HUD-1a Settlement Statement Optional for Transactions Without S

U.S. Department of Housing
and Urban Development

Settlement Statement
Optional Form for
Transactions without Sellers
Name & Address of Borrower:

Name & Address of Lender:

Property Location: (if different from above)

Settlement Agent:

OMB Approval No. 2502-0265
(expires 11/30/2009)

Place of Settlement:

Loan Number:

L.
800.
801.
802.
803.
804.
805
806.
807.
808.
809.
810.
811.
900.
901.
902.

Settlement Date:

Settlement Charges
Items Payable In Connection with Loan
Loan origination fee
% to
Loan discount
% to
Appraisal fee to
Credit report to
Inspection fee to
Mortgage insurance application fee to
Mortgage broker fee to

M.

Disbursement to Others

1501.
1502.
1503.
1504.
1505.
1506.

Items Required by Lender to be Paid in Advance
Interest from
to
@$
per day
Mortgage insurance premium for
months to

1507.
1508.

903. Hazard insurance premium for

year(s) to
1509.

904.
1000.Reserves Deposited with Lender
1001.Hazard insurance
months @ $
1002.Mortgage insurance
months @ $
1003.City property taxes
months @ $
1004.County property taxes
months @ $
1005.Annual assessments
months @ $
1006.
months @ $
1007.
months @ $
1008.
months @ $
1100.Title Charges
1101.Settlement or closing fee to
1102.Abstract or title search to
1103.Title examination to
1104.Title Insurance binder to
1105.Document preparation to
1106.Notary fees to
1107.Attorney's fees to
(includes above item numbers
1108.Title insurance to
(includes above item numbers
1109.Lender's coverage
$
1110.Owner's coverage
$
1111.
1112.
1113.
1200.Government Recording and Transfer Charges
1201.Recording fees:
1202.City/county tax/stamps:
1203.State tax/stamps:
1204.
1205.
1300.Additional Settlement Charges
1301.Survey to
1302.Pest inspection to
1303.Architectural/engineering services to
1304.Building permit to
1305.
1306.
1307.
1400.Total Settlement Charges (enter on line 1602)

1510.
per
per
per
per
per
per
per
per

month
month
month
month
month
month
month
month

1511.
1512.
1513.
1514.
1515.
1520. TOTAL DISBURSED (enter on line 1603)

)
)

N.

NET SETTLEMENT

1600.Loan Amount

$

1601.Plus Cash/Check from Borrower

$

1602. Minus Total Settlement Charges (line 1400)

$

1603. Minus Total Disbursements to Others (line 1520) $

1604.Equals Disbursements to Borrower
(after expiration of any applicable
rescission period required by law)

$

Borrower(s) Signature(s):

X
form HUD-1A (2/94)
ref. RESPA

Public reporting burden for this collection of information is estimated to average 0.35 hours 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 collect this information, and you are not required to complete this form, unless it displays a currently valid OMB control number.

Instructions for completing form HUD-1A
Note: This form is issued under authority of the Real Estate
Settlement Procedures Act (RESPA), 12 U.S.C. 2601 et seq. The
regulation for RESPA is Regulation X, codified as 24 CFR 3500,
and administered by the Department of Housing and Urban Development (HUD). Regulation Z referred to in the next paragraph is
the regulation implementing the Truth in Lending Act (TILA), 15
U.S.C. 1601 et seq. and codified as 12 CFR part 226.
HUD-1A is an optional form that may be used for refinancing
and subordinate lien federally related mortgage loans, as well as for
any other one-party transaction that does not involve the transfer of
title to residential real property. The HUD-1 form may also be used
for such transactions, by utilizing the borrower’s side of the HUD1 and following the relevant parts of the instructions set forth in
Appendix A of Regulation X. The use of either the HUD-1 or
HUD-1A is not mandatory for open-end lines of credit (homeequity plans), as long as the provisions of Regulation Z are
followed.
Background
The HUD-1A settlement statement is to be used as a statement of
actual charges and adjustments to be given to the borrower at
settlement. The instructions for completion of the HUD-1A are for
the benefit of the settlement agent who prepares the statement; the
instructions are not a part of the statement and need not be
transmitted to the borrower. There is no objection to using the
HUD-1A in transactions in which it is not required, and its use in
open-end lines of credit transactions (home-equity plans) is encouraged. It may not be used as a substitute for a HUD-1 in any
transaction in which there is a transfer of title and a first lien is
taken as security.
Refer to the “definitions” section of Regulation X for specific
definitions of terms used in these instructions.
General Instructions
Information and amounts may be filled in by typewriter, hand
printing, computer printing, or any other method producing clear
and legible results. Additional pages may be attached to the HUD1A for the inclusion of customary recitals and information used
locally for settlements or if there are insufficient lines on the HUD1A.
The settlement agent shall complete the HUD-1A to itemize all
charges imposed upon the borrower by the lender, whether to be
paid at settlement or outside of settlement, and any other charges
that the borrower will pay for at settlement. In the case of “no cost”
or “no point” loans, these charges include any payments the lender
will make to affiliated or independent settlement service providers
relating to this settlement. These charges shall be included on the
HUD-1A, but marked “P.O.C.” for “paid outside of closing,” and
shall not be used in computing totals. Such charges also include
indirect payments or back-funded payments to mortgage brokers
that arise from the settlement transaction. When used, “P.O.C.”
should be placed in the appropriate lines next to the identified item,
not in the columns themselves.
Blank lines are provided in Section L for any additional
settlement charges. Blank lines are also provided in Section M for
recipients of all or portions of the loan proceeds. The names of the
recipients of the settlement charges in Section L and the names of
the recipients of the loan proceeds in Section M should be set forth
on the blank lines.

