Download:
pdf |
pdfOMB Approval No. 2535-0102
(exp. 4/30/2020)
U.S. Department of Housing
and Urban Development
eLOCCS
Access Authorization Form
(exp
See Instructions, Public Burden, and Privacy Act statements before completing this form
This form is to be approved by the recipient’s (or grantee’s) Chief Executive Officer or equivalent. All forms must be sent to your HUD Program Office for
review and approval. Retain a copy. MANDATORY REQUIREMENT: New User, Reinstate User and Change Secure Systems ID must be NOTARIZED.
GRANTEE – Mail form to your grant program officer. PROGRAM OFFICER: Required to mail the completed and certified form to: OCFO, User Support
Branch (FYMU) 451 7th Street SW, Room 3114, Washington, DC 20410.
1. Type of Function(s)
1
2
3
4
□
□
□
□
New User
5
Reinstate User
6
Terminate User
7
□
□
□
2a. Secure Systems ID
(mandatory)
Revise Authorizations
2b. New Secure Systems ID
(if changing ID)
Name/Address Change
Other ______________________
Change Secure Systems ID
3. Authorized User’s Name (last, first, mi) Print or Type
Title (mandatory)
Office Telephone Number
(include area code)
Complete Mailing Address
E-Mail Address
4. Authorizations (see next page) are required for New User, Reinstate User and Revise Authorization functions. Attach one
or more authorization pages as needed. Record the number of attached pages to the right. Each page should be initialed by
the Approving Official and HUD Program Office POC.
Number of Authorization Pages
Attached
5. Authorized User’s Signature
Date (mm/dd/yyyy)
I authorize the person identified above to access eLOCCS via HUD’s Secure Systems.
6.LOCCS Approving Official Name (last, first, mi) Print or Type
7. Notary (must be different from user
and approving official) Seal, Signature, and
Date Notarized (mm/dd/yyyy)
Title
E-Mail Address
Secure Systems User ID (mandatory)
Complete Mailing Address
Office Telephone Number
(include area code)
Approving Official’s Signature
Date (mm/dd/yyyy)
8. HUD Program Office Point of Contact’s Name (last, first, mi) Print or Type
Title
E-Mail Address
Office Telephone Number (include area code)
HUD Program Office Point of Contact’s Signature
Date (mm/dd/yyyy)
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)
Previous editions are obsolete.
Page 1 of 2
Form HUD-27054e (4/2020)
Use one of the blocks below to enter requested authorizations as needed for the Type of Function checked in block 1. Most users should use block 9.
Use block 10 if you are requesting access for multiple organizations under the same program area (for example, SCMF users need access to many
organizations). Use multiples of this Authorization page as needed. Enter the number of Authorization pages used in block 4.
9. Program Area Authorizations
Reason:
Organization
Name:
Organization Tax ID:
Program Area
Q =Query
D=Drawdown
Program Area Name
10. Multiple Organizations for a Single Program Area
Reason:
Program
Area Name:
Program Area:
Organization Tax ID
Q =Query
D=Drawdown
Organization Name
11a. Authorized User’s Initials and date
11b. Approving Official’s Initials and date
11c. HUD Program Office Initials and date
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)
Previous editions are obsolete.
Page 2 of 2
Form HUD-27054e (4/2020)
Public reporting burden for this collection of information is estimated to average 10 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.
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 Line of Credit Control System (LOCCS) from unauthorized access. The data are used to ensure that individuals who no longer require
access to eLOCCS have their access capability promptly deleted. Provision of the Secure Systems ID is mandatory. HUD uses it as a unique identifier
for safeguarding the eLOCCS from unauthorized access. 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 eLOCCS.
Instructions for the
eLOCCS Access Authorization Form
For more information, including the LOCCS program area codes and names, go to the following webpage:
http://portal.hud.gov/hudportal/HUD?src=/program_offices/cfo/loccs_guidelines
1.
Type of Function:
(1) New User: User does not currently have eLOCCS
access. Form must be notarized with original signatures.
(2) Reinstate User: Used to reinstate the user's access
authorization in eLOCCS. Form must be notarized with
original signatures.
(3) Terminate User: Used to immediately terminate the
user's access authorization to eLOCCS.
(4) Change Secure Systems ID: Used to change the Secure
Systems ID recorded in eLOCCS.
(5) Revise Authorizations: Used to add, change, or delete
the eLOCCS authorizations for an existing user. Use Reason
in block 9 or 10 to describe the purpose of the revision.
(6) Name/Address Change: User is changing name, email,
telephone or address information.
(7) Other: Use only as directed by the LOCCS Security staff.
4. Authorizations: Enter the number of authorization pages
used. Not needed for all functions.
5. Signature/Date: The signature of the user requesting access
and the date (mm/dd/yyyy) this authorization was signed.
6. Approval Official: Enter the name, office telephone number,
title, Secure Systems User ID, office address, signature and date
of the approving official representing the grantee organization.
Approving officials cannot approve themselves for access to the
system, and must be the organizations chief executive officer or
equivalent.
7. Notary. Must be different from user and approving official.
The official who notarizes the form shall include his/her seal,
signature, and date (mm/dd/yyyy). Notary should notarize both
signatures. Notary is only required for new user, reinstate user
and change Secure Systems ID functions.
8. Program Office Validation. The HUD Program Office must
validate that the grantee is the correct official accessing the
grant, and all data as it appears on the form for accuracy. The
Program Official shall include his/her name, office telephone
number, title, e-mail address, signature, and date (mm/dd/yyyy).
2a. Secure Systems User ID: Field is mandatory. Approving
Officials and Users must register with Secure Systems to obtain
their Secure Systems User ID. It is a required field on this form. If
you do not have your Secure Systems ID or have questions,
contact your Program Office for procedures.
9. Program Area Authorizations: Enter the reason,
organization Tax ID and name, the program area codes and
names, and Q for Query or D for Drawdown (which includes query
access). Use multiple pages as needed.
2b. New Secure Systems User ID: Use only when correcting
the Secure Systems ID that eLOCCS has associated with the
user.
Use Reason to explain the authorization request. For example,
“new user”, “updating authorization”, “changing Tax ID”, or as
directed by HUD.
3. User Information: All fields are mandatory. Failure to
enter any of these fields will cause the HUD-27054e to be
rejected and returned for correction. Enter the user's last name,
first name, and middle initial. Enter the user's office phone
number. Enter user's mailing address, city, state and zip code.
Enter user’s e-mail address.
10. Multiple Organizations: Enter reason. Enter multiple
organization Tax IDs and names and Q for Query or D for
Drawdown for a single program area code and name. Use
multiple pages as needed.
Previous editions are obsolete.
Page i
11. Required:
11a. Authorized Users intiials and date
11b. Approving Official’s intials and date
11c. HUD Program Officer’s initials and date
Form HUD-27054e (4/2020)
File Type | application/pdf |
Author | Jane Lee |
File Modified | 2017-04-12 |
File Created | 2017-04-11 |