Payment Voucher
This information is required to obtain benefits under the Native American Housing Assistance and SelfDetermination Act of 1996. Reporting burden is estimated at 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.
The Line of Credit Control System (LOCCS) is HUD's primary grant and subsidy disbursement system for most HUD programs. Organizations and individuals have access to
these grants through an Internet Version of LOCCS called eLOCCS, where authorized Business Partners can access, manage, and draw down grant funds. LOCCS is accessed
through the Internet Portal, Secure Systems. The combination of the two systems is eLOCCS.
.
LOCCS /eLOCCS
Traditional Indian Housing
Development
U.S. Department of Housing
and Urban Development
Office of Public and Indian Housing
OMB Approval No. 2577-0166 (Exp. 03/31/2024)
4.
1 = Partial Disbursement
2 = Final Disbursement
5. Not applicable. 6. Grantee Organization's Name 7. Payee Organization's Name
8. Grant or Project No. 6a. Grantee Organization's TIN 7a. Payee Organization's TIN
9.
Line Item No. Type of Funds Requested Amount (dollars)
1406
1410
1425
1430
1440
1450
1451
1475
1480
1485
1495
1499
1500
Warning:
I/We, the undersigned, certify under penalty of perjury that the information provided above is true and correct. WARNING: Anyone who knowingly submits a false claim or makes a false statement is
subject to criminal and/or civil penalties, including confinement for up to 5 years, fines, and civil and administrative penalties. (18 U.S.C. §§ 287, 1001, 1010, 1012; 31 U.S.C. §3729, 3802)
Privacy Statement:
This statement is prov
ided
pursuant
to the Privacy Act of 1974 5 USC
§
552a
t
he authority for collecting Personally Identifiable Information (PII) in
the Regulatory Consistency Communication
Board (RCCB) Electronic Feedback Form is based in Section 313 of Public Law 112-95. The purpose of the data
is to safeguard Line of Credit Control System (LOCCS) from unauthorized access. The data are
used to ensure that individuals who no longer require to access
to LOCCS have their access capability promptly deleted. Failure to provide the information requested on the form may delay the processing of your
approval for
access to LOCCS.
10. Voucher Total $ *
I certify the data reported and funds requested on this voucher are correct and the amount requested is not in excess of immediate disbursement
needs for this program. In the event the funds provided become more than necessary, such excess will be promptly returned, as directed by HUD.
11. Name & Phone Number (including area code) 12. Name & Title of Authorized Signatory (type or print clearly)
of the Person who Completed this form
13. Signature 14. Date of Request
X
form HUD-50080-TIHD (4/2000)
3. Period Covered by this Request (mm/yyyy)
from: to:
Initial Operating Deficit
Construction Work/Contracts in Progress
FY 1994 & Prior Year Grants
