Appraiser Roster Application

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HUD OMB Approval No. 2502-0538 (Expires 07/31/2025)

Respondent Burden: The information you provide will enable the designated agency to determine whether you qualify for designation in the position for which you are applying. HUD is authorized to collect this information by Title 1, Section 1 of the National Housing Act (Pub. L 479, 48 Statute 1246,12 U.S.C., 1701 et seq.). Public reporting burden for this collection is estimated at an average of 12 minutes to review the instructions, find the information, and complete this form. This agencies cannot conduct or sponsor a collection of information unless a valid OMB number is displayed. You are not required to respond to a collection of information if this number is not displayed. Valid OMB numbers can be located on the OMB Internet page at https://www.reginfo.gov/public/do/PRAMain. If desired you can call 1-800-827-1000 to get information on where to send comments or suggestions about this form. Privacy Act Statement: These agencies will not disclose information collected on this form to any source other than what has been authorized under the Privacy Act of 1974 or title 38, Code of Federal Regulations 1.526 for routine uses (for example: Authorized for release of information to Congress when requested for statistical purposes). Reporting your social security number (SSN) is mandatory. The Housing and Community Development Act of 1987, 42 U.S.C. 3543 authorizes HUD to collect the SSN. Penalty: The provision of the SSN is mandatory. Failure to provide any of the requested information could affect the decision to approve your application since this decision will be made only on the basis of available information we currently have on record. This may result in a delay in the processing of your application. Ethnicity and Race: Please provide both ethnicity and race. For race, you may check more than one designation. Appraisers: The application is to be submitted to HUD only after the appraiser is State licensed or certified with credentials based on the minimum licensing/ certification criteria issued by the Appraiser Qualifications Board (AQB) of the Appraisal Foundation.

* Personal Information *

First Name:

Middle Initial:

Last Name:

Suffix:

Date of Birth:

Social Security Number:

Gender:

Ethnicity:

Race(s):

American Indian:	Asian:	Black:
Native Hawaiian:	White:

* Contact Information *

Home or Business Address:

Street Address:
City:		State:	Zip Code:

Is mailing address the same as home address?

Mailing Address:

Business Name:
Street Address:
City:	State:	Zip Code:

Contact Information:

Phone Number:

()

Fax Number:

()

E-mail Address:

Confirm E-mail:

* Credential Information *

Credential Type:

State:

Credential Number:

Expiration Date:

* Appraiser Certification *

All applicants must read, understand and agree to the following Agreement and Certifications prior to submitting an application.

To avoid the possibility of any conflict on interest and to ensure compliance with HUD appraisal standards, the following certifications are to be completed by personnel qualified to receive assignments from HUD or HUD approved lending institutions for HUD/FHA mortgage insurance applications. The term "interest" refers to direct interest as well as any "interest" held by relatives, business associates, or other controlled persons.

Note: Any of the following items that have been struck out and initialed are exempted from this certificate and are to be explained truthfully in an attached letter.

	(a)	I certify that I do not own more than 10% interest in any lender doing business with HUD in local HUD office jurisdiction.
	(b)	I certify that I do not actively engage in the management or operation of a lending institution doing business with HUD.
	(c)	I certify that I will not accept any assignments for fee work in a transaction in which I have an interest.
	(d)	I certify that I am not currently suspended, debarred, or in any way disqualified from participating in HUD programs.
	(e)	I certify that I have read and fully understand and will comply with HUD Handbook 4000.1 , Single Family Housing Policy Handbook and the FHA Single Family Appraisal Report and Data Delivery Guide, any updates to the Handbook, Mortgagee Letters, and all other instructions and standards, in performing all appraisals on properties that will be security for HUD/FHA insured mortgages.
	(f)	HUD or its authorized agent(s) may inspect my work files at my place of business during normal business hours after providing me reasonable notice of such inspection.

I, the undersigned, understand and agree that:

The approval of this application or license renewal does not constitute my appointment as an agent or employee of HUD/FHA.
In performing fee work my status is that of an independent contractor.
My sole interest in all transactions shall be to perform fee assignments as required by HUD standards and criteria.
An appraisal is a substantial and material element in the determination of the eligibility of an application for FHA mortgage insurance, and HUD/FHA will rely upon the accuracy and truthfulness of an appraisal completed by me in approving any insurance.

I hereby certify that to the best of my knowledge all the information stated herein, as well as any information provided in the accompaniment herewith, is true, accurate, and complete. I further certify that I have read the Warnings set forth below

Any person who knowingly presents materially false, fictitious, or fraudulent statements in a matter within the jurisdiction of HUD is subject to penalties, sanctions, or other regulatory actions, including but not limited to:

Fines and imprisonment under 18 USC 287, 1001, 1010, 1012, which provides for fines of a maximum of $25,000 for individual and $500,000 for organizations of imprisonment for up to 5 years, or both; or
civil penalties and damages under 31 USC 3729, of not less than $5000 and not more than $10,000, plus 3 times the amount of damages which the government sustains; and
administrative sanctions, claims, and penalties by HUD pursuant to 24 CFR Part 24, 28, and 30.

By electronically signing this fillable application, I understand my signature will be placed on the PDF copy of the HUD Form 92563-A which will be submitted to FHA.

I acknowledge and agree that my electronic signature has the same legal effect and validity as my written signature and that the resulting PDF of the HUD-92563-A is valid and will be given the same legal effect as a written and signed HUD-92563-A. I may retain a copy of the completed and binding HUD-92563-A by printing or saving the completed PDF from this online application portal for my records

Acceptance and Signature: (Please type full name in text box below. Do not enter name suffix.)

* Comments *
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