Hud 27053 A Orm Form PDF Details

Navigating the complexities of grant management in the realm of housing and urban development requires familiarity with specific forms and procedures, one of which is the HUD 27053 A Orm form. Essential for organizations seeking financial assistance through the U.S. Department of Housing and Urban Development's Special Needs Assistance Program (SNAP), this form acts as a request voucher for grant payment. It's designed to streamline the process of requesting disbursements, whether partial or final, ensuring that funds are allocated accurately and efficiently to support various programmatic needs such as acquisition, rehabilitation, new construction, operating costs, and more. Additionally, the form includes a comprehensive section for the grantee organization's details, the period covered by the request, and a detailed breakdown of the funds requested by category, underscoring its role in safeguarding the disbursement data from fraudulent actions. With its structured format and clear instructions, the HUD 27053 A Orm form exemplifies a critical tool in the administration of housing grants, facilitating accountability and smooth financial operations for grantees.

QuestionAnswer
Form NameHud 27053 A Orm Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesform hud 27053 a, hud 27053 a 2 95, HUD-27053-A, hud 27053 a

Form Preview Example

LOCCS/VRS

U.S. Department of Housing OMB Approval No. 2535-0102 (exp. 1/31/2004)

and Urban Development

SNAPS Special Needs Assistance Program

Office of Community Planning

Request Voucher for Grant Payment

and Development

 

See Instructions and Public Reporting Burden Statement on back

 

1. Voucher Number

2. LOCCS Pgrm. Area

SNAP HPAC

IHP

3. Period Covered by this Request (dates)

4. Type of Disbursement

Partial

 

Final

5.Voice Response No. (5 digits, hyphen, 5 more )

8.Grant No.

6.Grantee Organization's Name

6a. Grantee Organization's TIN

9. Line Item no.

Type of Funds Requested

1010

Acquisition

1020

Rehabilitation

1021

New Construction

1022

Substantial Rehabilitation

1023

Moderate Rehabilitation

1030

Operating Cost

1040

Rental Assistance

1050

Supportive Services

1060

Administrative Cost

1070

Child Care

1080

Employment Assistance

1090

Relocation

1100

Leasing

1110

Repair & Maintenance

1111

Prevention (RH)

1112

Capacity Building (RH)

1120

Other:

 

 

Amount (round to nearest dollar)

10.

Voucher Total

I hereby certify that all the information stated herein, as well as any information provided in the accompaniment herewith, is true and accurate.

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)

11.Name & Phone Number (including area code) of the Authorized Person who called SNAPs System VRS

12. Signature

13. Date of Request

X

Privacy 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 (except the Social Security Number (SSN)) which will be used by HUD to protect disbursement data from fraudulent actions. The Housing and Community Development Act of 1987, 42 U.S.C. 3543, authorizes HUD to collect the SSN. The data are used to ensure that individuals who no longer require access to Line of Credit Control System (LOCCS) have their access capability promptly deleted. Provision of the SSN is mandatory. HUD uses it as a unique identifier for safeguarding LOCCS from unauthorized access. Failure to provide the information requested may delay the processing of your approval for access to LOCCS. This information will not be otherwise disclosed or released outside of HUD, except as permitted or required by law.

Retain this form in your records for audit purposes

page 1 of 2

form HUD-27053-A (2/95)

Public reporting burden for this collection of information is estimated to average 15 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.

This information collection is to request payment of grant funds or to designate the appropriate officials who can have access to HUD voice activated payment system. The HUD voice activated payment system has been especially designed to help the recipient when calling in for a request of funds and improves the payment process so the recipient will know right away whether their request will be paid or not. This information collection is required under 24 CFR Subpart C, 85.21 - Post Award Requirements, the information collection is needed in order to obtain or retain a benefit.

Instructions for the Request Voucher for Grant Payment for the Special Needs Assistance Program (SNAPs)

Item 1. Voucher Number: The first 3 digits are the prefix to your program. Enter "001" if grant funds are being requested for a grant awarded under a SHDP or SHP (TH, PH, SAFAH and Renewal) grant. Enter "038" if funds are being requested for a Housing Opportunity for Persons with AIDs (HOPWA) competitive grant. Enter "054" if funds are being requested for an Innovative Housing Program (IHP) grant. (If you do not know your 3-digit program prefix, contact your local Field Office.) The remaining 6 digits will be assigned by LOCCS/VRS during the telephone call. The entire 9-digit number will have to be entered prior to ending the call.

Item 2. LOCCS Program Area: Circle "SNAP" (001) for SHDP and SHP grant requests, "HPAC" (038) for HOPWA competitive grant requests, and "IHP" (054) for Innova- tive Homeless Programs.

Item 3. Enter the period covered by this request.

Item 4. Type of Disbursement: Check "partial" until the final request for grant funds is made.

Item 5. Voice Response No: Enter the 10 digit Voice Response System (VRS) project number which was sent to you by mail. Your regular HUD project number will be repeated back for verification after the VRS project number is entered.

Item 6. Grantee Organization’s Name: Enter the name of the organization requesting funds. It must be the same name that appears on the Grant Agreement.

Item 6a. Grantee Organization's Tax Identification No: Enter

the tax (employer) Identification Number (TIN).

Item 7. Not applicable.

Item 8. Grant Number: Enter the project number that appears on the Grant Agreement.

Item 9. Type of Funds Requested: SNAPs grant VRS draw- downs are directed against specific funding categories called Budget Line Item (BLIs). LOCCS associates a 4- digit number with each line item. Enter the amount requested in each category (lines 1010 through 1120) and the total funds requested under item 10, Voucher Total.

Item 11. Name & phone number (including area code) of the authorized person who completed the call-in to VRS. The authorized person is shown on line 3 of form HUD-27054.

Item 12. Signature of the person identified in item 11.

Item 13. Date of this Request: Enter the date of the call-in to request funds.

Retain this form in your records for audit purposes

page 2 of 2

form HUD-27053-A (2/95)

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This form will need specific info to be filled in, therefore you should take whatever time to enter exactly what is asked:

1. The Grantee needs particular details to be typed in. Ensure the subsequent blank fields are finalized:

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2. Your next part is usually to fill in these particular fields: Employment Assistance, Relocation, Leasing, Repair Maintenance, Prevention RH, Capacity Building RH, Other, Voucher Total, I hereby certify that all the, Name Phone Number including area, Signature, Date of Request, Person who called SNAPs System VRS, Privacy Statement Public Law, and Retain this form in your records.

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As for Signature and Voucher Total, make sure you do everything correctly in this current part. The two of these are considered the most significant ones in the document.

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