HUD-50080-TIHD Traditional Indian Housing Development Payment Voucher

U.S. Department of Housing
and Urban Development
Office of Public and Indian Housing

LOCCS /eLOCCS
Traditional Indian Housing
Development
Payment Voucher

OMB Approval No. 2577-0166 (Exp. 01/31/2021)

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..

1. Voucher Number
2. LOCCS Pgrm. Area

031

TIHD

3. Period Covered by this Request (mm/yyyy)
from:

4.

1 = Partial Disbursement
2 = Final Disbursement

to:

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

1406

Operations

1410

Administration

1425

Initial Operating Deficit

1430

Planning

1440

Site Acquisition

1450

Site Improvements

1451

Off Site Sewer & Water

1475

Non-Dwelling Equipment

1480

Construction Work/Contracts in Progress

1485

Demolition

1495

Relocation Costs

1499

Development Used for Mod

1500

FY 1994 & Prior Year Grants

(dollars)

* (cents)
*
*
*

*
*
*
*
*
*
*
*
*
*
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)
of the Person who Completed this form

12. Name & Title of Authorized Signatory (type or print clearly)

13. Signature

14. Date of Request

X
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 provided pursuant to the Privacy Act of 1974 5 USC § 552a the 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.

form HUD-50080-TIHD

(4/2000)