Form HUD-52725 Schedule of Positions and Compensation

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Overview

Form 52725
Instructions

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Sheet 1: Form 52725

Schedule of Positions and Compensation					U.S. Department of Housing and Urban Development
					Office of Public and Indian Housing
					OMB Approval No. 2577-0272 (exp. XX/XX/20XX)
Public reporting for this collection is estimated to average 30 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 conduct or sponsor, and a person is not required to respond to, a collection of information unless that collection displays a valid OMB control number. The information does not lend itself to confidentiality.
										Report the cash compensation of the top management official, the top financial official, and the highest compensated employee who is not either the top management official or the top financial official. Only provide information for public housing agency (PHA) employees who received compensation from the PHA and any related organizations for the calendar year. Upon completion, the appropriate PHA representative must sign and certify that the information provided is true and correct. See the instruction sheet for directions on completing the form.
Section I: PHA Information
(A) PHA Code			(use drop-down list)
(B) Name of PHA*
(C) PHA Fiscal Year End			(use drop-down list)
Section II: Calendar Year Employee Compensation Data
Box 1	Box 2	Box 3	Box 4	Box 5	Box 6	Box 7	Box 8	Box 9	Box 10
Employee Last Name	First name, middle initial	Employee Title (Use drop-down list)	Total Compensation as reported on the PHA employee's 2014 IRS Form W-2 (box 5) ($)	Base Salary from Section 8 & 9 funds ($)	Bonus, incentive, and other compensation from Section 8 & 9 funds ($)	Base Salary from NON - Section 8 & 9 funds ($)	Bonus, incentive, and other compensation from NON - Section 8 & 9 funds ($)	Total (Box 5 + Box 6 + Box 7 + Box 8)	Completeness Check: (Box 4 = Box 9) Yes/No
Section III: Calendar Year NON W-2 Employee Compensation Data - Other CASH Compensation
[only complete if an employee in Section II above was paid cash compensation not inlcuded in the W-2 information reported]
Box 11	Box 12	Box 13	Box 14
Employee Last Name	First, middle initial	Employee Title (Use drop-down list)	Cash compensation paid to employee in CY 2014 NOT reported on the employee's W-2 ($)	If an amount is entered in Box 14, please explain the circumstances in the space provided below.
Section IV: Certification
I hereby certify that the above information is true and correct (please type name and title of individual signing and dating this form):					______________________________________________________, _______________
HUD will prosecute false claims and statements. Such false statements and/or entries may be subject to criminal and/or civil penalties (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802).
* The form will automatically fill in this value based on other entries.
								HUD-52725 (rev. X/XX/20XX)

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Sheet 2: Instructions

Instructions for Form HUD-52725

General Instructions

1. HUD will publish a notice that will provide additional instructions for submitting this form. All PHAs that administer public housing and/or housing choice voucher programs are required to complete this form.

2. Information is required for three executives. On this form, the covered individuals ("executives") include the following: (1) the top management official (e.g., the executive director, CEO, or person with similar duties); (2) the top financial official (e.g., the chief financial officer or person with similar duties); and (3) the highest compensated employee who is not either the top management official or the top financial official. If the top management official and the top financial official are the same person, the PHA is to report information for that person and the two other highest compensated employees. If a PHA has three or fewer employees the PHA should report the information for all of the employees.

Section I: PHA Information

(A) PHA Code. Select your PHA code from the drop-down list.

(B) Name of PHA. The form will automatically populate this box.

(C) PHA Fiscal Year End. Select your PHA's fiscal year end from the drop-down list.

Section II: Calendar Year Employee Cash Compensation Data

Box 1. Enter the executive/employee's last name.

Box 2. Enter the first name and middle initial of the executive/employee.

Box 3. Using the drop down menu, enter the executive/employee's job title or position. The drop down menu provides three options: Chief Executive Officer (CEO), Chief Financial Officer (CFO), and Other. Select CEO for the PHA's top management official. Select CFO for the PHA's top financial/accounting official. Select Other for the highest paid executive/employee who is not the CEO or CFO.

Box 4. Using the executive/employee's Internal Revenue Service FORM W-2 Wage and Tax Statement, enter the amount that is in Box 5 (Medicare wages and tips). If the executive/employee is an employee of another entity but a portion of his or her salary is allocated to the PHA, still enter the total amount reported on the individual's W-2 in Box 5.

NOTE when completing Boxes 5 through 8:
1) Section 8 funds include ALL Housing Choice Voucher program funds and all associated program funds under Section 8 that the PHA received.
2) Section 9 funds include ALL Public Housing operating subsidy, Capital funds and all associated program funds under Section 9 that the PHA received.
3) If an executive is paid with MTW funds, these are considered to be Section 8 and/or Section 9 funds.

Box 5. Enter the amount of the executive/employee's base salary that was paid from or allocated to Section 8 and 9 program funds in the calendar year.

Box 6. Enter the amount of the executive/employee's bonus, incentive, or other cash compensation that was paid from or allocated to Section 8 and 9 program funds in the calendar year.

Box 7. Enter the amount of the executive/employee's base salary that was paid from or allocated to NON-Section 8 and 9 program funds in the calendar year.

Box 8. Enter the amount of the executive/employee's bonus, incentive, or other cash compensation that was paid from or allocated to NON-Section 8 and 9 program funds in the calendar year.

Box 9. This box will auto-populate as the sum of boxes 5 through 8. The amount in Box 9 should equal the amount entered in Box 4. If these amounts do not agree, please revise the amounts in Boxes 5 through 8. If the executive/employee received additional CASH compensation from the PHA that was not reported on IRS FORM W-2 BOX 5, this compensation must be reported in Section III of this form.

Box 10. Box 10 will auto-populate and identifies if the amount in Box 9 is equal to the amount entered in Box 4. If these amounts do not agree, Box 10 will auto-populate with "NO." If Box 10 displays "NO" please revise the amounts in Boxes 5 through 9.

Section III: Calendar Year Employee NON W-2 Cash Compensation Data - Other CASH Compensation [This section is only used if employees received cash compensation during the calendar year that was not reported in Box 5 of the employee's W-2.]

Box 11. Enter the executive/employee's last name.

Box 12. Enter the first name and middle initial of the executive/employee.

Box 13. Using the drop down menu, enter the executive/employee's job title or position. The drop down menu provides 3 options: Chief Executive Officer (CEO), Chief Financial Officer (CFO), and Other. Select CEO for the PHA's top management official. Select CFO for the PHA's top financial/accounting official. Select Other for the highest paid executive/employee who is not the CEO or CFO.

Box 14. Please enter the total CASH compensation paid in the calendar year from Section 8 & 9 funds that was NOT reported on the individual's W-2. Do not include valid non-taxable PHA expense reimbursements paid to the employee (e.g., valid travel, training, etc. expenses). Please provide a written explanation for any amounts entered in Box 14 in the space provided.

Section IV: Certification. Enter the name and title of the individual who is certifying that the information is true and correct.