HUD-50095 Shortfall Application

Public Housing Operating Fund OMB Approval No. 2577-0300

Shortfall Application (Exp. 03/31/2025)

Public Reporting Burden for this collection of information is estimated to average 10 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. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions to reduce this burden to the Reports Management Officer, REE, Department of Housing and Urban Development, 451 7th Street SW, Room 8210, Washington, DC 20410–5000. When providing comments, please refer to OMB Approval No. 2577-0300. 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. The information is collected in accordance with 24 CFR Part 990 and annual Appropriations laws, including Full-Year Continuing Appropriations and Extensions Act, 2025 (Public Law 119-4). Participants applying for the Shortfall funding program are required to complete this form. Participants submit this form to self-certify the accuracy and completeness of financial data submitted to HUD. HUD uses this form as a record of the participants’ self-certification and request for Shortfall funds. The information requested does not lend itself to confidentiality.

U.S. Department of Housing and Urban Development

Office of Public and Indian Housing

CY 20___ Shortfall Funding Application

Public Housing Agency (PHA) Application for Shortfall Funds and PHA Certification of Accuracy and Completeness of Financial Data. 

PHA Name: _____________________________________________ 
 
PHA Number: _____________________________________________ 
 
Executive Director: _____________________________________________ 

The above referenced agency is applying for Shortfall funds and has submitted accurate and complete financial data to the U.S. Department of Housing and Urban Development (HUD). The application must be signed by the appropriate PHA official. 
 
I, ________________________, hereby certify to the following: 

1. Information submitted to HUD systems including, but not limited to, the Financial Assessment Subsystem (FASS), Financial Data Schedule (FDS), and Public Housing Information Center (PIC), used in the computation of the Months of Operating Reserves (MOR) and Shortfall Eligibility found in the Shortfall Notice is complete and accurate. Further, the information provided via these systems supports the conclusion that the PHA is in a shortfall position and eligible for Shortfall funding in accordance with the Shortfall Notice.  

2. If submitting an appeal, that the financial documentation and calculations provided by the PHA to support the basis of the appeal are accurate, complete, and truthful. 

3. The PHA acknowledges that any funds not drawn down and expended within the period of performance will be recaptured by HUD. 

4. The PHA understands that Shortfall funding can only be used to pay for immediate needs. 

5. The PHA agrees to collaborate with HUD in the development of an improvement plan, and to undertake reasonable cost saving or revenue increasing measure to improve its financial condition in accordance with the Shortfall Notice.

6. The PHA acknowledges that they must maintain an MOR as specified in the current year’s Shortfall Notice.
   
   

Certification: “I/We, 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 a false statement is subject to criminal and/or civil penalties, including confinement for up to 5 years, fines, and civil and administrative penalties. (18 U.S.C. §§ 287, 1001, 1010, 1012, 1014; 31 U.S.C. §3729, 3802).” 

 

Signature of Executive Director   Date 

__________________________________ ___________________ 

PHA Contact Name Phone Number 

__________________________________ _______________________ 

Form HUD-50095