residents who moved in with family

Number of residents evicted


Total number of move-outs

Page 2 of 7

Form HUD 92456 2/2014

8. Time Allocation of Monthly Tasks (List approximate % of time per month you performed these tasks. S um of all should equal 100%)

Contact with outside service providers



Paperwork not related to residents





Direct contact with project and neighborhood residents


Researching available services



Documentation of resident files







Meetings with property management staff













Total 100%



Please respond to the following items 9­14 by attaching

additional pages .



9. Professional Training Duration (hours or days )

List the training programs you attended during this reporting period. Provide the name of the training provider and program, its location, number of hours, and the number of continuing education hours earned.

10. Educational / Preventative Health Programs

List the programs you implemented for project and/or neighborhood residents during this reporting period.

11. Fundraising

Fundraising activities are optional, but if you have engaged in any activities during the reporting period, please list them.

12. Community Engagement

List meetings or visits with community partners and attendance at or planning of community events that encourage interaction between the

community and project residents.

13. Resident Problems / Issues

Provide anecdotes (no more than two paragraphs each) describing two resident issues with which you were involved during this reporting period.

14. Additional Information

Provide any other information relevant to the administration and performance of the Service Coordinator Program. Provide any recommended "Best Practices" you have found to be effective in providing service coordination and promoting independent living for residents.

Service Coordinator's Name


Page 3 of 7

Form HUD 92456 2/2014

Instructions for Completing Form HUD-92456General:

S ervice Coordinators whose positions are paid by any of the funding sources listed in item #3 must submit this

R eport. S ervice Coordinators must fill out the form; respond to all questions on the report, provide their name and the date the report is completed at the end of the form.

Multiple S ervice Coordinators, Projects, and Grants

*If one project has multiple Service Coordinators, each Service Coordinator should submit his/her own report.

*If one Service Coordinator serves multiple projects, submit one report per project. Y ou may submit one form per project, providing data for items1 through 8. Y ou may attach just one text document responding to items 9 through 14.

*If one Service Coordinator position is supported by two or more grants at one project, submit one report and include all grant numbers in item 3.

*If a Service Coordinator leaves his/her job during a reporting period, he or she must, to the extent possible, complete a performance report for the time worked during that reporting period. If a new S ervice Coordinator starts during the same reporting period, he or she should similarly complete a report for the time worked during that reporting period. The S ervice Coordinator who finishes out the reporting period must send both reports to HUD, to provide data for the entire reporting period.

Method of S ubmission

It is preferred that you complete items 1 through 8 on the form on your computer and create a text file that contains brief responses to items 9 through 14. Email both files together in one email to your representative in the HUD field office that services your project. If you are unable to create or email electronic files, you may complete and submit a hard paper copy to your local HUD representative.

S pecific Instructions for E ach Item:

1.R eporting Period: All Service Coordinators must submit this Report according to the Federal Fiscal Year dates. The reporting periods are October 1 through March 31 and April 1 through September 30. Your Report is due to your local Field Office 30 days after the end of the reporting period, i.e. April 30 and October 30, respectively. Fill in the two-digit year on March 31 or September 30.

2.S ervice Coordinator's Information. Enter your name, phone number, and email address. Provide the month and year you started in this position. Indicate the number of hours you work each week at the project listed in item #4.

3. S ource of Funds for the S ervice Coordinator.

Indicate all sources of HUD funding that are used to pay for your position. Many projects do use a combination of sources.

*If your position is supported by a HUD grant, check the "Grant" box and provide the grant number(s). The middle four digits of this number must begin with: "C93", "C94", "CS", OR "HS". An example is OK56HS02002.

Do not provide your project's Section 8 number (e.g. OK56H789021).

*Check "Debt S ervice S avings", "R esidual R eceipts", or "S ection 236 E xcess Income if your local HUD office has approved the use of thses funds for the S ervice Coordinator program.

*Check "S ection 8 or S ection 202 PR AC operating funds" if your local HUD office has approved the S ervice Coordinator as an on­going permanent expense in your project's operating budget.

