HUD-52681-B Voucher for Payment of Annual Contributions and Operatin

Voucher for Payment of
Annual Contributions and
Operating Statement

US Department of Housing
and Urban Development

Housing Assistance Payments Program

(Voucher Management System) Supplemental Reporting Form

OMB Approval No. 2577-0282
(Exp. 08/31/2018)

Office of Public and Indian Housing

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 a person is not
required to respond to, a collection of information unless that collection displays a valid OMB control number. Assurances of confidentiality are not provided under this collection.
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

Vouchers under lease on the First Day of the Month:
UML:

Rental Assistance Component 1
Rental Assistance Component 2
Litigation
Homeownership
New This Month
Moving To Work
One Year Mainstream – MTW
Family Unification – Non MTW
Family Unification – Pre2008 – MTW
Family Unification – 2008/Forward – MTW
Non-Elderly Disabled – Non-MTW
Non-Elderly Disabled – 2008/Forward – MTW
Portable Vouchers Paid
Hope VI
Tenant Protection
Enhanced Vouchers
Veterans Affair Supported Housing (VASH) Voucher
DHAP to HCV Vouchers Leased
All Other Vouchers
Total Vouchers
HAP Expenses:

Rental Assistance Component 1
Rental Assistance Component 2
Litigation
Homeownership
New This Month
Moving To Work
One Year Mainstream – MTW
Family Unification – Non MTW
Family Unification – Pre2008 – MTW
Family Unification – 2008/Forward – MTW
Non-Elderly Disabled – Non-MTW

Page 1 of 11

Form HUD 52681-B (08/2018)

Voucher for Payment of
Annual Contributions and
Operating Statement

US Department of Housing
and Urban Development

Housing Assistance Payments Program

(Voucher Management System)Supplemental Reporting Form

OMB Approval No. 2577-0282
(Exp. 08/31/2018)

Office of Public and Indian Housing

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 a person is not
required to respond to, a collection of information unless that collection displays a valid OMB control number. Assurances of confidentiality are not provided under this collection.
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.

HAP Expenses (cont.):

Non-Elderly Disabled – 2008 Forward – MTW
Portable Vouchers Paid
Hope VI
Tenant Protection
Enhanced Vouchers
Veterans Affair Supported Housing (VASH) Voucher
DHAP to HCV Vouchers Leased
All Other Vouchers
MTW – Family Unification 2008/Forward HAP expenses after the
First of the Month
MTW – Family Unification per-2008 HAP After the First of the Month
MTW – Non-Elderly Disabled 2008/Forward HAP Expenses after the
First of the Month
MTW- VASH HAP Expenses after the First of the Month
MTW – One Year Mainstream HAP After the First of the Month
FSS Escrow Deposits
All Voucher HAP Expenses After the First of Month
Total Vouchers
Other Voucher Reporting Requirements:
UML:

Number of Vouchers Under Lease (HAP Contract) on the Last day of month
HA Owned Units Leased – included in the units leased above
New Vouchers Issued but not under HAP contracts as of the
Last day of month
Portable Vouchers Administered (Port-In)
5 Year Mainstream
Number of PBVs under AHAP and not under HAP
Number of PBVs under HAP and Leased
Number of PBVs under HAP and not Leased
Number of PBVs under HAP and not Leased with vacancy payment and
associated vacancy HAP expense
HAP Expenses:

Portable Vouchers Administered (Port-In)
5 Year Mainstream
Number of PBVs under HAP and not Leased with vacancy payment and
associated vacancy HAP expense

Page 2 of 11

Form HUD 52681-B (08/2018)

Voucher for Payment of
Annual Contributions and
Operating Statement

US Department of Housing
and Urban Development

Housing Assistance Payments Program

(Voucher Management System)Supplemental Reporting Form

OMB Approval No. 2577-0282
(Exp. 08/31/2018)

Office of Public and Indian Housing

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 a person is not
required to respond to, a collection of information unless that collection displays a valid OMB control number. Assurances of confidentiality are not provided under this collection.
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.

