+------------------------------+-----------------+--------------------+
| **Travel Voucher**           | **U.S.          |                    |
|                              | Department of   |                    |
| **Attachment**               | Housing and     |                    |
|                              | Urban           |                    |
|                              | Development**   |                    |
|                              |                 |                    |
|                              | Office of Chief |                    |
|                              | Financial       |                    |
|                              | Officer         |                    |
+------------------------------+-----------------+--------------------+

+----------+----------------+---+------------------+-------------------+
| *        |                |   |                  |                   |
| *Privacy |                |   |                  |                   |
| Act      |                |   |                  |                   |
| Stat     |                |   |                  |                   |
| ement:** |                |   |                  |                   |
| Public   |                |   |                  |                   |
| Law      |                |   |                  |                   |
| 97-255,  |                |   |                  |                   |
| F        |                |   |                  |                   |
| inancial |                |   |                  |                   |
| I        |                |   |                  |                   |
| ntegrity |                |   |                  |                   |
| Act, 31  |                |   |                  |                   |
| U.S.C.   |                |   |                  |                   |
| 3512,    |                |   |                  |                   |
| au       |                |   |                  |                   |
| thorizes |                |   |                  |                   |
| the      |                |   |                  |                   |
| De       |                |   |                  |                   |
| partment |                |   |                  |                   |
| of       |                |   |                  |                   |
| Housing  |                |   |                  |                   |
| and      |                |   |                  |                   |
| Urban    |                |   |                  |                   |
| Dev      |                |   |                  |                   |
| elopment |                |   |                  |                   |
| (HUD) to |                |   |                  |                   |
| collect  |                |   |                  |                   |
| all the  |                |   |                  |                   |
| inf      |                |   |                  |                   |
| ormation |                |   |                  |                   |
| (except  |                |   |                  |                   |
| the      |                |   |                  |                   |
| Social   |                |   |                  |                   |
| Security |                |   |                  |                   |
| Number   |                |   |                  |                   |
| (SSN)    |                |   |                  |                   |
| which    |                |   |                  |                   |
| will be  |                |   |                  |                   |
| used by  |                |   |                  |                   |
| HUD to   |                |   |                  |                   |
| protect  |                |   |                  |                   |
| disc     |                |   |                  |                   |
| ursement |                |   |                  |                   |
| data     |                |   |                  |                   |
| from     |                |   |                  |                   |
| fr       |                |   |                  |                   |
| audulent |                |   |                  |                   |
| actions. |                |   |                  |                   |
| The      |                |   |                  |                   |
| Housing  |                |   |                  |                   |
| and      |                |   |                  |                   |
| C        |                |   |                  |                   |
| ommunity |                |   |                  |                   |
| Dev      |                |   |                  |                   |
| elopment |                |   |                  |                   |
| Act of   |                |   |                  |                   |
| 1987, 42 |                |   |                  |                   |
| U.S.C.   |                |   |                  |                   |
| 3543,    |                |   |                  |                   |
| au       |                |   |                  |                   |
| thorizes |                |   |                  |                   |
| HUD to   |                |   |                  |                   |
| collect  |                |   |                  |                   |
| the SSN. |                |   |                  |                   |
| The data |                |   |                  |                   |
| is used  |                |   |                  |                   |
| to       |                |   |                  |                   |
| d        |                |   |                  |                   |
| etermine |                |   |                  |                   |
| the      |                |   |                  |                   |
| amount   |                |   |                  |                   |
| to       |                |   |                  |                   |
| r        |                |   |                  |                   |
| eimburse |                |   |                  |                   |
| an       |                |   |                  |                   |
| employee |                |   |                  |                   |
| for      |                |   |                  |                   |
| expenses |                |   |                  |                   |
| incurred |                |   |                  |                   |
| in       |                |   |                  |                   |
| co       |                |   |                  |                   |
| nnection |                |   |                  |                   |
| with     |                |   |                  |                   |
| t        |                |   |                  |                   |
| emporary |                |   |                  |                   |
| duty     |                |   |                  |                   |
| travel.  |                |   |                  |                   |
| P        |                |   |                  |                   |
| rovision |                |   |                  |                   |
