Special Claims For Unpaid Rent
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1OMB Approval No. 2502-0182
U. S. Department of Housing
Special Claims for
(Exp. 06/30/2016)
and Urban Development
Unpaid Rent / Damages
Office of Housing
Federal Housing Commissioner
Instructions
Project Name
FHA Project No.
Section 8/PAC/PRAC Contract No.
Follow guidelines in
HUD Handbook 4350.3,
Vacated Tenant Name
Unit No.
Tenant Vacant Date
Rev. 1 Chapter 9
Total amount
Enter the security deposit amount required.
1.
collected from
tenant
2.
Enter the security deposit amount collected.
Enter the greater of lines 1 and 2.
3.
Enter the interest earned on the security deposit.
4.
5.
Enter the money collected for unpaid rents and damages (from tenant, insurance, etc.).
Total amount collected. Add lines 3 through 5.
6.
HUD's maximum
Enter the monthly contract rent at move-out for Section 8 or PAC units, or the monthly
7.
liability
operating rent for Section 202/811 PRAC.
Subtract line 6 from line 7 (equals maximum HUD liability). If this amount is 0 or
8.
negative, stop! This exceeds HUD's maximum and no claim is allowed.
Unpaid rent claim
Enter the rent and any other allowable charges due under the lease that were charged but
9.
unpaid at move-out.
Subtract line 6 from line 9 (not less than 0).
10.
Enter the lesser of lines 8 and 10. Round to the whole dollar. Also, enter in column 3 on
11.
HUD 52670-A Part 2.
HUD's remaining
Subtract line 11 from line 8. If this amount is 0 or negative, stop! This exceeds HUD's
12.
liability applicable
maximum and no claim for damages is allowed.
to damages
Enter cost to repair damage.
13.
Enter the remaining amount of the security deposit (line 6 minus line 9). This cannot be
14.
less than 0.
Amount of damage exceeding the remaining security deposit (line 13 minus line 14). This
15.
cannot be less than 0.
Enter the lesser of lines 12 and 15. Round to the whole dollar. Also, enter in column 4 on
16.
HUD 52670-A Part 2.
I certify: (a) I billed tenants for unpaid rent or damages and took all
HUD/Contract Administration Review
reasonable steps to collect the debt. (b) I determined the damage claim was
Claim approved
due to the tenant's negligence or abuse. (c) All documentation will be retained
in the project's file for 3 years.
Claim adjusted. Reason:
Claim denied. Reason:
Owner's printed name, signature, and date
Official's name, signature, and date
HUD will prosecute false claims and statements. Conviction may result in
criminal and/or civil penalties (18 U.S.C. Sections 1001, 1010, 1012; 31
U.S.C. Sections 3729, 3802.)
Claim ID: _________________________
Previous versions obsolete
form HUD-52671-A (05/2014)
ref. HB 4350.3 Rev. 1
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