HUD-52671-C Special Claims for Regular Vacancies

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

Special Claims
for Regular Vacancies
Instructions
Follow guidelines
in HUD Handbook
4350.3, Rev. 1,
Chapter 9

Project name

1.

Tenant's move-out
date

2.

No. days taken to
clean / repair unit

3.

Date unit ready for
occupancy

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

FHA project no.

Sec 8/PAC/PRAC Cont #

Vacated Tenant name

Unit No.

4.

Date unit ready for 5. Date unit was
occup. + 59 days
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.)

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)

0.00

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.)

(—)

0.00

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.
14. Tenant's move-out
date

15. No. days taken to 16. Date unit ready for
clean / repair unit
occupancy

17. Last day of mo. (or day before 18. Number of days vacant in first month
move-in if in same month)
(Line 17 minus line 16, plus one day.
Not to exceed 30.)

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.

0.00

21.Day of second month the unit was rented

Part B
(applies to)
886: Property
Disposition,
Subpart C

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.)

0.00

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.

0.00

26.Add lines 20 & 25

0.00

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.
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

0.00
HUD/Contract Administrator Review
Claim approved.
Claim adjusted. Reason:
Claim denied. Reason:
Official's name, signature, & date

Claim ID: _____________________
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 versions obsolete

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Print

form HUD-52671-C (09/2002)
ref. Handbook 4350.3 Rev. 1

This form must be completed so HUD can pay owners an amount to
offset 60 day vacancies.
Regulations require that owners complete this form using statutory formulas for calculating such vacancy loses.
The statutes requiring the submission are S8, United States
Housing Act (42 U.S.C. 1437 f), 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 880, 881, 883, 884, 886, and 891. The administrative requirements for these forms are provided 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.

Previous versions obsolete

Submit an Original and two copies

The Department of Housing & Urban Development is authorized to collect this information by the U.S. Housing Act of 1937, as
amended. The owner/agent must provide all this information. The
information provided will be used by HUD to review accuracy of
funds requested by owner/agent for vacancy losses up to 60 days
in length. 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 0.33 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
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-52671-C (09/2002)
ref. Handbook 4350.3 Rev. 1