HUD 52670-A part 5 Approved Special Claims foe Schedule of Tenant Assistanc

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

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

Approved Special Claims for 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.
Claim Type Code

2. Project Name:

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

7.
Claim ID

4. Section 8 / PAC / PRAC Contract No:

5. Type of Subsidy:

8a.
Amount Requested
Unpaid
Rent

Damages

Rent-Up
Vacancy

Regular
Vacancy

Debt
Service

8b.
Approved
(HUD/CA
use only)

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

Page __ of __

form HUD-52670-A part 5 (12/2007)
ref. Handbook 4350.3 Rev. 1