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t <br /> LOCOS U .S. Department of Housing OMB Approval No. 2535-0102 <br /> and Urban Development (exp. 03/31 /2007) <br /> Voice Response System <br /> Access Authorization <br /> See Instructions, Public Burden, and Privacy Act statements on back before completing this form <br /> This form is to be approved by the recipient's The Field Office will forward the original form f to : <br /> (or grantee's ) chief executive officer. For newFor Overnight delivery send to : <br /> users and reinstate users , retain a copy and U.S. Dept. of Housing and Urban Development Chief Financial Officer, FYM <br /> send a notarized original and one copy to Chief Financial Officer, FYM 451 7th Street SW <br /> Box 23774 Room 3114 <br /> local HUD Field Office for review.ew. WWaashington , DC 20026-3774 Washington , DC 20410 <br /> 1 . Type of Function (mark one) 2a. User ID (Please leave blank) 2b. Social Security Number (SSN) <br /> 1 New User - 5 ❑ Add new Program Area or Tax ID (CFO USE ONLY) (mandatory) <br /> r 2 ❑ Reinstate User 6 Change Tax ID <br /> 3 Terminate User 7 Change Address <br /> 4 Reset Password for active users 8 Resend User-ID <br /> 3. Authorized User's Name (last, first, mi) Print or Type Title (mandatory) Office Telephone No. <br /> (include area code) <br /> Complete Mailing Address E-Mail address (if available) <br /> 4. Recipient Organization for which Authority is being Requested - <br /> Tax ID Organization's Name <br /> Tax ID Organization's Name <br /> Tax ID - Organization's Name <br /> 5c. 0 = Query Only <br /> 5a. LOCCS Program Area 5b. Program Name D = Project Drawdown <br /> S = Project Set-Up (HOME, HOP3) <br /> A = Admin. Drawdown (HOME, HOP3) <br /> 6. Authorized User's Signature Date (mm/dd/yyyy) <br /> I authorize the person identified above to access LOCCS via the Voice Response System . <br /> 7. Approved by name (Last, First, Mi.) Print or Type Office Telephone Number (include area code) 8. Notary (must be different from user and <br /> approving official) <br /> (Seal, Signature, and Date Notarized (mm/dd/yyyy) <br /> Title (mandatory) Social Security Number (mandatory) <br /> Complete Mailing Address E-Mail address (if available) <br /> Approving Official's Signature Date (mm/dd/yyyy) <br /> 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) <br /> Previous editions are obsolete. Page 1 of 1 form HUD-27054 (06/2003) <br />