Form hud 27053 a 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin with Item 1, Voucher Number. Enter the appropriate prefix based on your program type, followed by the assigned digits from LOCCS/VRS.
3. For Item 2, select the LOCCS Program Area by circling 'SNAP', 'HPAC', or 'IHP' as applicable.
4. In Item 3, specify the period covered by this request using the date format provided.
5. For Item 4, indicate the Type of Disbursement. Check 'partial' until you make a final request.
6. Enter your Voice Response No. in Item 5, ensuring it matches the number sent to you via mail.
7. Complete Items 6 and 6a with your Grantee Organization's Name and Tax Identification Number (TIN).
8. Fill in Item 8 with your Grant Number as shown on your Grant Agreement.
9. In Item 9, detail the Type of Funds Requested by entering amounts for each Budget Line Item (BLI) from lines 1010 to 1120.
10. Finally, provide your name and phone number in Item 11, sign in Item 12, and date your request in Item 13 before submitting.

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