Memorandum Reporting:
UML:

Number of Hard to House Families Leased
Number of LBP Initial Clearance Tests
Number of LBP Risk Assessments
HAP Expenses:

Fraud Recovery Total Collected This Month
Interest or other income earned this month from the investment of HAP
funds and Restricted Net Position (formerly Net Restricted Assets)
FSS Escrow Forfeitures This Month
Portable HAP costs Billed and Unpaid – 90 Days or older
Administrative Expenses:
HAP Expenses:

FSS Coordinator Expenses Covered by FSS Grant
FSS Coordinator Expenses Not Covered by FSS Grant
Non-MTW Administrative Expenses
Audit
Financial Status:
HAP Expenses:

Unrestricted Net Position (UNP) as of the Last Day of the Month
Restricted Net Position Funds (RNP) as of the Last Day of the Month
Cash/Investment as of the Last Day of the Month – Voucher Program Only
MTW:
HAP Expenses:

MTW – HCV Administrative Expenses
MTW – Public Housing Rehabilitation
MTW – Debt Service Repayment
MTW – Development Activities
MTW – Local Housing Program

Page 3 of 11

Form HUD 52681-B (08/2018)

Voucher for Payment of
Annual Contributions and
Operating Statement

US Department of Housing
and Urban Development

Housing Assistance Payments Program

(Voucher Management System) Supplemental Reporting Form

OMB Approval No. 2577-0282
(Exp. 08/31/2018)

Office of Public and Indian Housing

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 a person is not
required to respond to, a collection of information unless that collection displays a valid OMB control number. Assurances of confidentiality are not provided under this collection.
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.

Other - Unspent Funds Fund Source 1
Misc.:

Unspent Fund Source (HCV, CAP, OP or MTW) – 1
Type of Account – 1
Activity – 1
Funds Committed – 1
Type of Commitment – 1
Date of Commitment – 1 (MM/DD/YYYY)
Funds Obligated – 1
Type of Obligation – 1
Date of Obligation – 1 (MM/DD/YYYY)
Funds Expended from Commitment/Obligation – 1
Projected Date of Full Expenditure – 1 (MM/DD/YYYY)
Other - Unspent Funds Fund Source 2
Misc.:

Unspent Fund Source (HCV, CAP, OP or MTW) – 2
Type of Account – 2
Activity – 2
Funds Committed – 2
Type of Commitment – 2
Date of Commitment – 2 (MM/DD/YYYY)
Funds Obligated – 2
Type of Obligation – 2
Date of Obligation – 2 (MM/DD/YYYY)
Funds Expended from Commitment/Obligation – 2
Projected Date of Full Expenditure – 2 (MM/DD/YYYY)

Page 4 of 11

Form HUD 52681-B (08/2018)

Voucher for Payment of
Annual Contributions and
Operating Statement

US Department of Housing
and Urban Development

Housing Assistance Payments Program

(Voucher Management System) Supplemental Reporting Form

OMB Approval No. 2577-0282
(Exp. 08/31/2018)

Office of Public and Indian Housing

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 a person is not
required to respond to, a collection of information unless that collection displays a valid OMB control number. Assurances of confidentiality are not provided under this collection.
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.

Other - Unspent Funds Fund Source 3
Misc.:

Unspent Fund Source (HCV, CAP, OP or MTW) – 3
Type of Account – 3
Activity – 3
Funds Committed – 3
Type of Commitment – 3
Date of Commitment – 3 (MM/DD/YYYY)
Funds Obligated – 3
Type of Obligation – 3
Date of Obligation – 3 (MM/DD/YYYY)
Funds Expended from Commitment/Obligation – 3
Projected Date of Full Expenditure – 3 (MM/DD/YYYY)
Other - Unspent Funds Fund Source 4
Misc.:

Unspent Fund Source (HCV, CAP, OP or MTW) – 4
Type of Account – 4
Activity – 4
Funds Committed – 4
Type of Commitment – 4
Date of Commitment – 4 (MM/DD/YYYY)
Funds Obligated – 4
Type of Obligation – 4
Date of Obligation – 4 (MM/DD/YYYY)
Funds Expended from Commitment/Obligation – 4
Projected Date of Full Expenditure – 4 (MM/DD/YYYY)

Page 5 of 11

Form HUD 52681-B (08/2018)

Voucher for Payment of
Annual Contributions and
Operating Statement

US Department of Housing
and Urban Development

Housing Assistance Payments Program

(Voucher Management System)Supplemental Reporting Form

OMB Approval No. 2577-0282
(Exp. 08/31/2018)

Office of Public and Indian Housing

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 a person is not
required to respond to, a collection of information unless that collection displays a valid OMB control number. Assurances of confidentiality are not provided under this collection.
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.

