Form 27054

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Voice Response System
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OMB Approval No. 2535-0102
(exp. 8/31/2013)

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This form is to be approved by the recipient's
(or grantee's) chief executive officer. )RUQHZ
XVHUVDQGUHLQVWDWHXVHUV, retain a copy and
send a QRWDUL]HGRULJLQDO and one copy to
your local HUD Field Office for review.

The Field Office will forward the original form to:

For Overnight delivery send to:

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1. Type of Function (mark one)

1
2
3
4

New User
Reinstate User
Terminate User
Reset Password for active users

2a. User ID (Please leave blank)

5
6
7
8

Add new Program Area or Tax ID
Change Tax ID
Change Address
Resend User-ID

3. Authorized User's Name (last, first, mi) 3ULQWRU7\SH

2b. Social Security Number (SSN)

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(PDQGDWRU\)

Title (PDQGDWRU\)

Office Telephone No.
(include area code)

Complete Mailing Address

E-Mail address (if available)

4. Recipient Organization for which Authority is being Requested
Tax ID

Organization's Name

Tax ID

Organization's Name

Tax ID

Organization's Name

5a.LOCCS Program Area

6. Authorized User's Signature

5c. 4
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5b. Program Name

=
=
=
=

Query Only
Project Drawdown
Project Set-Up (HOME, HOP3)
Admin. Drawdown (HOME, HOP3)

Date (mm/dd/yyyy)

I authorize the person identified above to access LOCCS via the Voice Response System.
7. Approved by name (Last, First, Mi.) 3ULQWRU7\SH

Office Telephone Number (include area code)

8. Notary (must be different from user and
approving official)
(Seal, Signature, and Date Notarized (mm/dd/yyyy)

Title (PDQGDWRU\)

Social Security Number (PDQGDWRU\)

Complete Mailing Address

E-Mail address (if available)

Approving Official's Signature

Date (mm/dd/yyyy)

:DUQLQJ 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)
Previous editions are obsolete.

Page 1 of 1

form +8' (06/2003)

Public reporting burden for this collection of information is estimated to average 10 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.
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 drawdown 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.
3ULYDF\$FW6WDWHPHQW 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 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 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. Provision of the SSN is mandatory. 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. Failure to provide the information requested on the form may delay the processing of your
approval for access to LOCCS.

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1.

Type of Function:

4.

Recipient Organization for which Authority is being requested. This will identify the organization the user will be
representing. Enter the organization's Tax ID and organization name.

5.

Program Authority. Identify the HUD program(s) this user
will be authorized to access for the recipient organization and
then enter the corresponding code(s)/name(s). [Program
Office should provide this information.]

(1) New User: User does not currently have a LOCCS user ID.
Form must be notarized with original signatures.
(2) Reinstate User: Used to renew the user's access authorization in LOCCS. Form must be notarized with original
signatures.
(3) Terminate User: will immediately terminate the user's
access authorizations in LOCCS.

a./b. Contact your local HUD Field Office for the appropriate
3 or 4-character LOCCS Program Area/Name

(4) Reset Password for active users: A temporary password will be mailed back to the user to inform him/her of the
reset password's value. The user will be required to change
the password on the next access to LOCCS.

c. Enter either "Q" for Query only access, "D" for Project
Drawdown access. Users who select Project Drawdown
access, Project Set-Up access, or Administrative Drawdown
access will automatically receive Query access. Persons who
have Project Set-Up Authority for a given Tax ID cannot also
have Project Drawdown Authority for the same Tax ID. "S"
and "A" are reserved for use with the HOME and HOPE
Programs.

(5) Add new Program Area or Tax ID: User has a current
user ID and will be increasing access capability.
(6) Change Tax ID : User has a current ID and will be
changing the Tax ID. This function is not to be used to change
approving official, or substitute a user. Contact Field Office
contact for procedures.

6.

Signature. The signature for whom access is being requested and the date (mm/dd/yyyy) this authorization was
signed.

7.

Approval. Enter the name, title, SSN (social security number), office phone, office address, signature and date (mm/
dd/yyyy) of the approving official representing the recipient
organization. Approving officials cannot approve themselves for access to the system, and must be the user's
supervisor.

8.

Notary. Must be different from user and approving official.
Seal and signature of the official who notarizes this form and
date (mm/dd/yyyy). Notary should notarize both signatures.
Notary is only required for new user and reinstate user.

(7) Change Address: User is changing the current mailing
address.
(8) Resend User-ID. User has no knowledge of existing
User-ID
2

a. User ID: This block will be filled in by the LOCCS
Security Officer for all ID's.
b. Social Security Number: Mandatory. Used to preclude
duplicate issuance of authorization for the same person. See
the Privacy Act Statement above. [Do not use Federal Tax
ID Number]

3.

User Information: All fields are mandatory. Failure to
enter any of these fields will cause the security request to be
rejected. Enter the user's last name, first name, and middle
initial. Enter the user's office phone number. Include the area
code. Enter user's mailing address, city, State and zip code.

Previous editions are obsolete.

Page i

form +8' (06/2003)