HUD-52670-A-part 3 Adjustments to schedule of Tenant Assistance Payements D

OMB Approval No. 0000-0000
(xx/xx/xxxx

U.S. Department of Housing and Urban Development
Office of Housing
Federal Housing Commissioner

Adjustments to Schedule of
Tenant Assistance Payments Due

Before completing this form, read and follow the instructions in the Monthly Activity Transmission (MAT) User's Guilde. See the statements on the form HUD-52670 for information on public burden.
1. Asst. Pymts Due For (mm/yyyy):

6.
Head of Household Name
Last, First, Initial

2. Project Name:

3. FHA / EH / Non-Insured Proj. No:

7.
Unit Number

8. Adjusting Certification
Prior or
New
Billing?

New
Cert?

Cert.
Type

Effective
Date

9.
Adjustment Period
Asst.
Pmt.

4. Section 8 / PAC / PRAC Contract No:

10. Calculation Detail
Beginning Partial
Month
No. of
Days

Daily
Rate

Full
Months
No. of
Months

Monthly
Rate

Ending Partial
Month
No. of
Days

5. Type of Subsidy:

11a.
Requested

11b.
Approved
(HUD/CA
use only)

Daily
Rate

12. Totals for this page
Previous editions are obsolete
Submit an Original and two copies

Page __ of __

form HUD-52670-A part 3 (12/2007)
ref. Handbook 4350.3 Rev. 1