Section 8 Special Claims Data Form

Project:______________________________

Unit No.: __________________________

_________________________,  ______________________
Move-out Tenant Last Name	 First

Move-Out date: ____-____-____
Last Day Move-out tenant was in unit. (In case of death, 4350.3 specifies earlier of last day tenant possession were in unit or 14 days after death).

“Ready” Date: ____-____-____
Day unit was ready to occupy after being cleaned.

Damages (above normal wear): 	$________

Unpaid Rent as of Move-out: 	$________

Security Deposit held on this tenant: 	$________

Interest earned on security deposit:  	$________

Other monies collected toward unpaid rent/damages: $__________
Include utility reimbursement held on negtive rent tenant.

Other monies collected toward vacancy only: $___________
That portion of the security deposit forfeited due to lack of 30 day notice (ONLY if state or local law permits). Also include Title I funds specifically for vacancy.

Day Next tenant moved into unit: ____-____-____
Special claims are normally submitted to HUD or your CA after the unit becomes re-occupied. HOWEVER, If 60 days have passed since the "ready" date, the vacancy claim should be submitted without a "new Move-in" date. Special claims MUST be submitted no later than 180 days from the "ready" date (Date the unit was ready to occupy after being cleaned and turned around).