HUD-50080h1a LOCCS/VRS HOPE 1 Planning Grant Payment Voucher

U.S. Department of Housing
and Urban Development
Office of Public and Indian Housing

LOCCS / VRS
HOPE 1 Planning Grant
Payment Voucher

OMB Approval No. 2577-0166
(exp. 07/31/2007)

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

021

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

8. Grant or Project No.

9. Line Item No.

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

HOP1

from:

4.

1 = Partial Disbursement
2 = Final Disbursement

to:

6. Grantee Organization's Name

7. Payee Organization's Name

6a. Grantee Organization's TIN

7a. Payee Organization's TIN

Type of Funds Requested

Amount

(dollars)

*

9310

Development of RMCs/RCs

*

9320

Training & Technical Assistance

*

9330

Feasibility Studies

*

9340

Economic Development

*

9350

Preliminary Architectural/Engineering Work

*

9360

Counseling & Training

*

9370

Security Plans

*

9380

Application for Implementation Grant

*

9390

Other Activities

*

(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 & Phone Number (including area code)
of the Person who Completed this form

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

13. Signature

14. Date of Request

X
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-HOP1-a

(4/2000)