HUD Form 27055 IDIS OnLine Access Request Form and Instructions

IDIS OnLine Access Request Instructions
U.S. Department of Housing and Urban Development
Office of Community Planning and Development

GRANTEE & REQUESTOR
INSTRUCTIONS

OMB Approval No. 2506-0171 exp 12/31/2012
Privacy Act 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 which will be used by HUD to protect disbursement data from
fraudulent actions. The purpose of the data is to safeguard the Integrated
Disbursement and Information System (IDIS) from unauthorized access. The data
are used to ensure that individuals who no longer require access to IDIS have their
access capability promptly deleted. This information will not be otherwise
disclosed or released outside of HUD, except as permitted or required by law.
Failure to provide the information requested on the form may delay the
processing of your approval for access to IDIS.

This form is to be completed by the
recipient’s (or grantee’s) Chief
Executive Officer or designated
representative. Send notarized original
to your local HUD CPD Field Office.
NOTE: Every IDIS user can view
activities and generate reports even if
no functions are authorized.
You cannot authorize yourself, only
your CEO or “grant holder” can.

GRANTEE APPROVING OFFICIAL
NOTES: (HUD FIELD OFFICES ONLY)
1. Form must be completed in its
entirety and accurately to
prevent delay in processing, such
as User’s email.
2. Please scan and email the
notarized form to
[email protected]
3. Subject of email should include
the following: Grantee Name
followed by Type of Request such
as New, Profile Check, etc.
4. For scanning Instructions using
multifunctional devices (MFD), go
to http://hudatwork.hud.gov/po/d/progproc/otcsupport/hardware/printers/setup/index.cfm

HUD Form 27055 (10/10)

For more detailed information on how to obtain an IDIS OnLine account, technical assistance and password reset, go to
http://www.hud.gov/offices/cpd/systems/idis/idis.cfm
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)

OMB Approval No. 2506-0171 exp 12/31/2012

IDIS OnLine Access Request

Privacy Act 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
which will be used by HUD to protect disbursement data from fraudulent actions. The
purpose of the data is to safeguard the Integrated Disbursement and Information System
(IDIS) from unauthorized access. The data are used to ensure that individuals who no longer
require access to IDIS have their access capability promptly deleted. This information will
not be otherwise disclosed or released outside of HUD, except as permitted or required by
law. Failure to provide the information requested on the form may delay the processing of
your approval for access to IDIS.

U.S. Department of Housing and Urban Development
Office of Community Planning and Development

GRANTEE & REQUESTOR INFORMATION
REQUEST TYPE

Role to be Performed by Headquarters Role to be Performed by Field or Local IDIS Administrator
New Request
Drop from IDIS
Renew Lapsed ID
Change Function or Program Area
Change Name
Add Access for Another Grantee
Last 5 Digits of the Social Security Number (SSN): [ ] [ ] [ ] [ ] [ ]
Requestor’s Name (Last, First, MI):
E-mail Address:
Office Address:

Office Phone:

Grantee Name in IDIS:

GRANTEE TYPE
City
County

ext.:

State

Sub Grantee*

DUNS#:
[ ][ ]–[ ][ ][ ]–[ ][ ][
Please Mark All Necessary Functions & Programs
Authorized
Functions

] - [

Set Up Activity
Approve Drawdown
CDBG
CDBG-R

Program
Areas

][

][

][

][

][

]

Request Drawdown
Local IDIS Administrator

HOME
TCAP

ESG
HPRP

HOPWA
Other

If other, please specify name of program

*Approval of State Sub Grantee Request – CPD State Coordinator or State Official name, signature and date:
Name:
Signature:
Date:

GRANTEE APPROVING OFFICIAL
NOTARY

Approving Official’s Name:

Date:

Title:

(signature)

Office Phone:

ext.:
SEAL

Office Address: (Street, City, State, Zip)

Signature:

Date:

I authorize the person above to have access to IDIS functions checked.

HUD FIELD OFFICES ONLY
Field Office Approval (CPD Director or Designee)
Name:

Signature:

For more detailed information on how to obtain an IDIS OnLine account, technical assistance and password reset, go to
http://www.hud.gov/offices/cpd/systems/idis/idis.cfm

Date:
HUD Form 27055 (10/10)

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)