*Check multiple boxes if you use two or more HUD sources of funds to pay for your program. For example, many programs are supported by a combination of grant funds and residual receipts or grant funds and S ection 8 funds.

4.Project Information. Provide the name and address of the property where you work. Give the total number of units (i.e. apartments) in the project and the total number of residents. R emember that if you serve two or more projects you must complete a separate report for each project.

5.People S erved

5a. R esident Age R anges. Provide number of residents in each age category. The total of the four categories should match the number of residents provided in item #4.

5b. R esidents' Functional S tatus. Provide the estimated number of frail, at­risk, and well elderly (aged 62+) and the number of non­elderly people with disabilities. (aged 18­61). The "All others" line refers to the "well" elderly.

Indicate the number of residents in each category whom you assisted in any way during the reporting period. Do not count residents twice. R egardless of the amount of time spent assisting one resident, only count that individual once. The total of the four categories in the "Number of Project R esidents" column should match the number of residents provided in item #4.

A "Frail" elder is someone who has difficulty performing three or more Activities of Daily Living (ADLs). An "At­risk" elder is one who has difficulty performing one or two ADLs. ADL deficiencies do not appy to non­elderly people with disabilities.

Page 4 of 7

Form HUD 92456 2/2014

HUD's definition of ADLs includes eating, dressing, bathing, grooming, and transferring, as further described below:

(1)Eating--may need assistance with cooking, preparing, or serving food, but must be able to feed self;

(2)Bathing--may need assistance in getting in and out of the shower or tub, but must be able to wash self;

(3)Grooming--may need assistance in washing hair, but must be able to take care of personal appearance;

(4)Dressing--must be able to dress self, but may need occasional assistance;

(5)Transferring---actions such as going from a seated to standing position, getting in and out of bed, and using the toilet.

5c. Neighbors S erved. Provide the number of low-income elderly or people with disabilities who live in the neighborhood whom you assisted during the reporting period (if any). Working with neighborhood residents is optional. HUD is interested in knowing how many S ervice Coordinators serve the greater community and how many individuals are covered.

5d. First Timers. Provide the number of project residents and neighbors whom you assisted for the first time during the reporting period.

Make a distinction between those who moved in within the last six months ("New move-ins") and those who have lived in the project or neighborhood longer, but only started coming to you for assistance during this reporting period.

6.Type of S ervice Coordination Performed. For each of the listed services, provide the sum of project residents and neighbors (in the "Number of Individuals" column) who received that service during the reporting period. Provide the number of contacts

with all individuals related to those services. Choose only the category you feel most appropriately represents the service you coordinated.

Count individuals once but report each contact with that one person. For example, you assisted three project residents in obtaining transportation services during the reporting period. To do this you had to meet with one resident three times, another resident five times and the third resident three times. S o the number of individuals is three and the number of contacts is 11.

If you additionally helped one neighborhood resident obtain transportation services and if you met with that person three times during the reporting period, then the number of individuals will be 4 and the number of contacts will be 14. R efer to the Glossary of S ervice Types (HUD­92456­G) for explanations and examples of services.

7. Aging in Place S tatistics. Provide the number of project residents who left the project during the reporting period.

Residents counted in this section must have been residents of the project at the time of their departure. Do not count neighborhood residents. Provide the reason and number for each move-out. Add other reasons on the "Other" line if relevant.

HUD wants to know how the Service Coordinator program affects aging-in-place over time. Include the numbers from the last report as a comparison. You'll do this on each subsequent report. If you are a new S ervice Coordinator and don't have a previous report or access to previous data, indicate "No Data" in the revelant box.

8. Time Allocation of Monthly Tasks. List the approximate or average % of time per month you spent performing the listed tasks. Add others if appropriate. Sum of all should equal 100% of your average time each month.

*Contact with outside service providers. Includes any activity related to obtaining information about or advocating for affordable supportive services or assistance for residents. Such activity may include telephone conversations, face-to-face meetings, coalition or task force meetings, or working groups.

