Form HUD-27053-A at a glance
What it is: The LOCCS/VRS SNAPS Special Needs Assistance Program Request Voucher for Grant Payment requests payment of grant funds or designates the appropriate officials who can have access to the HUD voice activated payment system.
Who signs: The signature is that of the person identified in item 11.
A filled-in Form HUD-27053-A example: a grantee requests a partial payment
How to fill out Form HUD-27053-A, box by box
Voucher number, period covered and type of disbursement
The first 3 digits of the Voucher Number 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.
Circle "SNAP" (001) for SHDP and SHP grant requests, "HPAC" (038) for HOPWA competitive grant requests, and "IHP" (054) for Innovative Homeless Programs.
Enter the period covered by this request.
Check "partial" until the final request for grant funds is made.
Voice response number, grantee and grant
For Voice Response No, enter the 10 digit Voice Response System (VRS) project number which was sent to you by mail.
Enter the name of the organization requesting funds. It must be the same name that appears on the Grant Agreement.
For Tax Identification No, enter the tax (employer) Identification Number (TIN).
Enter the project number that appears on the Grant Agreement.
Type of funds requested
Enter the amount requested in each category (lines 1010 through 1120) and the total funds requested under item 10, Voucher Total.
Round each Amount to the nearest dollar.
Authorized person, signature and date of request
Enter the name and 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.
Enter the date of the call-in to request funds as the Date of Request.
By signing you 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)
More rules for Form HUD-27053-A
Item 7 is not applicable.
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.
Retain this form in your records for audit purposes.
Sources
[1] Form HUD-27053-A (2/95), LOCCS/VRS SNAPS Special Needs Assistance Program Request Voucher for Grant Payment, U.S. Department of Housing and Urban Development (the Official source link on this page).