Form Number: HUD-92068-A

Form Description:

The
information you provide will enable HUD to determine the potential risk to HUD's insurance fund. It will be used to evaluate mortgagee's servicing practices,
monitor default and foreclosure rates, and for accounts 90 or more days delinquent, will be furnished to HUD's Credit Alert Interactive Voice Response System
(CAIVRS). HUD may disclose certain information to Federal, State and local agencies when relevant to civil, criminal, or regulatory investigations and
prosecutions. It will not be otherwise disclosed or released outside of HUD, except as required and permitted by law.
You must provide all of the information requested in this report. Failure to provide any of the information can result in the assessment of civil money penalties
and in the curtailment of interest on claims form insurance benefits.