Line item instructions
The identification information at the top of the HUD-1A should be
completed as follows:
The borrower’s name and address is entered in the space
provided. If the property securing the loan is different from the
borrower’s address, the address or other location information on
the property should be entered in the space provided. The loan
number is the lender’s identification number for the loan. The
settlement date is the date of settlement in accordance with § 3500.2
of Regulation X, not the end of any applicable rescission period.
The name and address of the lender should be entered in the space
provided.
Section L. Settlement Charges. This section of the HUD-1A is
similar to section L of the HUD-1, with the deletion of lines 700
through 704, relating to real estate broker commissions. The
Instructions for filling out the HUD-l as set forth in Appendix A of
Regulation X provide additional information regarding Section L,
if needed.
Line 1400 in the HUD-1A is for the total settlement charges
charged to the borrower. Enter this total on line 1602 as well. This
total should include Section L amounts from additional pages, if
any are attached to this HUD-1A.
Section M. Disbursement to Others. This section is used to list
payees, other than the borrower, of all or portions of the loan
proceeds (including the lender, if the loan is paying off a prior loan
made by the same lender), when the payee will be paid directly out
of the settlement proceeds. It is not used to list payees of settlement
charges, nor to list funds disbursed directly to the borrower, even
if the lender knows the borrower’s intended use of the funds.
For example, in a refinancing transaction, the loan proceeds are
used to pay off an existing loan. The name of the lender for the loan
being paid off and the pay-off balance would be entered in Section
M. In a home improvement transaction when the proceeds are to
be paid to the home improvement contractor, the name of the
contractor and the amount paid to the contractor would be entered
in Section M. In a consolidation loan, or when part of the loan
proceeds is used to pay off other creditors, the name of each
creditor and the amount paid to that creditor would be entered in
Section M. If the proceeds are to be given directly to the borrower
and the borrower will use the proceeds to pay off existing obligations, this would not be reflected in Section M.
Section N. Net Settlement. Line 1600 normally sets forth the
principal amount of the loan as it appears on the related note for this
loan. In the event this form is used for an open-ended home equity
line whose approved amount is greater than the initial amount
advanced at settlement, the amount shown on Line 1600 will be the
loan amount advanced at settlement. Line l60l is used for all
settlement charges that are both included in the totals for lines 1400
and 1602 and are not financed as part of the principal amount of the
loan. This is the amount normally received by the lender from the
borrower at settlement, which would occur when some or all of the
settlement charges were paid in cash by the borrower at settlement,
instead of being financed as part of the principal amount of the
loan. Failure to include any such amount in line 1601 will result in
an error in the amount calculated on line 1604. P.O.C. amounts
should not be included in line 1601.
Line 1602 is the total amount from line 1400.
Line 1603 is the total amount from line 1520.
Line 1604 is the amount disbursed to the borrower. This is
determined by adding together the amounts for lines 1600 and
1601, and then subtracting any amounts listed on lines 1602 and 1603.

form HUD-1A (2/94)
ref. RESPA