SAMS 1101 Define Lessees/Lease

Single Family Acquired Asset
Management System (SAMS)

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

Define Lessees/Lease
See Instructions on back before completing this form.

I. DSAE or GBIN Screen: First Lessee's TIN or SSN and Name (Items 1 - 3)
1. Check one:

Add

2. First Lessee's TIN/SSN:

Modify

3. First Lessee's Name: (Last, First, MI)

Delete

II. GBNA Screen: Lessee's Address and Employer (Items 4 - 21)
4. HOC Area Identifier 5. HOC Area Name

6. Payee Type:

7. First Lessee's NAID:

LE
8. First Lessee's Address: (Number & Street, City, State, County and Zip Code + 4)

9. Home Phone: (Area Code)

10. Work Phone: (Area Code)

11. Employer's Business Name:

12. Employer's Phone: (Area Code)

13. Employer's Business Address: (Number & Street, City, State and Zip Code + 4)

14. Second Lessee's Name (Last, First, MI) (Not entered into SAMS)

15. Second Lessee's TIN/SSN:

16. Home Phone: (Area Code)

17. Second Lessee's Address (Number & Street, City, State, County and Zip Code + 4)

18. Work Phone (Area Code)

19. Employer's Business Name:

20. Employer's Business Address: (Number & Street, City, State and Zip Code + 4)

21. Employer's Phone: (Area Code)

III. TMLE Screen: Lease Information (Items 22 - 42)
22. Case Number:

23. Unit Sequence Number:

25. M & M's NAID:

26. M & M's Business Name

27. Lease Number:

28. Lease Type:

33. Rent Amount:

34. Rent Per: (Check one)

Month
38. Liability Insurance Expiration Date:

24. Unit Number:

29. Lease Reason Code:

30. Lease Effective Date:

31. Lease Expiration Date:

32. Lease Termination Date:

35. Daily Rent Amount:

36. Number of Option Renewal Years: 37. Eviction Reason Type:

Year
39. Is Work-Out Agreement in Effect?

Yes

40. Amount of Work-Out:

41. Eff. Date of Work-Out:

42. Exp. Date of Work-Out:

No

43. Comments:

44. Preparer's Signature

45. Title

46. Date (mm/dd/yy)

47. Phone (area code)

X
48. Reviewer's Signature

49. Title

50. Date (mm/dd/yy)

51. Phone (area code)

X
52. Approver's Signature (HOC Director or Designee)

53. Title

54. Date (mm/dd/yy)

55. Phone (area code)

X

Previous edition is obsolete

Page 1 of 2

form SAMS-1101 (09/2002)
ref Handbook 4310.5

Public reporting burden for this collection of information is estimated to average 18 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 collect this information, and you are not required to complete this form, unless it displays a currently
valid OMB control number.
This information enables HUD to record and process financial transactions in its automated Single Family Acquired Asset Management
System (SAMS) to dispose of acquired single-family properties. HUD reimburses M & M Contractors, closing agents, selling brokers, and
trade vendors for their services in maintaining, marketing, and selling HUD homes, and HUD collects funds associated with the sales
of these properties. The information enables HUD to create and maintain sound financial management practices and effective internal
controls over the property disposition program. A response is required to obtain or maintain a benefit.
Privacy Act Statement. The Department of Housing & Urban Development (HUD) is authorized to collect the information on this form
by the U.S. Housing Act of 1937, as amended. The Housing & Community Development Act of 1987, 42 U.S.C. 3543, authorizes HUD
to collect Social Security Numbers (SSN). The information is being used to indicate changes in the rental status of the property and to
track tenant payment responsibility. The SSN 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. It will not be otherwise disclosed or released
outside of HUD, except as required and permitted by law. Providing the SSN is mandatory. Failure to provide the information could result
in leasehold termination and/or eviction of tenant(s).
Instructions for Completing Form SAMS-1101 Please use typewriter or print in ink.
1..

Check One: Indicate whether lessee information is being added,
modified, or deleted.

2.

