SAMS1108 Eviction Status

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

Single Family Acquired Asset
Management System (SAMS)
Eviction Status

Public reporting burden for this collection of information is estimated to average 30 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 track eviction processing and/or leasehold workout agreements. 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 additional holding cost to the Department or an improper eviction.
1. File ID No.:

FHA Case Number

Date (mm/dd/yy)

HOC Area Identifier

HOC Area Name

M & M's NAID

M & M's Business Name

2. Mark One:

3. Unit

New Eviction

4. Lease

Eviction Follow-Up

5. Lessee

6. TIN/SSN

7. Eviction Reason (Mark One):

Adverse Possession (AP)
No Lease - Expired (LE)

Lease Term Violated (LV)
Lessee Denied Access (N/A)

8. Eviction Status:

a. Date (mm/dd/yy)

Other Program (OP)
Workout Agreement (WO)
b. Comments

EA – Authorization
EN – Notification (Lessee)
EP – Expected Possession
ES – Suspension
EW – Issuing of Writ
9a. Eviction Complete:

Yes

9b. Eviction Completion Date (mm/dd/yy)

No

Instructions for Completion of Form SAMS-1108 (Please use typewriter or print in ink)
The File ID No. should be a sequential number assigned by the originator of
the form.
1. ID Information: The originator of the form completes the file ID number,
case number, date, HOC Area identifier, HOC Area name, M & M's
NAID, and M & M's Business name.
2. Check One: Check New Eviction to establish initial eviction information. Check Eviction Follow-Up to update existing eviction information.
3. Unit: Enter the unit number of the property, if applicable.
4. Lease: Enter the lease identifier subject to eviction.
5. Lessee: Enter the lessees responsible for the lease.

6.
7.
8a.
8b.
9a.
9b.

TIN/SSN: Enter the Tax Identification Number/Social Security Number
of the lessees responsible.
Eviction Reason: Mark in the appropriate box the reason for eviction
using the codes provided on form SAMS-1108.
Eviction Status: Enter the date a specific status went into effect next
to its status code. You may list more than one status change per form.
Comments: Enter additional remarks, if needed.
Eviction Complete: Check "Yes" if the physical eviction has occurred.
Check "No" if the eviction has not occurred.
Eviction Completion Date: Enter the date the physical eviction
occurred (if applicable).
form SAMS-1108 (05/2002)
ref. Handbook 4310.5