Hud-50080-sngp Loccs / Vrs

LOCCS / VRS
Safe Neighborhood
Grants Program
Payment Voucher

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

OMB Approval No. 2502-0520
(exp. 6/30/2000)

Public reporting burden for this collection of information is estimated to average 15 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.
HUD implemented the Line of Credit Control System/Voice Response System (LOCCS/VRS) to process requests for payments to grantees. Grant
recipients fill out a voucher form for the applicable HUD program with all the necessary information prior to making a telephone call using a touch tone
telephone to initiate the drawdwon process. The grantee will be prompted for entering the information and for confirming information that is spoken back
by the VRS simulated voice. This information is required to obtain benefits under the U.S. Housing Act of l937, as amended. The information requested
does not lend itself to confidentiality.
1. Voucher Number

2. LOCCS Pgrm. Area

3. Period Covered by this Request (mm/yy)

SNGP

078

from:

4.

1 = Partial Disbursement
2 = Final Disbursement

to:

5. Voice Response No. (5 digits, hyphen, 5 more )

6. Grantee Organization's Name

7. Payee Organization's Name

8. Grant or Project Number

6a. Grantee Organization's TIN

7a. Payee Organization's TIN

9. Line Item No.

Type of Funds Requested

Amount (dollars)

*

9150

Increased Law Enforcement

*

9160

Security Services

*

9170

Investigation/Prosecution

*

9180

Capital Improvements

*

9190

Other Program Costs (10% maximum)

*

(cents)

*
*
*
*
*
*
*
*
10.

Voucher Total

$

*

I certify the data reported and funds requested on this voucher are correct and the amount requested is not in excess of immediate disbursement needs
for this program. In the event the funds provided become more than necessary, such excess will be promptly returned, as directed by HUD.
11. Name and Phone Number (including area code)
of the person who completed this form

12. Name and Title of Authorized Signatory (type or print clearly)

13. Signature

14. Date of Request (mm/dd/yyyy)

Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)
Privacy Statement: Public Law 97-255, Financial Integrity Act, 31 U.S.C. 3512, authorizes the Department of Housing and Urban Development (HUD)
to collect all the information (except the Social Security Number (SSN)) which will be used by HUD to protect disbursement data from fraudulent actions.
The purpose of the data is to safeguard the Line of Credit Control System (LOCCS) from unauthorized access. The data are used to ensure that individuals
who no longer require access to LOCCS have their access capability promptly deleted. Failure to provide the information requested on the form may delay
the processing of your approval for access to LOCCS. While the provision of the SSN is voluntary, HUD uses it as a unique identifier for safeguarding
the LOCCS from unauthorized access. This information will not be otherwise disclosed or released outside of HUD, except as permitted or required by law.
form HUD-50080-SNGP (4/2000)