Other - Unspent Funds Fund Source 5
Misc.:

Unspent Fund Source (HCV, CAP, OP or MTW) – 5
Type of Account – 5
Activity – 5
Funds Committed – 5
Type of Commitment – 5
Date of Commitment – 5 (MM/DD/YYYY)
Funds Obligated – 5
Type of Obligation – 5
Date of Obligation – 5 (MM/DD/YYYY)
Funds Expended from Commitment/Obligation – 5
Projected Date of Full Expenditure – 5 (MM/DD/YYYY)
Other - Unspent Funds Fund Source 6
Misc.:

Unspent Fund Source (HCV, CAP, OP or MTW) – 6
Type of Account – 6
Activity – 6
Funds Committed – 6
Type of Commitment – 6
Date of Commitment – 6 (MM/DD/YYYY)
Funds Obligated – 6
Type of Obligation – 6
Date of Obligation – 6 (MM/DD/YYYY)
Funds Expended from Commitment/Obligation – 6
Projected Date of Full Expenditure – 6 (MM/DD/YYYY)

Page 6 of 11

Form HUD 52681-B (08/2018)

Voucher for Payment of
Annual Contributions and
Operating Statement

US Department of Housing
and Urban Development

Housing Assistance Payments Program

(Voucher Management System) Supplemental Reporting Form

OMB Approval No. 2577-0282
(Exp. 08/31/2018)

Office of Public and Indian Housing

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 a person is not
required to respond to, a collection of information unless that collection displays a valid OMB control number. Assurances of confidentiality are not provided under this collection.
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.

Other - Unspent Funds Fund Source 7
Misc.:

Unspent Fund Source (HCV, CAP, OP or MTW) – 7
Type of Account – 7
Activity – 7
Funds Committed – 7
Type of Commitment – 7
Date of Commitment – 7 (MM/DD/YYYY)
Funds Obligated – 7
Type of Obligation – 7
Date of Obligation – 7 (MM/DD/YYYY)
Funds Expended from Commitment/Obligation – 7
Projected Date of Full Expenditure – 7 (MM/DD/YYYY)
Other - Unspent Funds Fund Source 8
Misc.:

Unspent Fund Source (HCV, CAP, OP or MTW) – 8
Type of Account – 8
Activity – 8
Funds Committed – 8
Type of Commitment – 8
Date of Commitment – 8 (MM/DD/YYYY)
Funds Obligated – 8
Type of Obligation – 8
Date of Obligation – 8 (MM/DD/YYYY)
Funds Expended from Commitment/Obligation – 8
Projected Date of Full Expenditure – 8 (MM/DD/YYYY)

Page 7 of 11

Form HUD 52681-B (08/2018)

Voucher for Payment of
Annual Contributions and
Operating Statement

US Department of Housing
and Urban Development

Housing Assistance Payments Program

(Voucher Management System) Supplemental Reporting Form

OMB Approval No. 2577-0282
(Exp. 09/30/2017)

Office of Public and Indian Housing

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 a person is not
required to respond to, a collection of information unless that collection displays a valid OMB control number. Assurances of confidentiality are not provided under this collection.
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.

