RD 3560-29 Notice of Payment Due Report

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Form RD 3560-29
(02-05)

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FORM APPROVED
OMB No. 0575-0189
Exp. Date: MM/DD/YY

UNITED STATES DEPARTMENT OF AGRICULTURE
RURAL DEVELOPMENT

NOTICE OF PAYMENT DUE REPORT
1. BORROWER NAME

2. CASE NUMBER

3. PROJECT NO.

4. AUDIT RECEIVABLES

5. LATE FEES

6. COST ITEMS

7. OVG/SURG

8. LOAN PAYMENT

9. PAST DUE

10. UNITS ON RA

11. TOTAL RA

12. RA CHECK

13. TOTAL PAYMENT

ONLY FOR SECTION 8 PROJECTS WHERE HUD RENT EXCEEDS THE RHS NOTE RATE RENT
14. No. of Section 8 units
17. No. of Section 8 units

x 15. HUD Rent
x 18. RHS Note Rate Rent

ADDITIONAL PAYMENT TO THE RESERVE ACCOUNT

-

16.

- 19.

20.

In accordance with Rural Housing Service's (R.HS) formula and procedures, all rental units are occupied by households who have executed Form
RD 3560-8 ''Tenant Certification,'' and for labor housing projects, farmworkers, or for rental housing projects, have incomes within the limits set
in Agency regulations or the project has written permission from RHS to rent to ineligible occupants on a temporary basis.
I certify that the statements made above and per attached Multi-Family Information System Notice of Payment Due Report are true to the best of
my knowledge and belief and are made in good faith.

*WARNING: Section 1001 of title 18, United States Code provides, ''Whoever, in any matter within the jurisdiction of the executive,
legislative, or judicial branch of the Government of the United States, knowingly and willfully falsifies, conceals, or covers up by any trick,
scheme, or device a material fact, makes any materially false, fictitious, or fraudulent statement or representation, or makes or uses any false
writing or document knowing the same to contain any materially false, fictitious, or fraudulent statement or entry, shall be fined under this title
or imprisoned not more than 5 years, or both.''

21.

22.
(Borrower or Borrower 's Representative)

(Date)

A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a
collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB Control
Number. The OMB Control Number for this information collection is 0575-0189. Public reporting for this collection of information is estimated to be approximately 15
minutes per response, including the time for reviewing instructions, searching existing data sources, gathering, and maintaining the data needed, completing, and
reviewing the collection of information. All responses to this collection of information are voluntary. However, in order to obtain or retain a benefit, the information in
this form is required under Section 515 Rural Rental Housing, which includes Congregate Housing, Group Homes, and Rural Cooperative Housing. Rural
Development has no plans to publish information collected under the provisions of this program. Send comments regarding this burden estimate or any other aspect of
this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, Rural Development Innovation Center,
Regulations Management Division at ICRMTRequests@usda.gov

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PART II
1.

Apt.
No.

Submit
Reflects date as of 1st day of

Name of Borrower
2.
Type

Page
3.
No. of
Indiv.
In
Unit

of
4.
Initial
Occupancy
Date

5.
Exp. Date
of
Certification

6.
Leased To

7.

8
.

9.

10.

Basic
Rent

Note Rate
Rent

HUD
Rent

%
of
GTC

11.
Utility
Allowance

NTC

TOTALS

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' 20
14.
Rental
Assistance
Due
Borrower

$0
16.

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13.
Amt. Due
Tenant to
Cover
Utilities

12.

17.

15.
Overage
and/or
Surcharge

$0

$0
18