646 Worksheet for Reconcilement of Insurance Charges from th

OMB Approval No. 2502-0328
(exp. 08/31/2009)

Worksheet for Reconcilement of Insurance Charges from the Title I Monthly Statement
Public reporting burden for this collection of information is estimated to average 1 hour 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 information is required to
obtain benefits. HUD 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 is being collected to permit more efficient risk management of the Title I loan portfolio as well as facilitate claims processing for loan defaults.
The information provides a more comprehensive basis for evaluating Title I lender underwriting practices and thereby improving risk management of the loan
portfolio and also enhances management’s ability to determine appropriate policy changes affecting the Title I portfolio as a whole. While no assurances of
confidentiality are pledged to respondents, HUD generally discloses this data only in response to a Freedom of Information request.

The use of this worksheet is optional. The worksheet is provided to assist Title I Lenders to make the proper deductions from their
monthly bill amount and assist them to make the proper electronic payment using the Automated Clearing House (ACH) system.
A.Total insurance charge on this statement

$

Contract Number

Statement Date (MM/YYYY)

B. Deductions: Schedule 1 $
Deductions: Schedule 2 $
Total Deductions from Schedules 1 and 2
C. Amount of Remittance (A-B)

$
$

Schedule 1. Loans Paid in Full Prior to Insurance Charge Due Date.
All other allowable deductions should be listed under Schedule 2.
Title I
Case Number

Name of Borrower

Date of Loan
Dusbbursement
MM/DD/YY

Date Paid
in Full
MM/DD/YY

Insurance
Charge

Total
See additional schedules on the back

Worksheet

form HUD-646 (06/2003)
ref Handbook 4710.1

Schedule 2.

Insurance charge remittances withheld for other reasons. The Standard Codes for reason for withholding are: (D=Duplicate Loan; N=Not Our
Loan; C=Claim Filed Prior to This Statement; I=Ineligible for Insurance).

Title I Case Number

Name of Borrower

Code

Reason for Withholding Remittance

Insurance Charge

Total

Schedule 3.

Differences in loans listed on current monthly statement.

Title I Case Number

Should Be
Name of Borrower

Should Be
Institution Loan No.

Date of Ln. Disb.
MM/DD/YYYY

Should Be
Loan Amount

Term

Schedule 4. Loans reported but not shown on monthly statement
Date Reported

Schedule 5.

Name of Borrower

Loan Amount

Refinanced loans reported 60 days or more prior to the date of this monthly statement.

Date Reported

Name of Borrower

Loan Amount

Worksheet

form HUD-646 (06/2003)
ref Handbook 4710.1