*Direct contact with project and neighborhood residents. This is the time you spend with your residents, for example in one­on­one meetings, informal conversation, while conducting needs screenings, or at educational program gatherings.

Page 5 of 7

Form HUD 92456




*Documentation of resident files. Includes any notes you make, forms completed, or other information entered in resident files.

*M eetings with property management staff. Includes meetings with site manager or administrator, supervisor, other property management staff, or any other related meeting.

*Paperwork not related to a resident. Includes any reports written for management staff, supervisors, or peers.

Also relevant is paperwork related to registering for training, arranging travel, or purchasing supplies or equipment.

*Researching available services. Includes time spent searching for program information on the Internet, by phone, reading literature, and meeting with knowledgeable professionals.

*O ther. If you perform other work on a monthly basis, please list function and percentage of time.

Please attach a Microsoft Word (or other text file) that contains brief responses to items 9-14. Your report is not

complete without this additional document and adequate responses to each item.

9. Professional raining Duration (hours or days)

.*List the eligible training programs you attended during this

reporting period. Provide the following information for each program you attended:

*Name of the training program

*Name of sponsoring organization that planned and executed the training ( i.e. training provider)


*Duration ( hours or days)

*Number of training hours completed

* Training pursuant to guidance in HUD' s M anagement Agent Handbook4381 .5 REV ­ 2 CHG­ 2, Chapter 8.9. First time S ervice Coordinators must complete 36 hours in the first year of employment as a S ervice Coordinator, unless they have received recent revelant training. All other S ervice Coordinators must complete 12 hours of eligible training each year.

10.Educational and Preventative Health Pro grams. List the programs you developed and/or implemented for project and/or neighborhood residents during this reporting period. Provide the name or topic of each program only and give the approximate number of individuals who attended. Indicate whether events were one time only or ongoing programs.

Examples of such programs are talks on osteoporosis, nutrition, or accessibility issues for people with disabilities, “brown bag” medication meetings with pharmacists, or remembrance groups.

Page 6 of 7

Form HUD 9245 62 2 14

11. Fundraising. List optional fundraising activities, if any, completed during this reporting period. Provide the name

or brief description of each activity, the amount of funds raised, and the intended use of these funds. Please note that fundraising activities must relate to assisting the residents to age in place.

Examples of items that you might assist in fundraising include but are not limited to:

Another part-time Service Coordinator or aide position

Exercise equipment

Blood pressure machine for health clinic use

Ramp to make the project or immediate area more accessible

Purchase or lease of a van

Creation of computer Center and purchase of computer equipment

Examples of items that you should not directly engage in fundraising activities for include:

Holiday parties

Large screen TVs for community rooms

DVD players

Pianos and organs

Bingo sets

12. Community Engagement. List meetings with service providers and local area partners and attendance at or planning of local events that encourage interaction between the greater community and project residents.

Community engagement is defined as follows:

*Visits or meetings with new service providers and/or local vendors, churches, schools, etc.

*Attendance at community organization events that would make the greater community aware of your property and the needs of your residents.

*Planning events that encourage the greater community to visit and interact with project residents.

13. Resident Problems/Issues. Provide anecdotes (no more than two paragraphs each) describing two resident issues with which you were involved during the reporting period. Indicate whether or not the issue was resolved during the

reporting period. Describe positive and/or negative outcomes. The objective of this item is to give readers of the report

a description of your work and the types of issues dealt with on a daily basis. Unresolved situations will be viewed as

examples of difficult problems or circumstances and not as a negative reflection on your efforts. Please be candid in your account, in order to give the reader an accurate description of your work. Do not provide any personal identifiable


14.Additional Information. Provide any other information relevant to the administration and performance of the Service Coordinator Program. Provide any recommended "Best Practices" you have found to be effective in providing service

coordination and promoting independent living for the residents. Examples of your "Best Practices" will be essential in helping others develop effective S ervice Coordinator programs and obtaining needed resources.

Page 7 of 7

Form HUD 92456 2/2014

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