Form HUD-4734 Labor Standards Deposit Account Voucher

Labor Standards Deposit Account Voucher OMB 2501-0021 Expiration XX-XX-XXXX

U.S. Department of Housing and Urban Development Office of Davis-Bacon & Labor Standards

Control ID/Transaction No:

Refund: LR-     -VR-    -     (Not taxable)

Payment: LR-     -VP-    -    

Prompt Payment Act – Not Applicable

Tax ID No:

     

Issue 1099

Issue 1099-NEC

Direct Deposit (Refunds/Optional for Wage Restitution):

To:	Bank Name:	     
	Address:	     
	City/State:	     
ACH/Direct Deposit:	ABA Routing No:	     
For Credit To:	Account No.	     
	Payee Account Name:	     
	Account Type	Checking Savings
Address:	Street:	     
	City/State/Zip:	     

Wage Restitution Check:

Payee Name & Address

     

     

     

Amount of Refund/Payment:

$     

Pursuant to authority vested in me, I certify that this voucher is correct and proper for payment. (Name/Signature)

     

Deputy Director, Davis-Bacon and Labor Standards

Date:

     

Evidence of deposit: (HQLS)

Verified Updated LSIS Date of last disbursement:      

Pursuant to authority vested in me, I certify that this voucher is correct and proper for payment. (Name/Signature)

     

Authorized Approving Official, Office of Davis-Bacon & Labor Standards

Date:

     

The public reporting burden for this collection of information is estimated to average .1 hour, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions to reduce this burden, to the Reports Management Officer, Paperwork Reduction Project, to the Office of Information Technology, US. Department of Housing and Urban Development, Washington, DC 20410-3600.  When providing comments, please refer to OMB Approval No. 2501-0021.  HUD may not conduct and sponsor, and a person is not required to respond to, a collection of information unless the collection displays a valid control number.

Previous editions are obsolete

HUD-4734 (01/2024)