Form SAMS-1111 at a glance
What it is: Form SAMS-1111 is the Single Family Acquired Asset Management System (SAMS) Payee Name and Address form of the U.S. Department of Housing and Urban Development.
Who signs: 17 -20. Preparer's Signature: Enter legible signature, title, date, and phone number of person completing this form.
Where and when to file: Send the completed form to HUD HOC, Attention: Director, Homeownership Center.
What to bring and attach to Form SAMS-1111
When modifying an existing payee, attach applicable documentation relating to modification, e.g., change of banking institution, attach new Form SF-3881. For All Payees, attach Internal Revenue Service (IRS) documentation showing Business Name/Individual Name and Tax Identification Number (TIN).
Examples include IRS Form 147C, Tax Return with preprinted label, IRS payment coupon. State issued forms are not acceptable.
In addition, for Payees not under formal contract with HUD, as the check marks under your Payee Type on page 2 of the form show: Copy of Driver's License; Copy of first page of a recent telephone bill, utility bill, or bank statement; Copy of Local or State business license for payee's trade, if applicable; Copy of State Real Estate Broker's license; Completed Form SF-3881, ACH Vendor/Misc. Payment Enrollment Form; Completed Form SAMS-1111A, Real Estate Broker Certification; IRS Ruling/Determination Letter. If the HOC Area Office does not intend to make payments to the vendor, check box in Item 27 and do not include Form SF-3881. If a nonprofit organization cannot show proof of tax-exempt status, the payee type must be listed as TS.
A filled-in Form SAMS-1111 example: a real estate broker adds a new payee
How to fill out Form SAMS-1111, box by box
I. Type of Application
1a. Add New Payee: Check if new payee and complete items 2 or 3 through 20.
1b. Modify Existing Payee: Check if modifying information for an existing payee. Items 4 and 17 - 20 and any changes must be completed.
1c. Add New NAID for Existing Payee: Check if linking a new NAID to an existing payee. Items 4, 9, 10 & 17-20 must be completed.
1d. Real Estate Broker Recertification: Check if recertifying real estate broker. Items 4 and 17-20 must be completed.
II. Payee's Information: EIN and Business Name or SSN and Individual Name
Enter Either Payee's EIN and Business Name or SSN and Individual Name, NOT BOTH (Items 2 - 3). 1099 information to be forwarded to IRS under EIN/SSN and name shown in Item 2 or 3, and address shown in Item 8. Item 2 or 3 must match IRS documentation. 2c. Principal Broker's Name (if applicable).
2a. EIN: Enter the Employer Identification Number for the business.
2b. Business Name: Enter the name of the business as it should appear on checks or IRS form 1099-Misc.
2c. Principal Broker's Name: Enter the name of the principal broker as it should appear on checks or IRS Form 1099-Misc.
3a. SSN: Enter the individual's Social Security Number.
3b. Individual Name: Enter the name of the individual as it should appear on checks and IRS Form 1099-Misc.
4. Payee's NAID
4. For HUD Use Only. Payee's NAID: Enter the Name/Address Identifier (NAID) if existing payee.
7. Business Phone Number and 8. Business Address
Business Phone Number: Enter the area code and telephone number.
8. Business Address: Enter complete mailing address of the company or individual named in item 2b or 3b above.
9. Remittance Name and 10. Address
9 - 10. Remittance Name and Address: Enter the Name and Address for remittance of compensation only if different from Business/Individual Name and Address. This is typically the Doing Business As (DBA) Name.
11. Minority-owned? and the minority type
11. Minority-owned?: Check “Yes” if the company is minority-owned. Check “No” if not.
If yes, check the appropriate minority code for the business. Check only one type.
12. Small Business Owned? and 13. Woman Owned?
12. Small Business Owned?: Check “Yes” if the company qualifies as a small business. Check “No” if not.
13. Woman Owned?: Check “Yes” if the company qualifies as a woman owned business. Check “No” if not.
14. Name of Contact Person and 15. Name(s) of Owner(s)/Principal(s)
14. Contact Person: Enter the name, telephone number, fax number, and email address of the contact person.
15. Names of Owners/Principals: Enter the name(s) of the company's owner(s) or principal(s). Continue on separate page if necessary.
16. Family/External Business Relationship to HUD/M&M Contract employees?
16. Related Parties: Enter “Yes” if the payee has either a family relationship or an external business relationship with any HUD/M&M Contract employee. Attach explanation. Enter “No” if no such relationship exits.
17 - 20. Preparer's Signature, Title, Date and Phone
17 -20. Preparer's Signature: Enter legible signature, title, date, and phone number of person completing this form.
More rules for Form SAMS-1111
The preparer completes Items 1 and 2 or 3, and 7 thru 20 legibly in ink or type.
HUD Office Staff complete Items 4 thru 6, and 21 thru 29 legibly in ink or type.
Sign Items 21 and 28 in ink.
The information is being used as Payee reference information, IRS 1099 applicability, minority data collection information, payment remittance instructions and proof of business viability. The SSN is used as a unique identifier.
Common questions about Form SAMS-1111
Where do I file it?
Send the completed form to HUD HOC, Attention: Director, Homeownership Center.
Sources
[1] Form SAMS-1111 (2/2023), Single Family Acquired Asset Management System (SAMS) Payee Name and Address, U.S. Department of Housing and Urban Development (the Official source link on this page).
