Hud-27054, 2013, Voice Response System Access Authorization
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2OMB Approval No. 2535-0102
U.S. Department of Housing
LOCCS
(exp. 11/30/2016)
and Urban Development
Voice Response System
Access Authorization Form
See Instructions, Public Burden, and Privacy Act statements on back before completing this form
This form is to be approved by the recipient’s
The Program Office will forward the original form to:
For overnight delivery send to:
(or grantee’s) chief executive officer. For
U.S. Dept. of Housing and Urban Development
U.S. Dept. of Housing and Urban Development
new users, reinstate users, and resend
Chief Financial Officer, FYM
Chief Financial Officer, FYM
user ID, retain a copy and send a notarized
Attention: User Support Branch
Attention: User Support Branch
th
original to your HUD Program Office for
PO Box 23774
451 7
Street SW, Room 3114
review.
Washington, DC 20026-3774
Washington, DC 20410
1. Type of Function (mark one)
2a. User ID (please leave blank)
2b. Social Security Number (SSN)
1
New User
(CFO USE ONLY)
(mandatory)
5
Add New Program Area or Tax ID
2
Reinstate User
6
Change Tax ID
3
Terminate User
7
Change Address
4
Reset Password for Active Users
8
Resend User ID
9
Name Change
3. Authorized User’s Name (last, first, mi) Print or Type
Title (mandatory)
Office Telephone No.
(include area code)
Complete Mailing Address
E-Mail Address
4. Recipient Organization for which Authority is being Requested
Tax ID
Organization’s Name
Tax ID
Organization’s Name
Tax ID
Organization’s Name
5c. Q = Query Only
5a. LOCCS Program Area
5b. Program Name
D = Project Drawdown
6. Authorized User’s Signature
Date (mm/dd/yyyy)
I authorize the person identified above to access LOCCS via the Voice Response System.
7. Approving Official’s Name (last, first, mi) Print or Type
Office Telephone Number
8. Notary (must be different from user
(include area code)
and approving official)
Seal, Signature, and Date Notarized
(mm/dd/yyyy)
Title
Social Security Number (mandatory)
Complete Mailing Address
E-Mail Address
Approving Official’s Signature
Date (mm/dd/yyyy)
Office Telephone Number (include area code)
9. Program Office Point of Contact’s Name (last, first, mi) Print or Type
E-Mail Address
Title
Date (mm/dd/yyyy)
Program Office Point of Contact’s Signature
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)
Previous editions are obsolete.
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Form HUD-27054 (11/2013)
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