DI-381 Claim for Relocation Payments - Residential - Schedule B

DI-381 (03-2019)
Department of the Interior

OMB Control Number: 1084-0010
Expiration Date: 12/31/2021

Schedule B
Claim of Home Owners Replacement Housing Payments – Residential
(Under Sec. 204 (a), P.L.91-646, as amended)

Section 1 – To Be Completed By Claimant
1. NAME:

2. PROJECT/TRACT:

3. At the time you received the Agency’s written offer to acquire your dwelling, was this dwelling owned and occupied by you for 90 consecutive
days immediately prior thereto as your permanent residence? YES ❑ NO ❑
4. INCIDENTAL EXPENSES: (Attach a copy of the closing statement and/or other documentation in support of the amounts claimed
(49CFR24.401(e))
ITEM

AMOUNT
CLAIMED

FOR AGENCY
USE ONLY

ITEM

AMOUNT
CLAIMED

FOR AGENCY
USE ONLY

LEGAL, CLOSING , AND
RELATED COSTS

$ __________

______________

ESCROW FEE

$ __________

______________

TITLE SEARCH FEE

$ __________

______________

TRANSFER TAXES

$ __________

______________

NOTARY FEE

$ __________

______________

$ __________

______________

RECORDING FEES

$ __________

______________

LOAN ORIGINATION OR
ASSUMPTION FEES (that do
not represent prepaid interest)

SURVEY COSTS

$ __________

______________

CERTIFICATION FEE

$ __________

______________

LENDER’S APPRAISAL FEE

$ __________

______________

HOME INSPECTION FEE

$ __________

______________

LENDER’S APPLICATION FEE $ __________

______________

TERMITE INSPECTION FEE

$ __________

______________

CREDIT REPORT FEE

$ __________

______________

OTHER (LIST) ___________

$ __________

______________

OWNER’S AND MORTGAGEE’S $ __________
EVIDENCE OF TITLE

______________

_______________________

$ __________

______________

_______________________

$ __________

______________

TOTAL

0.00
$ __________

0.00
______________

5. AMOUNT OF RENTAL ASSISTANCE PAYMENT PREVIOUSLY RECEIVED (if any)
6. AMOUNT OF REPLACEMENT HOUSING PAYMENT ADVANCED (if any)

$ ______________________

$ ____________________________

SIGNATURE: ____________________________________________

SIGNATURE: ___________________________________________

DATE: _________________________________________________

DATE: _________________________________________________

Section 2 – To Be Completed By Agency
COMPUTATION OF AMOUNT OF PAYMENT
LAST RESORT HOUSING PAYMENT

YES ❑

NO ❑

PRICE OF A COMPARABLE DWELLING:

$ _______________

MORTGAGE INTEREST COST: (See note) $ ________________
AMOUNT OF INCIDENTAL EXPENSES

$ ________________

PRICE PAID FOR REPLACEMENT DWELLING: $ _______________

TOTAL PAYMENT:

$ ________________

PRICE PAID FOR ACQUIRED DWELLING:

AMOUNTS PREVIOUSLY PAID OR
ADVANCED:

$ ________________

TOTAL DUE UNDER THIS CLAIM:

0.00
$ ________________

PAYMENT: (The lesser of the difference
between the comparable and acquired OR
the replacement and acquired dwelling)

$ _______________

$ _______________

Note: Increased mortgage interest costs can be claimed only if there was a bona fide mortgage(s) on the acquired dwelling for at least 90 days
immediately prior to the initiation of negotiations to acquire the property.

DI-381 Schedule B - Page 1 of 2

DI-381 (03-2019)
Department of the Interior

OMB Control Number: 1084-0010
Expiration Date: 12/31/2021
COMPUTATION OF INCREASED MORTGAGE INTEREST COSTS
AGENCY ACQUIRED DWELLING MORTGAGE(S)

REPLACEMENT
DWELLING
MORTGAGE
(b)

(a)
ITEM

FIRST

SECOND

THIRD

1. ISSUANCE DATE OF MORTGAGE
2. OUTSTANDING MORTGAGE BALANCE

$

$

$

$

3. AMOUNT OF MONTHLY MORTGAGE
PAYMENT

$

$

$

$

4. ANNUAL INTEREST RATE OF MORTGAGE

%

%

%

%

5. MONTHS REMAINING ON MORTGAGE
BALANCE: .....................................................
6. MONTHLY PAYMENTS OF:.. (line 3) ............

$

0.00

$

0.00

0.00

$

At the current prevailing fixed interest rate

7. FOR NUMBER OF MONTHS ... (line 5) .......
8. WILL PAY OFF A BALANCE OF: ...................

$

$

9. INTEREST DIFFERENTIAL PAYMENT FOR
EACH MORTGAGE: .....................................
(line 2 minus line 8)

$

10. SUM OF PAYMENTS TO EACH
MORTGAGE: .....................................
(from line 9, but not less than 0)

$ ___________

11. COST OF POINTS FOR MORTGAGE:

$ ___________

12. TOTAL:

$ ___________

0.00

$

$

0.00

0.00

$

13. IF line 2(b) IS LESS THAN THE TOTAL OF line 8 THEN:
_________ - _____________ = ______________ x ___________ = ___________
line 2(b)
total of line 8
factor
line 12
total
REMARKS:

PAYMENT

AMOUNT

SIGNATURE

TITLE

DATE

RECOMMENDED:

_________________

________________________________________

_________________

______________

APPROVED:

_________________

________________________________________

_________________

______________

FBMS INVOICE NO.:_________________

DI-381 Schedule B - Page 2 of 2