U.S. Department of Housing
and Urban Development
Office of Housing
Federal Housing Commissioner
form SAMS-1111-A (03/2004)
ref Handbook 4310.5
Single Family Acquired Asset
Management System (SAMS)
Selling Broker Certification
For HUD Use Only
NAID
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 (Please print or type) Telephone Number (include area code)
Broker's License Number TIN/SSN
Company's Name & Mailing Address (include City, State, and Zip Code)
Public reporting burden for this collection of information is estimated to average 12 minutes 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 information enables HUD to record and process financial transactions in its automated Single Family Acquired Asset Management System (SAMS) to
dispose of acquired single-family properties. HUD reimburses M & M Contractors for their services in maintaining, marketing, and selling HUD homes, and
HUD collects funds associated with the sales of these properties. The information enables HUD to create and maintain sound financial management practices
and effective internal controls over the property disposition program. A response is required to obtain or maintain a benefit.
Privacy Act Statement. The Department of Housing & Urban Development (HUD) is authorized to collect the information on this form by the U.S. Housing
Act of 1937, as amended. The Housing & Community Development Act of 1987, 42 U.S.C. 3543 authorizes HUD to collect Social Security Numbers (SSN).
The information is being used as vendor reference information, minority data collection, payment/remittance instructions and proof of business viability. 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 required and permitted by law. Providing the SSN
is mandatory. Failure to provide the information could result in a delay or rejection of your eligibility approval.
Earnest Money Deposit
As a condition to participate in HUD's single family REO sales
program, I 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 understand that I am fully responsible for any deposit
accepted and placed in my escrow account (or client's trust
account). I also understand that any deposit accepted and for-
warded to HUD with a contract will only be in the form of a
cashier's check, certified check, or money order with no termi-
nation date or cancellation provision.
Earnest money deposits being held in my escrow account (or
client's trust account) shall be accounted for at the sales closing,
unless the contract is terminated. I agree to immediately comply
with HUD's instructions for the ultimate disposition of each
earnest money deposit.
I 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)
X
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.
It is further agreed that 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 Guide-
lines 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 major-
ity groups for staff.
Violation of any of the above provisions shall be subject to
debarment procedures set forth in 24 CFR 24.
Broker's Signature & Date (mm/dd/yyyy)
X
Instructions: Send completed form to local HUD HOC, Attn: Director, REO Division
This form is to be kept on file in the HUD HOC.
Previous editions are obsolete
OMB Approval #2502-0306
(exp. 11/30/2013)
