form HUD-52671-C (09/2002)
ref. HB 4350.3 Rev. 1
Previous versions obsolete Submit an Original and two copies
19.Enter daily assistance payment
(Divide assistance payment in effect on move-out date by
actual no. days in move-out month.)
20.Multiply lines 18 by line 19
This is the most HUD will pay for the first month.
If vacancy continues for a second month, continue with line 21.
However, if a new tenant moved in the same month as the
previous tenant moved out, skip to line 26.
21.Day of second month the unit was rented
22.Subtract one (1) day from line 21 (Or enter actual no. days
vacant if the unit was not re-rented.)
23.Enter daily contract rent/operating rent (Divide contract rent/
operating rent in effect on move-out by actual no. days in
move-out month.)
24.Multiply line 22 by line 23
25.Multiply line 24 by 0.80
This is the most HUD will pay for the second month.
26.Add lines 20 & 25
27.Enter amounts paid by other sources
(Security deposit, Title I, etc.)
28.Subtract line 27 from 26
Enter in column 6 on HUD 52670-A Part 2.
15. No. days taken to
clean / repair unit
Part B
(applies to)
886: Property
Disposition,
Subpart C
I certify: (a) Units are in decent, safe, and sanitary condition, and are available for
occupancy during the vacancy period in which the payments are claimed. (b) The Owner
/ Agent did not cause the vacancy by violating the lease, the contract, or any applicable
law. (c) I notified HUD or the contract administrator immediately upon learning of the
vacancy, or prospective vacancy, and the reasons for it. (d) I complied with all HUD
requirements on termination of tenancy (Chapter 8, Section 3 of Handbook 4350.3 Rev.1)
if the vacancy was caused by an eviction. (e) All documentation will be retained in the
project's file for 3 years.
Owner's printed name, signature, & date
HUD will prosecute false claims & 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).
HUD/Contract Administrator Review
Claim approved.
Claim adjusted. Reason:
Claim denied. Reason:
Official's name, signature, & date
Claim ID: _____________________
(—)(—)
(—)(—)
(—)
14. Tenant's move-out
date
16. Date unit ready for
occupancy
17. Last day of mo. (or day before
move-in if in same month)
18. Number of days vacant in first month
(Line 17 minus line 16, plus one day.
Not to exceed 30.)
Project name FHA project no. Sec 8/PAC/PRAC Cont #
Vacated Tenant name Unit No.
7. Contract rent/operating rent at move-out
8. Enter daily contract rent/operating rent (Divide contract rent/
operating rent in effect on move-out date by actual no. days
in move-out month)
9. Multiply lines 6 and 8 (Contract rent /operating rent for days
vacant)
10.Multiply line 9 by 0.80 for Section 8/PAC units or 0.50 for
Section 202/811 PRAC units (This is the most HUD will pay)
11.Enter amounts paid by other sources
(Security deposit, Title I, etc.)
12.Subtract line 11 from line 9
13.Compare line 10 with line 12 & enter the lesser amount
Enter in column 6 on HUD 52670-A Part 2.
1. Tenant's move-out
date
2. No. days taken to
clean / repair unit
3. Date unit ready for
occupancy
4. Date unit ready for
occup. + 59 days
5. Date unit was
re-rented
Part A
(applies to the
following)
880: Section 8 New
Construction
881: Substantial
Rehabilitation
884: Rural Housing
Services
886: LMSA Subpart A
891: Elderly Housing
6. No. of days vacant
(Not to exceed 60.
Include day in line 3
but not day in line 5.)
Instructions
Follow guidelines
in HUD Handbook
4350.3, Rev. 1,
Chapter 9
(—)
OMB Approval No. 2502-0182
Special Claims
for Regular Vacancies
U.S. Department of Housing
and Urban Development
Office of Housing
Federal Housing Commissioner
(Exp. 06/30/2016)
