Form HUD-52670-A at a glance
What it is: Special Claims Schedule is a form of the U. S. Department of Housing and Urban Development, Office of Housing, Federal Housing Commissioner.
Who signs: Enter the owner's printed name, date and phone no., and sign.
A filled-in Form HUD-52670-A example: an owner claims one tenant's unpaid rent
How to fill out Form HUD-52670-A, box by box
Contract number, project number and project name
Enter the Section 8 / PAC / PRAC Contract No., the FHA Project No. and the Project Name, and follow the guidelines in HUD Handbook 4350.3, Rev. 1 Chapter 9.
Unit number and head of household name
Enter the Unit Number and the Head of Household Name as Last, First, Initial.
Unpaid Rent
Under Type and Amount of Claim ($), enter the Unpaid Rent from HUD 52671-A.
Tenant Damages
Enter the Tenant Damages from HUD 52671-A.
Rent-Up Vacancies
Enter the Rent-Up Vacancies from HUD 52671-B.
Regular Vacancies
Enter the Regular Vacancies from HUD 52671-C.
Debt Service
Enter the Debt Service from HUD 52671-D.
Totals
Enter the Totals.
Owner's printed name, signature, date and phone no.
Enter the owner's printed name, date and phone no., and sign.
By signing, you certify that the above amounts have been computed in accordance with all instructions and requirements prescribed by HUD and the applicable Section 8 / PAC / PRAC Contract, that all prerequisites to and conditions for the assistance claimed have been met, and that all required documentation will be retained in the project's files for 3 years.
Common questions about Form HUD-52670-A
Is there a penalty?
HUD will prosecute false claims and statements, and conviction may result in criminal and/or civil penalties (18 U.S.C. Sections 1001, 1010, 1012; 31 U.S.C. Sections 3729, 3802).
Sources
[1] Form HUD-52670-A Part 2 (05/2014), Special Claims Schedule, U.S. Department of Housing and Urban Development (the Official source link on this page).