First Lessee's TIN/SSN: Enter the Federal Tax ID Number or Social
Security Number of the lessee, if available. Every effort should be made
to obtain Social Security or Tax Identification Numbers for all lessees,
as the TIN/SSN is a key data element in SAMS.

3.

First Lessee's Name: Enter the full name of the lessee. For a second
lessee use lines 14 to 21. For three or more lessees attach additional
SAMS-1101(s).

4.

HOC Area Code: Enter the HOC Area code.

5.

HOC Name: Enter the HOC name.

6.

Payee Type(s): The payee type is preprinted on the form.

7.

First Lessee's NAID:
(NAID).

8.

First Lessee's Address: Enter the complete mailing address of the
lessee.

9.

Home Phone: Enter the home phone number of the lessee (including
area code), if available.

Enter the lessee's Name/Address Identifier

10. Work Phone: Enter the office phone number of the lessee, if available.
11. Employer's Business Name: Enter the name of the lessee's employer, if available.

22. Case Number: Enter the case number
23. Unit Sequence Number: Enter the unit sequence number.
24. Unit Number: Enter the unit number, if applicable.
25. M & M's NAID: Enter the M & M's NAID.
26. M & M's Business Name: Enter the M & M's Business name.
27. Lease Number: Enter the lease number.
28. Lease Type: Enter the lease type from the following:
AP Adverse Possession
OC
Occupied Conveyance
HA Public Housing Authority
RR
Regular Rental
HH Housing for Homeless
SH
Supportive Housing
LO Lease-Option to Buy
29. Lease Reason Code: Enter the reason for the lease from the following:
CD Closing Delay
MI
Military
DV Disaster Victim
MU
Multi-Unit Property
IE Inventory Exceeds Market PV
Prevent Vandalism
IL Illness or Injury
RP
Renting to Purchase
30. Lease Effective Date: Enter the effective date of the lease.
31. Lease Expiration Date: Enter the expiration date of the lease. The
lease expiration date is the last day of the lease period. The expiration
date for month-to-month leases is the last day of the month in which the
lease became effective.

12. Employer's Phone: Enter the employer's phone number, if available.

32. Lease Termination Date: Enter the last day the lessee is legally
responsible for the terms of the lease.

13. Employer's Business Address: Enter the employer's address, if
available.

33. Rent Amount: Enter the dollar amount of the rent assessment.

14. Second Lessee's Name: Enter the full name of the second lessee.

34. Rent Per: Check the type of rent assessment: monthly or annual.

15. Second Lessee's TIN/SSN: Enter the Tax ID Number or Social
Security Number of the lessee, if available. Every effort should be made
to obtain Social Security or Tax Identification Numbers for all lessees,
as the TIN/SSN is a key data element in SAMS.

39. Is Work-Out Agreement in Effect?:
agreement is in effect.

16. Home Phone: Enter the home phone number of the lessee (including
area code), if available.

41. Effective Date of Work-Out: Enter the date the work-out agreement
began.

17. Second Lessee's Address: Enter the complete mailing address of the
second lessee, if different than the address of the HUD-owned
property.

42. Expiration Date of the Work-Out: Enter the expiration date of the
work-out agreement.

18. Work Phone: Enter the office phone number of the lessee, if available.
19. Employer's Business Name: Enter the name of the second lessee's
employer, if available.
20. Employer's Business Address: Enter the employer's address, if
available.
21. Employer's Phone: Enter the employer's phone number, if available.

Previous edition is obsolete

Check "Yes" if a work-out

40. Amount of Work-Out: Enter the dollar amount of the work-out
agreement for delinquent rent, if applicable.

43. Comments: Enter a brief description of the lease, if desired.
44.-47. Preparer's Signature: Enter legible signature, title, phone number,
and date signed.
48.-51. Reviewer's Signature: Enter legible signature, title, date signed,
and phone number.
52.-55. Approver's Signature: Enter legible signature, title, date signed,
and phone number.

Page 2 of 2

form SAMS-1101 (09/2002)
ref Handbook 4310.5