Form Hud 52665 PDF Details

Are you a first time homebuyer? If so, you may be wondering what Form HUD 52665 is. This form is known as the Homebuyers’ Eligibility Checklist and it is used to determine your eligibility for certain mortgage programs. In this blog post, we will discuss what the Homebuyers’ Eligibility Checklist is and how to fill it out. We will also provide some tips on how to improve your chances of being approved for a mortgage.

Here is the details concerning the form you were in search of to complete. It will show you how much time it takes to complete form hud 52665, exactly what fields you will need to fill in, etc.

QuestionAnswer
Form NameForm Hud 52665
Form Length4 pages
Fillable?Yes
Fillable fields80
Avg. time to fill out17 min 4 sec
Other namesportability form 52665, hud 52665 portability form, 52665, hud form 52665

Form Preview Example

Family Portability Information

U.S. Department of Housing

OMB Approval No. 2577-0169

Housing Choice Voucher Program

and Urban Development

(exp. 04/30/2018)

Office of Public and Indian Housing

 

Public reporting burden for this collection of information is estimated to average .50 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 information. This agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless that collection displays a valid OMB control number.

This collection of information is authorized under Section 8 of the U.S. Housing Act of 1937 (42 U.S.C. 1437f). The information is used to standardize the information submitted to the receiving Public Housing Agency (PHA) by the initial PHA. In addition, the information is used for monthly billing by the receiving PHA.

Sensitive Information. The information collected on this form is considered sensitive and is protected by the Privacy Act. The Privacy Act requires that these records be maintained with appropriate administrative, technical, and physical safeguards to ensure their security and confidentiality. In addition, these records should be protected against any anticipated threats or hazards to their security or integrity which could result in substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom the information is maintained.

Privacy Act Statement. The Department of Housing and Urban Development (HUD) is authorized to collect the information required on this form by Section 8 of the U.S. Housing Act of 1937 (42 U.S.C. 1437f) and by the Housing and Community Development Act of 1987 (42 U.S.C. 3534(a)). Collection of this information, including SSN and annual income, is mandatory. The information is used to standardize the information submitted to the receiving Public Housing Agency (PHA) by the initial PHA. In addition, the information is used for monthly billing by the receiving PHA. The SSN is used as a unique identifier. HUD may disclose this 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 permitted or required by law. Failure to provide any of the information may result in delay or rejection of a family port.

Part I Initial PHA Information and Certification

Instructions: This portion of the form is to be completed by the initial PHA for a family that is moving out of the initial PHA’s jurisdiction under the portability procedures.

1. Headof Household Name

2. Headof Household SocialSecurityNumber

3. Voucher Number (if applicable)

4. Bedroom Size

5.IssuanceDate (mm/dd/yyyy)

6.Expiration Date (mm/dd/yyyy)

7.Dateof LastIncomeExamination (mm/dd/yyyy)

8.

Annual income if new admission (not currently a voucher participant)

$ ___________________________

9.

Date by which initial billing must be received (90 days following the expiration date of the initial PHA voucher) (mm/dd/yyyy)

__________________________

10.

Initial PHA administrative fee rate

$ ____________________________

 

(Note: include proration, if applicable. For example, if the proration factor for the year is 79% and your column B rate is $60, enter $47.4)

11.

80% of initial PHA ongoing administrative fee (line 10 x 0.8)

$ _____________________________

12.

Receiving PHA to which family has been referred: ___________________________________________________.

 

Attachments:

a.A copy of the voucher issued by the initial PHA.

b.The most recent form HUD-50058 and copies of all related verification information for the current form HUD-50058. (Note: This is the latest form HUD-50058 completed for either an applicant, a new admission, an annual reexamination, or an interim redetermination. It is not the form HUD- 50058 that the initial PHA completes to report the portability move-out.)

Certification Statement:

The family is a current program participant or is not a current program participant but is income-eligible in the receiving PHA’s jurisdiction (see line 8 above), and the voucher was issued in accordance with the program regulations. Please issue the family a receiving PHA voucher that does not expire before 30 days from the expiration date indicated in Item 6 (the expiration date on the initial PHA’s voucher) for the appropriate bedroom size (based on the receiving PHA’s policies). I certify that the information contained on Part I of this form and the attached documents provided by my agency are true and correct. My agency will promptly reimburse amounts paid on behalf of the above family within 30 calendar days of receipt of Part II of this form and thereafter ensure that subsequent billing payments are received by your agency no later than the fifth working day of each month. Failure to comply with these payment due dates may result in the transfer of the family's voucher in accordance with program rules and regulations.

Name of Certifying PHA Official __________________________________________

Type Full Name and Address of Initial PHA below

Signature

___________________________________________

 

Initial PHA Contact Name

___________________________________________

 

Phone Number

_________________

Email _______________________

 

Form Submission Date (mm/dd/yyyy) ____________________

 

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Part II-A Receiving PHA Information and Certification Instructions: The receiving PHA must always complete Part II-A.

1. Headof Household Name

2. Headof Household SocialSecurityNumber

3. VoucherBedroom Size(per receivingPHA’s policies)

4. HAP Contract Number(if applicable)

5. Receiving PHA administrative fee rate

$ ____________________________

(Note: include proration, if applicable. For example, if the proration factor for the year is 79% and your column B rate is $60, enter $47.4)

Certification Statement:

I certify that the information contained on Part II of this form and, if applicable, the attached form HUD-50058, is true and correct and that my agency will promptly remit any overpayment to your agency.

