HUD-426 form

OMB Number. 2501-0044
Expiration Date: 2/28/2027

Indirect Cost Information for Award Applicant/Recipient
1. Federal Program/Assistance Listing Program Title:
2. Legal Name of Applicant/Recipient:
3. Indirect Cost Rate Information for the Applicant/Recipient:
Please check the box that applies to the Applicant/Recipient and complete the table only as provided
by the instructions accompanying this form.
The Applicant/Recipient will not charge indirect costs using an indirect cost rate.
☐
☐

The Applicant/Recipient will calculate and charge indirect costs under the award by applying a
de minimis rate as provided by 2 CFR 200.414(f), as may be amended from time to time.

☐

The Applicant/Recipient will calculate and charge indirect costs under the award using the
indirect cost rate(s) in the table below, and each rate in this table is included in an indirect cost
rate proposal developed in accordance with the applicable appendix to 2 CFR part 200 and, if
required, has been approved by the cognizant agency for indirect costs.
Agency/department/major
function

Indirect cost Type of Direct Cost
rate
Base
%
%
%

Type of Rate

4. Submission Type (check only one):
5. Effective date(s):
☐ Initial submission ☐ Update
6. Certification of Authorized Representative for the Applicant/Recipient:
**Under penalty of perjury, I certify on behalf of the Applicant/Recipient that
(1) all information provided on this form is true, complete, and accurate, and
(2) the Applicant/Recipient will provide HUD with an update to this form immediately upon learning
of any change in the information provided on this form, and
(3) I am authorized to speak for the Applicant/Recipient regarding all information provided on this
form.
Signature: _____________________________________________ Date: _____________________
Name: ________________________________________ Title: _____________________________
**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; 24 CFR § 28.10(b)(iii)).
Public Reporting Burden Statement: This collection of information is estimated to average 0.25 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 the requested information. Comments regarding the accuracy of this burden estimate and any suggestions for reducing
this burden can be sent to: U.S. Department of Housing and Urban Development, Office of the Chief Data Officer, R, 451 7th St SW, Room
8210, Washington, DC 20410-5000. Do not send completed forms to this address. This agency may not conduct or sponsor, and a person
is not required to respond to, a collection of information unless the collection displays a valid OMB control number. This agency is
authorized to collect this information under Section 102 of the Department of Housing and Urban Development Reform Act of 1989. The
information you provide will enable HUD to carry out its responsibilities under this Act and ensure greater accountability and integrity in
the provision of certain types of assistance administered by HUD. This information is required to obtain the benefit sought in the grant
program. Failure to provide any required information may delay the processing of your application and may result in sanctions and
penalties including of the administrative and civil money penalties specified under 24 CFR §4.38. This information will not be held
confidential and may be made available to the public in accordance with the Freedom of Information Act (5 U.S.C. §552). The information
contained on the form is not retrieved by a personal identifier, therefore it does not meet the threshold for a Privacy Act Statement.

OMB Number. 2501-0044
Expiration Date: 2/28/2027

Instructions for Completing the Indirect Cost Information for the Award Applicant/Recipient
Number
1
2
3

Item
Federal Program/
Assistance Listing
Program Title
Legal Name of
Applicant/
Recipient
Indirect Cost Rate
Information for the
Applicant/
Recipient

4

Submission Type

5
6

Effective date(s)
Certification of
Authorized
Representative for
the Applicant/
Recipient

Instructions
Enter the title of the program as listed in the applicable funding
announcement or notice of funding availability.
Enter the legal name of the entity that will serve as the recipient of the
award from HUD.
Mark the one (and only one) checkbox that best reflects how the
indirect costs of the Applicant/Recipient will be calculated and
charged under the award. Do not include indirect cost rate
information for subrecipients.
The table following the third checkbox must be completed only if that
checkbox is checked. When listing a rate in the table, enter the
percentage amount (for example, “15%”), the type of direct cost base
to be used (for example, “MTDC”), and the type of rate
(“predetermined,” “final,” “fixed,” or “provisional”).
If using the Simplified Allocation Method for indirect costs, enter the
applicable indirect cost rate and type of direct cost base in the first
row of the table.
If using the Multiple Allocation Base Method, enter each major
function of the organization for which a rate was developed and will be
used under the award, the indirect cost rate applicable to that major
function, and the type of direct cost base to which the rate will be
applied.
If the Applicant/Recipient is a government and more than one agency
or department will carry out activities under the award, enter each
agency or department that will carry out activities under the award,
the indirect cost rate(s) for that agency or department, and the type of
direct cost base to which each rate will be applied.
To learn more about the indirect cost requirements, see 2 CFR part
200, subpart E, and the applicable appendix that is listed under 2 CFR
200.414(e).
Check the appropriate box to identify whether this is the first
submission of this form for the award or an update to a previous
submission of this form for the award.
Enter the date(s) for which the information on this form applies.
An employee or officer of the Applicant/Recipient with the capacity
and authority to make this certification for the Applicant/Recipient
must make the certification by signing as provided. They must also
provide the date of their signature, full name, and position title.