HUD-50096 Shortfall Appeal (Redline)

Public Housing Operating Fund
Shortfall Appeal

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-50096: Shortfall Appeal

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CY 20__ Operating Fund Grant Program – Shortfall Funding Eligibility Amount AppealAppeal
Public Housing Agency (PHA) Form to Appeal Published Shortfall Eligibility Amount

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PHA Name: _____________________________________________

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PHA Number: _____________________________________________

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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).
As specified in the Shortfall Notice, please submit the following items to submit your appeal:
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1) a re-calculation of Operating Reserves assuming HUD approves the amount
of the requested appeal accepted
1) 2) a copy of the approved accepted FDS the PHA used to calculate Shortfall
eligibilitythat contains the error
3) an indication of the corrected entries and financial information
2)4) for PHAs that will submit a revised financial statement to HUD, a written
concurrence from the PHA’s auditor
3)5) a signed statement (signed pdf is acceptable) by the PHA’s Executive
Director certifying that the submitted information is accurate
4)6)

other documentation to support appeal outside of the above categories

Justification for appealAppeal:

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________________________________________________________________________

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________________________________________________________________________

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________________________________________________________________________
________________________________________________________________________

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Form HUD-50096

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PHA Contact Name

DatePhone Number

__________________________________

___________________

Paperwork Reduction Act burden statement:
Public Reporting Burden for this collection of information is estimated to average 1 hour 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 Fform, 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 appealing their eligibility or the published Shortfall funding eligibility award amount are required to
complete this form. HUD reviewsuses the information provided to review the participants’ appeal and Shortfall
funding eligibility. The information requested does not lend itself to confidentiality.Public reporting burden for this
collection of information is estimated to average 1 hour 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.

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HUD collects this information in accordance with 24 CFR Part 990 annual Appropriations laws, including FY 2021
Consolidated Appropriations Act (Public Law 116-260). PHAs appealing their Shortfall Funding eligibility are
required to complete this form. PHAs will use this form to appeal the published Shortfall eligibility amount they
were awarded. HUD will use this application form in making a determination on the appeal 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-50096

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