HUD-50095 Shortfall Application (Redline)

Public Housing Operating Fund
Shortfall Application

U.S. Department of Housing and Urban Development
Office of Public and Indian Housing
OMB Approval No. 2577-0300 (Exp. 03/31/2025)

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OMB Approval No. 2577-0300
(Exp. 03/31/2025)

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HUD-50095: Shortfall Application
CY 20___ Operating Fund Grant Program – Application for Funds from the Shortfall Funding
Set-Aside Application
Public Housing Agency (PHA) Application for Shortfall Funds and PHA Certification of
Accuracy and Completeness of Financial Data.

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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).
First, please check the portion of Shortfall Funding for which your PHA is applying. Second,
please check the category “Shortfall Tier 1” or “Shortfall Tier 2” for which your PHA is applying.
The application must be signed by the appropriate PHA official.
 PHA is requesting full Shortfall Funding eligibility as published by HUD.
 PHA is requesting a lower amount than the Shortfall Funding eligibility as published by

HUD.
PHA Requested Lower Amount: ___________

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If requesting a lower amount, please indicate reason below. (Please note that if requesting a
lower amount due to an error in the FDS or PIC data, an Appeal must be submitted per the
Shortfall Notice.)
Type/write reason here:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
 Shortfall Tier 1: For PHAs with a Months of Operating Reserves (MOR) ratio less than
zero.

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Form HUD-50095

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, to submit a Shortfall budget, and to undertake reasonable cost saving or
revenue increasing measure to improve its financial condition in accordance with
the Shortfall Notice.
5.6. The PHA acknowledges that they must maintain an MOR as specified in the
current year’s Shortfall Notice.

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 Shortfall Tier 2: For PHAs with a Months of Operating Reserves (MOR) ratio greater than or
equal to zero.
I, ________________________, hereby certify to the following:
1) That I will comply with all the requirements listed in Shortfall Scenario 1.
2) If that PHA is receiving Shortfall funding to raise their MOR above zero, the PHA
must maintain an MOR as specified in the current year’s Shortfall Notice. Note that,
for the last-funded Tier 2 PHA, if that PHA receives only partial funding an
alternative requirement will apply. The last funded PHA will have to demonstrate an
MOR that is equal to the MOR achieved when adding Tier 1 and the first increment
of Tier 2 funding.

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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).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; 31 U.S.C. §3729, 3802)”
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Form HUD-50095

Signature of Executive Director

Date

__________________________________

___________________

PHA Contact Name

Phone Number

__________________________________

___________________

Paperwork Reduction Act burden statement:
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.Public reporting burden for this collection of information is estimated to average .25
hours 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. HUD may not collect
this information, and you are not required to complete this form, unless it displays a currently valid OMB control
number.
HUD collects this information in accordance with 24 CFR Part 990 and annual Appropriations laws, including FY
2021 Consolidated Appropriations Act (Public Law 116-260). PHAs applying for the Shortfall Funding Program are
required to complete this form. This Shortfall Application Form will be used by PHAs to self-certify the accuracy
and completeness of financial data submitted, and for HUD to review that self-certification. HUD will use this
application form in reviewing applications and to ensure that PHAs have submitted accurate and complete
financial data. No assurances of confidentiality are provided for this information collection.

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Form HUD-50095