Name of Certifying PHA Official _____________________________________________

Type full Name and Address of Receiving PHA below

Signature

_____________________________________________

 

Receiving PHA Contact Name

_____________________________________________

 

Phone Number

_________________

Email _______________________

 

Form Submission Date (mm/dd/yyyy) _____________________

Part II-B Family Status, Initial HAP Contract Execution and Billing Changes After HAP Contract Execution

Instructions: for initial billings, Part II-B must be completed by the receiving PHA and received by the initial PHA within 90 days following the expiration date of the initial PHA’s voucher. For changes in the family status or the billing amount, Part II-B must be completed and sent within 10 working days from the effective date of the change. The receiving PHA does not submit the billing form each month unless the monthly amount due changes or both

PHAs agree to a different billing schedule that requires a more frequent billing submittal.

Check all statements below that apply:

1.The above family has failed to submit a request for tenancy approval for an eligible unit within the allotted time period. You may therefore reissue your voucher to another family and, if applicable, modify any records concerning local preference usage and income targeting requirements.

STOP. Do not complete remainder of form.

2.We have executed a HAP contract on behalf of the family and are absorbing the family into our own program effective

_________________(mm/dd/yyyy). You may reissue your voucher to another family. STOP. Do not complete remainder of form.

3.We executed a HAP contract on __________________ (mm/dd/yyyy) with an effective date of ________________ (mm/dd/yyyy) and are billing your agency. The effective date of the family’s annual reexamination will be _________________ (mm/dd/yyyy). A copy of the new form HUD-50058 is attached to this form. No other documentation is required. (Note: Receiving PHAs are required to complete and submit a form HUD-50058 for families moving into their jurisdiction under portability. The receiving PHA may elect to conduct a special recertification of the family to conform the dates of the unit inspection and recertification, but is not required to do so by HUD in order to complete the form HUD- 50058 for a portability move-in.) Complete line 10 below.

4.The HAP amount has changed effective ________________ (mm/dd/yyyy) for the family because of: (Check all applicable items. Complete line 10 below).

annual recertification

interim/special recertification

change in payment standard

the family moved to another unit in the receiving PHA jurisdiction.

other: (specify)

Comments continued on separate page Yes

No

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5.The HAP payments have been abated effective _______________ (mm/dd/yyyy). Please suspend the HAP to owner portion from your payment effective _______________ (mm/dd/yyyy) until further notice. STOP. Do not complete remainder of form.

6.The HAP payments that were abated beginning ________________ (mm/dd/yyyy) have resumed effective ________________ (mm/dd/yyyy). Please resume payment of HAP effective ___________________ (mm/dd/yyyy). (Note: do not complete remainder of form unless line 4 above also apply. In such cases, complete line 10 below.)

7.We will no longer bill your agency because we are terminating the family's participation in the program or the family is voluntarily leaving the program.

Billing arrangement termination effective date:________________________ (mm/dd/yyyy).

Reason for termination: (specify)

STOP. Do not complete remainder of form.

8.We are absorbing the family into our program and terminating the billing arrangement effective: ____________________ (mm/dd/yyyy).

STOP. Do not complete remainder of form.

9.The HAP contract has been terminated effective ___________________ (mm/dd/yyyy) and no new HAP contract has yet been executed on behalf of the family.

The family:

will not be remaining in our jurisdiction and has been referred to your agency.

intends to remain in our jurisdiction. The family’s voucher expires _________________ (mm/dd/yyyy). (Note: submit this form again once

you know the outcome of the family’s search).

STOP. Do not complete remainder of form.

 

10. Billing Information

 

Regular Billing Amount:

 

a. Monthly HAP amount due

_____________________

(line 12s or 12af of form HUD-50058)

 

b. Ongoing admin fee

_____________________

((1) lesser of: Part I, line 11 or Part II, line 5, or (2) amount otherwise agreed upon)

 

c. Total regular monthly billing amount

$ 0.00

_____________________

(sum of lines a and b)

 

Additional Amount Due, If Applicable:

 

d. Prorated HAP to owner from ____________to _____________

_____________________

e. Hard-to-house fee, if applicable

____________________

f. Other (explain)

_____________________

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g. Total additional amount (sum of lines d, e and f)

$ 0.00

____________________

Total Billing Amount:

 

h. Payment Due This Billing Submission (sum of lines c and g)

$ 0.00

_____________________

(After this submission, billing amount is amount recorded on line c, unless otherwise notified by the receiving PHA.)

Comments:

Clear All

 

Print

 

 

 

 

 

 

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form HUD-52665 (08/2016)

How to Edit Form Hud 52665 Online for Free

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Step 1: At first, pick the orange "Get form now" button.

Step 2: You're now on the document editing page. You may edit, add information, highlight particular words or phrases, put crosses or checks, and insert images.

Fill out the hud 52665 form PDF by providing the text necessary for each individual section.

portion of empty spaces in 52665

Jot down the details in NameofCertifyingPHAOfficial, Signature, InitialPHAContactName, PhoneNumber, Email, FormSubmissionDatemmddyyyy, and formHUD.

Filling in 52665 step 2

In the HeadofHouseholdName, HeadofHouseholdSocialSecurityNumber, HAPContractNumberifapplicable, ReceivingPHAadministrativefeerate, NameofCertifyingPHAOfficial, Signature, ReceivingPHAContactName, PhoneNumber, Email, and FormSubmissionDatemmddyyyy box, describe the key data.

Filling out 52665 part 3

Inside of box annualrecertification, interimspecialrecertification, and changeinpaymentstandard, identify the rights and obligations.

Completing 52665 stage 4

Complete the form by analyzing all these sections: otherspecify, CommentscontinuedonseparatepageYes, and formHUD.

52665 otherspecify, CommentscontinuedonseparatepageYes, and formHUD blanks to complete

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