Form SAMS-1111-A at a glance
What it is: This form is the Single Family Acquired Asset Management System (SAMS) Real Estate Broker Certification of the U.S. Department of Housing and Urban Development.
Where and when to file: Send completed form to local HUD HOC, Attn: Director, REO Division.
A filled-in Form SAMS-1111-A example: a broker signs both certifications
How to fill out Form SAMS-1111-A, box by box
Earnest Money Deposit
As a condition to participate in HUD's single family REO sales program, you agree to abide by the Department's earnest money policy.
Should HUD instruct me to collect earnest money deposits from prospective buyers, I agree to do so at the time the contract is written and, according to HUD's instructions, deposit such funds either in my escrow account (or client's trust account) or in such other manner as HUD may direct no later than the close of the next banking day; or forward such deposits to HUD with the contract. I also understand that any deposit accepted and forwarded to HUD with a contract will only be in the form of a cashier's check, certified check, or money order with no termination date or cancellation provision.
Earnest money deposits being held in your escrow account (or client's trust account) shall be accounted for at the sales closing, unless the contract is terminated. You agree to fully explain to each purchaser, prior to a contract being written, HUD's earnest money forfeiture policy.
Broker's Signature (Required) & Date (mm/dd/yyyy).
Non-Discrimination
The undersigned broker participating in the sales of HUD-owned properties agrees that neither she/he nor her/his sales or rental personnel, employees or others authorized to act for her/him, in violation of Title VIII of the Civil Rights Act of 1968 (the "Fair Housing Act" Title VIII or Public Law 90-284) or Executive Order 11063, will decline to show or will discriminate in the sale or rental of any property now or hereafter listed with her/him.
The undersigned will: (1) refrain from discrimination on the basis of race, color, creed, religion, sex, national origin, age or handicap in the sale or rental of property; (2) instruct their staffs in the policies of nondiscrimination and all applicable local, State, and Federal fair housing laws; (3) prominently display the Fair Housing Poster in all offices in which sale and rental activity takes place; (4) use the HUD-approved Equal Housing Opportunity logo, slogan, or statement in all advertising in conformance with the Advertising Guidelines for Fair Housing; (5) utilize any available minority media (in addition to other media that is used) when advertising HUD-owned properties; and (6) maintain a nondiscriminatory hiring policy in affirmatively recruiting from both minority and majority groups for staff.
Violation of any of the provisions shall be subject to debarment procedures set forth in 24 CFR 24.
Broker's Signature & Date (mm/dd/yyyy).
I am a signatory to a voluntary affirmative marketing agreement
I am a signatory to a voluntary affirmative marketing agreement between HUD and the local board named: For this reason, I am exempt from signing the non-discrimination portion of this certification.
Broker's Name, Telephone Number, License Number, TIN/SSN and Company
Enter Broker's Name (Please print or type) and Telephone Number (include area code).
Enter Broker's License Number and TIN/SSN.
Providing the SSN is mandatory.
Enter Company's Name & Mailing Address (include City, State, and Zip Code).
More rules for Form SAMS-1111-A
This form is to be kept on file in the HUD HOC.
Common questions about Form SAMS-1111-A
Where do I file it?
Send completed form to local HUD HOC, Attn: Director, REO Division.
Sources
[1] Form SAMS-1111-A (2/2023), Single Family Acquired Asset Management System (SAMS) Real Estate Broker Certification, U.S. Department of Housing and Urban Development (the Official source link on this page).