HUD-52681-B Voucher for Payment of Annual Contributions

Voucher for Payment of
Annual Contributions
and Operating Statement

OMB Approval No. 2577-0169
(Exp. 05/31/2004)

US Department of Housing
and Urban Development
Office of Public and Indian Housing

Housing Assistance Payments Program
Supplemental Reporting Form
Public reporting burden for this collection of information is estimated to average 1.50 hours 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 conduct or
sponsor, and you are not required to respond to, a collection of information unless that collection displays a valid OMB control number. Authority for this collection
of information is the Housing and Community Development Act of 1987. Housing Agencies (HAs) required to maintain financial reports in accordance with
accepted accounting standards to permit timely and effective audits. The financial records identify the amount of annual contributions that are received and
disbursed by HAs. Responses to the collection of information are required to obtain a benefit or to retain a benefit. The information requested does not lend itself
to confidentiality.

HA Number:

HA Name:

HA FYE:

Housing Choice Voucher Program – Utilization and Administrative Fee and Expense Reporting
Administrative Fee Reserve (Operating Reserves) Balance as of January 31, 2003 (01/31/03)

Aug 2002

Sep 2002

Oct 2002

Nov 2002

Dec 2002

Jan 2003

Unit Months Leased:
Vouchers:
Report the following leasing separately:
Litigation:
Mainstream 1 - Year:
Mainstream 5 - Year:
HAP: (Housing Assistance Payments to Landlords,
Utility Reimbursement, FSS Escrow, Home Purchase
Escrow) Exclude: Portability payments due from
another Housing Authority.
Admin Fee Earned:
Admin Expenses: (Accts 4110, 4130, 4150, 4180,
7520, 7540, 4190, 4540, and 4510) Exclude: FSS
Coordinator, Special Fee, Mobility Counseling, ROC
costs, Preliminary Expenses, and Portability
payments due from another Housing Authority.

Audit:
Hard to House:
FSS Coordinator:
LBP Test:
LBP Risk Assessment:
Mobility Counseling:
Preliminary Fees: (New HA's Only)
Housing Conversion Fees:
ROC:
Other (Brief Description)

Page 1 of 2

form HUD-52681-B (03/2003)
Ref Handbook 7420.8

HA Number:

HA Name:

HA FYE:

Usage of Section 8 Administrative Fee Reserve
(Operating Reserves) for Non-Section 8 Purposes
Total Amount of Section 8 Administrative Fee Reserve (Operating Reserves) for Non-Section
8 purposes in the 2002 HA Fiscal Year: (How much of the Administrative Fee Reserve (Operating Reserve) was
used for non-section 8 purposes, during the past 2002 HA Fiscal Year.)

Amount of Non-Section 8 2002 Fee Reserve Usage by category:
Public Housing Operations:
Low-Income Housing Development:
Resident or Supportive Services:
Homeownership: (not related to Housing Choice Voucher program)
Other: (Brief Description)

By submitting this document, I certify that the above information has been examined by me and is true, correct and complete to the best of my knowledge.
This data collection submission does not include as an expense Portability payments from another Housing Authority.
Warning: HUD will prosecute false claims and statements. Convictions may result in criminal and/or civil penalties (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729,3802

Name of Authorized HA Official:

Date:

Page 2 of 2

form HUD-52681-B (03/2003)
Ref Handbook 7420.8