Form HUD-5369C.pdf

This is a HUD Form 5369C, which is a Department of Housing and Urban Development certification and consent of financial interests form used by agencies and jurisdictions administering HUD programs. The form serves as a disclosure document for individuals and organizations involved in HUD-funded projects to certify their financial interests and compliance with conflict-of-interest regulations. The form requires disclosure of any financial interests, including employment, ownership stakes, or contractual relationships that could present conflicts of interest in connection with HUD assistance. Signatories must certify that they have disclosed all relevant financial interests and understand the restrictions on lobbying activities and conflicts of interest related to HUD funding.

The form establishes requirements for transparency and accountability in the administration of HUD programs by requiring responsible officials and other parties to document their financial relationships and certify compliance with applicable regulations. It includes provisions addressing the false certification penalties and emphasizes the importance of disclosure in maintaining the integrity of HUD-funded projects. The document does not establish pricing terms, set-asides, or specific contract timelines, as it functions as a compliance and disclosure tool rather than a procurement solicitation or award document. Organizations and individuals must complete and submit this certification form as part of the application or administration process for HUD funding to demonstrate their eligibility and commitment to regulatory compliance.