Form Hud-94210-F1 - Invoice Approval For Contract/purchase Order
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1Invoice Approval for
U.S. Department of Housing
and Urban Development
Contract/Purchase Order
Office of Housing
Federal Housing Commissioner
Field Offices
Part A.
Attention: To (Approving Official/GTR)
Room Number
From (Transmitting Office)
Phone Number
Date (mm/dd/yyyy)
Room Number
Part B.
1. Invoice Number
2. Date Invoice Received (mm/dd/yyyy)
3. Date Due to CMIS (mm/dd/yyyy)
4. Tax ID Number
5. Contract Number, P.O. Number
6. Voucher Number
7. Schedule Number
8. Payment Number
Part C.
(To be Completed by Approving Official /GTR)
Instructions. Return all approved invoices, with a copy of this transmittal to the Cash Management and Investment staff within 5 calendar days
(3 calendar days for Rush Discount) or ______________ days of the date of this transmittal. Any money penalties incurred due to processing
delays are chargeable to your organization. In the case of disputed invoices, see Part D.
9. Date Goods/Services Delivered (mm/dd/yyyy)
10. Date Goods/Services Accepted (mm/dd/yyyy)
11. Amount Approved for Payment
$
12. Account Symbol (Appropriation) (86X_________________________).
13. ABA Number (9 digits)
4070 $ ______________________________
4077 $ ______________________________
4072 $ ______________________________
4587 $ ______________________________
14. Bank Account Number
0200 $ ______________________________
00183 $ ______________________________
Single Family Program Codes
Multifamily Program Codes
SFAES
SFCRT
SFHMA
SFMCS
OBR
FIF
UPG
MPG
SFRMT
SFVST
SFFMT
SFLMA
MFCRR
MFRCS
MFSSP
MFCES
SFSEC
SFMMI
TICLP
MFTDP
MFDPR
15. Check the appropriate box
16. Check method of payment
Approved for payment
Check
ACH
Same Day Payment
Disapproved for payment/Disputed Invoice
If Check, include address
Subject to Prompt Pay Yes
No
______________________________________________________
______________________________________________________
______________________________________________________
Check the appropriate box
partial payment
Signature of Approving Official
final payment
Name of Approving Official (print)
Phone Number
Date (mm/dd/yyyy)
Part D.
Action to be taken with disputed invoice (check one)
Pay invoice as is
Do not pay. Reason _______________________________________
Do not pay. Vendor will submit a revised invoice
Pay invoice as modified below
Amount $ _______________________
Remarks
Signature of Contract Specialist
Phone Number (include area code)
Date (mm/dd/yyyy)
Notify approving official of resolution. Return approved invoices/completed transmittals to: Cash Management and Investment Staff
P.O. Box 44815
Washington D.C. 20026
Previous editions are obsolete
Page 1of 1
form HUD-94210-F1 (5/2000)
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