Travel Voucher Attachment {HUD-1012}

Travel Voucher Attachment U.S. Department of Housing and Urban Development Office of Chief Financial Officer 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 2101 2102 2103 2104 2105 2106 2107 2108 2109 2110 2111 2199 Lodging Description Amount Meals and Miscellaneous Expenses GSA Vehicles Rental Vehicles Privately Owned Vehicles Airfare Bus Train Taxi Airfare, Chartered Other Late Payment Charge Travel Total form HUD-1012 (3/95) American LegalNet, Inc. www.FormsWorkflow.com