U.S. Department of Housing and Urban Development Office of Chief Financial Officer Travel Voucher Attachment Privacy Act Statement: Public Law 97-255, Financial Integrity Act, 31 U.S.C. 3512, authorizes the Department of Housing and Urban Development (HUD) to collect all the information (except the Social Security Number (SSN)) which will be used by HUD to protect disbursement data from fraudulent actions. The Housing and Community Development Act of 1987, 42 U.S.C. 3543, authorizes HUD to collect the SSN. The data is used to determine the amount to reimburse an employee for expenses incurred in connection with temporary duty travel. Provision of the SSN is mandatory. Failure to provide the information requested may delay the processing of your travel claim. This information will not be otherwise disclosed or released outside of HUD, except as permitted or required by law. Name (Last, first, middle initial) Social Security Number Travel Authorization Number Travel Purpose Code ( For Purpose of Travel Codes see HUD-25, Block 11d) Appropriation Budget Organization Code Number Description Amount 2101 Lodging 2102 Meals and Miscellaneous Expenses 2103 GSA Vehicles 2104 Rental Vehicles 2105 Privately Owned Vehicles 2106 Airfare 2107 Bus 2108 Train 2109 Taxi 2110 Airfare, Chartered 2111 Other 2199 Late Payment Charge Travel Total form HUD-1012 (3/95) American LegalNet, Inc. www.FormsWorkflow.com