HUD-52670 Housing Owner's Certification and Application for Housin

Housing Owner's Certification
and Application for Housing
Assistance Payments

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

OMB Approval No. 2502-0182 (04/30/2009)

Part I - Contract Information
1. Project Name :

4. Type of Subsidy (one only):

Sec. 8
Rent Supp.
RAP
PAC
PRAC

HUD/CA Use Only
2. FHA / EH / Non-Insured No. 3. Section 8/PAC/PRAC Contract Number:

Voucher Number:

5a. Management Agent's Name:
Date Received :

Date Paid :
5b. EIN :

Part II - Occupancy & Income Eligibility Information
6. General Occupancy Information (contract specific):

7. Exceptions to Limitations on Admission of Low-Income Families (only for Sec. 8
contracts effective on or after 10/1/81):

a. Total Units in contract

a. Project-based exceptions in use

b. Number of Units receiving
subsidy under this contract

b. Project-based exceptions allocated

c. Number of units abated
under this contract
d. Number of Units vacant
under this contract

c. Tenant-based exceptions in use
d. Total exceptions

(line b + line c)

e. Number occupied by
Market Rent Tenants
Note: 6a must equal 6b + 6c + 6d + 6e

e. Date Field Office last changed allocations

for project-based exceptions (mm/dd/yy)

Part III - Breakdown of Assistance Payment Requested

HUD/CA Use Only
9. Number of
Units in Billing

8. Type of Assistance

10.
Amount Requested

11.
Amount Approved

a. Regular Tenant Assistance Payments for (mo./yr.):
b. Adjustments to Regular Tenant Assistance Payments
c. i. Section 8 Special Claims for Unpaid Rent
ii. Section 8 Special Claims for Tenant Damages
iii. Section 8 Special Claims for Vacancies
iv. Section 8 Special Claims for Debt Service

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Total Subsidy Authorized under instructions in Handbook 4350.3 123456789012
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Rev. 1
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d. Miscellaneous Accounting Requests
e.

Part V - Owner's Certification I certify that: (1) Each tenant’s Part IV - Distribution of Subsidy Earned (HUD/CA Use Only)

eligibility and assistance payment was computed in accordance
with HUD’s regulations, administrative procedures, and the
Contract, and are payable under the Contract; (2) all required
inspections have been completed; (3) the units for which assistance is billed are decent, safe, sanitary, and occupied or
available for occupancy; (4) no amount included on this bill has
been previously billed or paid; (5) all the facts and data on which
this request for payment is based are true and correct; and (6)
I have not received and will not receive any payments or other
consideration from the tenant or any public or private source for
the unit beyond that authorized in the assistance contract or the
lease, except as permitted by HUD. Upon request by the
Department of Housing and Urban Development, its duly authorized representative, or the Comptroller General of the United
States, I will make available for audit all books, records and
documents related to tenants’ eligibility for, and the amount of,
assistance payments. Warning: 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).
Previous editions are obsolete

Amount Approved
12. Applied to HUD-held mortgage
13. Applied to debts owed by mortgagor
14. Paid to Project
15. $

of the amount in
item E, part III was released from the
Residual Receipts Account.

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Printed Name, Date, Title & Phone No. (include area code) & Signature :

X

Submit an Original and two copies

form HUD-52670 (10/2002)
ref. Handbook 4350.3 Rev. 1

This form is submitted monthly by owners/agents to their Contract Administrator or HUD for each subsidy contract and provides basic information on
the project, reports the number of contract units which are occupied by
eligible tenants and bills HUD for the housing assistance payments. Section
8 projects also must report exceptions to the rule requiring that all units be
leased to families with incomes below 50 percent of area median income.
This form must be completed so HUD/CA can pay owners the difference
between the gross rent and the total tenant payment (housing assistance
payments) according to regulation. It is also necessary for the forms to be
completed so the owner can recoup money lost during vacancy, and money
spent to fix damaged units and cover rent when these expenses are unpaid
by the vacating tenant.
Regulations require that owners complete this form using statutory
formulas for calculating housing assistance payments, unpaid rent and
tenant damages and vacancy loss payments.
The statutes requiring the submission are S101, Housing and Urban Development Act of 1965 (12 U.S.C. 1701s), S236(f)(2), National Housing Act (12
U.S.C.17152z-1, S8, United States Housing Act (42 U.S.C. 1437f), Section 202
of the Housing Act of 1959 as amended by Section 801 of the National Affordable
Housing Act (12 U.S.C. 1701(g)), and Section 811 of the National Affordable
Housing Act (42 U.S.C. 8013). The regulations stipulating these rules are: 24
CFR 215, 236, 880, 881, 883, 884, 886, and 891. The administrative requirements for these forms are provide in HUD Handbook 4350.3 Rev. 1, Chapter 9.
HUD does not promise confidentiality but will not disclose data on a
specific project or tenant. No questions of a sensitive nature are asked in
this form.

The Department of Housing & Urban Development is authorized to collect
this information by the U.S. Housing Act of 1937, as amended, and to request
the Employer Identification Number (EIN) by the Housing & Community
Development Act of 1987, 42 U.S.C. 3543. The owner/agent must provide all
this information including the EIN. The information provided will be used by
HUD for the following: (1) Review accuracy of funds requested by owner /
agent for tenants’ housing assistance payments and special claims payments.
(2) Review owner / agent computation of tenant assistance payment and
tenants’ rents using specific forms and formulas. (3) Evaluate the date owner/
agent re-certify assisted tenants. (4) Limit the number of Section 8 units that
may be leased to low-income families whose incomes exceed 50% of the area
median income. (5) Restrict or prohibit the admission of tenants who are
ineligible for assistance. (6) The EIN may be cross-checked against the EIN
reported on the Management Entity Profile (form HUD-9832) or the Rent
Schedule (form HUD-92458). This cross-check will assist in identifying
inconsistencies whereby corrective action may be taken. The EIN 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. Otherwise, it will not be disclosed or released outside of HUD,
except as permitted or required by law. Providing all information is mandatory,
and failure to provide information will affect participation in HUD programs.
Public reporting burden for this collection of information is estimated to
average 30 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 agency may
not conduct or sponsor, and a person is not required to respond to, a collection
information unless that collection displays a valid OMB control number.

form HUD-52670 (10/2002)
ref. Handbook 4350.3, Rev. 1