| of the   |                |   |                  |                   |
| SSN is   |                |   |                  |                   |
| ma       |                |   |                  |                   |
| ndatory. |                |   |                  |                   |
| Failure  |                |   |                  |                   |
| to       |                |   |                  |                   |
| provide  |                |   |                  |                   |
| the      |                |   |                  |                   |
| inf      |                |   |                  |                   |
| ormation |                |   |                  |                   |
| r        |                |   |                  |                   |
| equested |                |   |                  |                   |
| may      |                |   |                  |                   |
| delay    |                |   |                  |                   |
| the      |                |   |                  |                   |
| pr       |                |   |                  |                   |
| ocessing |                |   |                  |                   |
| of your  |                |   |                  |                   |
| travel   |                |   |                  |                   |
| claim.   |                |   |                  |                   |
| This     |                |   |                  |                   |
| inf      |                |   |                  |                   |
| ormation |                |   |                  |                   |
| will not |                |   |                  |                   |
| be       |                |   |                  |                   |
| o        |                |   |                  |                   |
| therwise |                |   |                  |                   |
| d        |                |   |                  |                   |
| isclosed |                |   |                  |                   |
| or       |                |   |                  |                   |
| released |                |   |                  |                   |
| outside  |                |   |                  |                   |
| of HUD,  |                |   |                  |                   |
| except   |                |   |                  |                   |
| as       |                |   |                  |                   |
| p        |                |   |                  |                   |
| ermitted |                |   |                  |                   |
| or       |                |   |                  |                   |
| required |                |   |                  |                   |
| by law.  |                |   |                  |                   |
+----------+----------------+---+------------------+-------------------+
| Name     |                | S |                  | Travel            |
| (Last,   |                | o |                  | Authorization     |
| First,   |                | c |                  | Number            |
| Middle   |                | i |                  |                   |
| initial) |                | a |                  | ----------        |
|          |                | l |                  |                   |
| --       |                | S |                  |                   |
| -------- |                | e |                  |                   |
|          |                | c |                  |                   |
|          |                | u |                  |                   |
|          |                | r |                  |                   |
|          |                | i |                  |                   |
|          |                | t |                  |                   |
|          |                | y |                  |                   |
|          |                | N |                  |                   |
|          |                | u |                  |                   |
|          |                | m |                  |                   |
|          |                | b |                  |                   |
|          |                | e |                  |                   |
|          |                | r |                  |                   |
|          |                |   |                  |                   |
|          |                | - |                  |                   |
|          |                | - |                  |                   |
|          |                | - |                  |                   |
|          |                | - |                  |                   |
|          |                | - |                  |                   |
|          |                | - |                  |                   |
|          |                | - |                  |                   |
|          |                | - |                  |                   |
|          |                | - |                  |                   |
|          |                | - |                  |                   |
+----------+----------------+---+------------------+-------------------+
| Travel   |                | A |                  | Budget            |
| Purpose  |                | p |                  | Organization      |
| Code     |                | p |                  |                   |
|          |                | r |                  | ----------        |
| (For     |                | o |                  |                   |
| Purpose  |                | p |                  |                   |
| of       |                | r |                  |                   |
| Travel   |                | i |                  |                   |
| Codes    |                | a |                  |                   |
| see      |                | t |                  |                   |
| HUD-25,  |                | i |                  |                   |
| Block    |                | o |                  |                   |
| 11d)     |                | n |                  |                   |
|          |                |   |                  |                   |
| --       |                | - |                  |                   |
| -------- |                | - |                  |                   |
|          |                | - |                  |                   |
|          |                | - |                  |                   |
|          |                | - |                  |                   |
|          |                | - |                  |                   |
|          |                | - |                  |                   |
|          |                | - |                  |                   |
|          |                | - |                  |                   |
|          |                | - |                  |                   |
+----------+----------------+---+------------------+-------------------+
| Code     | Description    |   | Amount           |                   |
| Number   |                |   |                  |                   |
+----------+----------------+---+------------------+-------------------+
| 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)