Form Hud-50080-Hoz - Homeownership Zone Grant Payment Voucher - 2010

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U.S. Department of Housing

LOCCS / VRS

OMB Approval No. 2577-0166 (exp. 09/30/2010)

and Urban Development

Homeownership Zone Grant

Office of Community Planning and Development

Payment Voucher

HUD implemented the Line of Credit Control System/Voice Response System (LOCCS/VRS) to process requests for payments to grantees. Grant recipients

fill out a voucher form for the applicable HUD program with all the necessary information prior to making a telephone call using a touch tone telephone to

initiate the drawdwon process. The grantee will be prompted for entering the information and for confirming information that is spoken back by the VRS

simulated voice. This information is required to obtain benefits under the U.S. Housing Act of l937, as amended. The information requested does not lend

itself to confidentiality.

1. Voucher Number

2. LOCCS Pgrm. Area

3. Period Covered by this Request (mm/yy)

082

HOZ

from:

to:

5. Voice Response No. (5 digits, hyphen, 5 more ) 6. Grantee Organization's Name

8. Grant or Project No.

6a. Grantee Organization's TIN

Line Item No.

Type of Funds Requested

Amount

(dollars)

(cents)

1000

Program Administration

2000

Property Acquisition

2200

Housing Construction

2400

Housing Rehabilitation

2600

Site Preparation

2800

Direct Financial Assistance to Homebuyers

3000

Relocation Assistance

3200

Homebuyer Counseling and Education

3400

Marketing

3600

Project Related Soft Costs

4000

Other Activities Approved by the Secretary

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 :

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)

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

purpose of the data is to safeguard the Line of Credit Control System (LOCCS) from unauthorized access. The data are used to ensure that individuals who

no longer require 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. While the provision of the SSN is voluntary, HUD uses it as a unique identifier for safeguarding the LOCCS

from unauthorized access. This information will not be otherwise disclosed or released outside of HUD, except as permitted or required by law.

form HUD-50080-HOZ (4/2000)