Other - Unspent Funds Fund Source 9
Misc.:

Unspent Fund Source (HCV, CAP, OP or MTW) – 9
Type of Account – 9
Activity – 9
Funds Committed – 9
Type of Commitment – 9
Date of Commitment – 9 (MM/DD/YYYY)
Funds Obligated – 9
Type of Obligation – 9
Date of Obligation – 9 (MM/DD/YYYY)
Funds Expended from Commitment/Obligation – 9
Projected Date of Full Expenditure – 9 (MM/DD/YYYY)
Other - Unspent Funds Fund Source 10
Misc.:

Unspent Fund Source (HCV, CAP, OP or MTW) – 10
Type of Account – 10
Activity – 10
Funds Committed – 10
Type of Commitment – 10
Date of Commitment – 10 (MM/DD/YYYY)
Funds Obligated – 10
Type of Obligation – 10
Date of Obligation – 10 (MM/DD/YYYY)
Funds Expended from Commitment/Obligation – 10
Projected Date of Full Expenditure – 10 (MM/DD/YYYY)

Page 8 of 11

Form HUD 52681-B (08/2018)

Voucher for Payment of
Annual Contributions and
Operating Statement

US Department of Housing
and Urban Development

Housing Assistance Payments Program

(Voucher Management System) Supplemental Reporting Form

OMB Approval No. 2577-0282
(Exp. 08/31/2018)

Office of Public and Indian Housing

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 a person is not
required to respond to, a collection of information unless that collection displays a valid OMB control number. Assurances of confidentiality are not provided under this collection.
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.

Other - Unspent Funds Fund Source 11
Misc.:

Unspent Fund Source (HCV, CAP, OP or MTW) – 11
Type of Account – 11
Activity – 11
Funds Committed – 11
Type of Commitment – 11
Date of Commitment – 11 (MM/DD/YYYY)
Funds Obligated – 11
Type of Obligation – 11
Date of Obligation – 11 (MM/DD/YYYY)
Funds Expended from Commitment/Obligation – 11
Projected Date of Full Expenditure – 11 (MM/DD/YYYY)
Expenses:
HAP Expenses:

Expense Amount 1
Expense Amount 2
Expense Amount 3
Expense Amount 4
Expense Amount 5
Misc.:
Expense Amount 1 Comment

Expense Amount 2 Comment

Expense Amount 3 Comment

Expense Amount 4 Comment

Expense Amount 5 Comment

Page 9 of 11

Form HUD 52681-B (08/2018)

Voucher for Payment of
Annual Contributions and
Operating Statement

US Department of Housing
and Urban Development

Housing Assistance Payments Program

(Voucher Management System) Supplemental Reporting Form

OMB Approval No. 2577-0282
(Exp. 08/31/2018)

Office of Public and Indian Housing

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 a person is not
required to respond to, a collection of information unless that collection displays a valid OMB control number. Assurances of confidentiality are not provided under this collection.
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.

MTW Other Expense Category
HAP Expenses:

MTW – Other PHA to identify the type of expense incurred Amount – 6
MTW – Other PHA to identify the type of expense incurred Amount – 7
MTW – Other PHA to identify the type of expense incurred Amount – 8
Misc.:
MTW – Other PHA to identify the type of expense incurred Amount – 6
Comment

MTW – Other PHA to identify the type of expense incurred Amount – 7
Comment

MTW – Other PHA to identify the type of expense incurred Amount – 8
Comment

Comments:

Misc.:
Comments
Disaster Voucher Program (DVP):
Misc.

Disaster Name
UML:

Disaster Families Assisted (UML)
HAP Expenses:

Disaster Families Assisted
Disaster Security Deposit
Disaster Security Deposit Returned
Disaster Utility Deposit
Disaster Utility Deposit Returned
Disaster Administrative Expenditures
Disaster Broker Fee

Page 10 of 11

Form HUD 52681-B (08/2018)

Voucher for Payment of
Annual Contributions and
Operating Statement

US Department of Housing
and Urban Development

Housing Assistance Payments Program

(Voucher Management System) Supplemental Reporting Form

OMB Approval No. 2577-0282
(Exp. 08/31/2018)

Office of Public and Indian Housing

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 a person is not
required to respond to, a collection of information unless that collection displays a valid OMB control number. Assurances of confidentiality are not provided under this collection.
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.

Comments:

Name of PHA Point of Contact:

POC Phone Number:

Date Submitted:

Official HA Email Address:

Page 11 of 11

Ext:

Form HUD 52681-B (08/2018)