HUD-52681-B Voucher for Payment of Annual Contributions

Voucher for Payment of
Annual Contributions and
Operating Statement

US Department of Housing
and Urban Development

OMB Approval No. 2577-0169

(Exp. 07/31/2007)

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:
Submission Type:

HA Name:
Original Submission

Revised Submission

HA FYE:
Special Submission

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)

n/a

Unit Months Leased:
Litigation
Mainstream 1 – year
Mainstream 5 – year
Homeownership
Moving to Work
All Other Vouchers
Total Vouchers
Hope VI Section 8 Vouchers
Tenant Protection
Tenant Protection – New this Month
Enhanced Voucher - this Month
New Home Owners – this Month (Identify the number of New
Homeownership voucher issued for the specified month)

HAP Expenses:

(Housing assistance payments to landlord, utility reimbursement, FSS Escrow, Home Purchase Escrow) Exclude: Portability
payments due from another Housing Authority

Litigation
Mainstream 1 – Year
Mainstream 5 – Year
Homeownership
Moving to Work
All Other HAP Expenses
Hope VI Section 8 Vouchers
Total HAP Expenses
Admin Fees Earned
Admin Expenses:

(Accts 4110, 4130, 4150, 4180, 7520, 7540, 4190, 4540, and
4540) Exclude FSS Coordinator, Special Fee, Mobility Counseling, ROC Costs,
Preliminary Expenses, and Portability payments due from another Housing Authority.

Audit:

(Enter the audit cost for the entire period. Do not breakdown by month)

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)

Additional HAP Expenses
Fraud Recover – Amount booked this month
FSS Escrow Forfeitures
Regular Portable (Units)
Port In
Port Out

Page 1 of 2

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

Voucher for Payment of
Annual Contributions and
Operating Statement

US Department of Housing
and Urban Development

OMB Approval No. 2577-0169

(Exp. 07/31/2007)

Office of Public and Indian Housing

Housing Assistance Payments Program
Supplemental Reporting Form

Regular Portable (HAP)
Port In
Port Out
Disaster Relief – Non KDHAP (Units)
Port In
Port Out
Disaster Relief – Non KDHAP (HAP)
Port In
Port Out
KDHAP Disaster Relief (Units)
Disaster Relief Families Assisted (Exclude Ports)
New KDHAP Families Assisted – This month
KDHAP Disaster Relief (HAP)
Actual KDHAP Rental Assistance Provided
Actual Security Deposit
KDHAP Security Deposit Refunds
Actual Utility Deposit
KDHAP Utility Deposit Refunds
Comments:

Name of PHA Point of Contact

POC Phone Number
Date Submitted

Page 1 of 2

Ext:

Official HA E-mail Address:

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