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Summary of Materials Stored U.S. Department of Housing OMB Approval No. 2577-0157
and Urban Development (@p. 1/31/2027)
Office of Public and Indian Housing
Public reporting burden for this collection of information is estimated to average 2.5 hours per response, including the time for reviewing instructions, searching
existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. HUD may not conduct or sponsor, and an applicants not
required fo respeng to a collection of information ures if displays a currenily valid OMB control number, Cornments regarding the accuracy of this burden estimate and any suggestion
for reducing this burden can be sent to the Reports Management Officer, Office of Policy Development and Research, REE, Department of Housing and Urban Development, 451 7th
St SW, Room 4176, Washington, DC 20410-5000, When providing comments, please refer to OMB Approval No. 2577-0157. This information is collected under the authority of
Section 6(¢) of the U.S Housing Act of 1937 and HUD regulations. HAs are responsible for contract administration to ensure that the work for project development is done in
accordance with State laws and HUD requirements. The contractor/subcontractor reports provide details and summaries on payments, change orders, and schedule of materials stored
Tor the project The information wil be used to ensure that tha total development costs, identified in the ACC, are kept as low as possible and consistent with HUD construction
requirements, Responses to the collection are necessary to obtain a benefit. The information requested dass not lend itself to confidentiality.
Instructions: This form is for the Contractor to summarize the value of materials stored at the site (as shown on the schedule, form HUD-51003). Use a
separate line for the contractor and each of his/her subcontractors. Prepare an original and one copy, attach form HUD-51003, and send to the Public
Housing Agency with the Periodic Estimate for Partial Payment, form HUD-51001. Payment Value. No more ihan 90 percent of the estimated value of the
stored materials will be allowed, and only the net amount will be carried te line 13 on the back of the Periodic Estimate for Partial Payment, form HUD-51001.
Signatures. This form must be signed by those employees of the contractor and of the Public Housing Agency who prepare and check the Schedule of
Materials Stored, form HUD-51003.
Name of Public Housing Agency Supporting Periodic Estimate Period
for Partial Payment Number From (mmiddéyyyy) To (mmiddyyyy)
Location of Project Project Number
Name of General Contractor Contract Number
Name of General Contractor or Subcontractor Amounts
General Contractor $
Subcontractors $
: fFotal $
ce ;
' Less: 10% $
: Net $
Prepared by [Date (mmiddiyyyy) Checked by Date (mmiddlyyyy)
| certify that | or my authorized representatives have examined and checked in detail the invoices representing the cost of materials set forth
in appended "Schedule of Materials Stored", form HUD-51003, dated (mmédd/yyyy) __-
submitted by consisting of sheets with an indicated cost
of $ , and find that the net unit prices set forth in the schedule are the same or less than the invoices examined,
and that such materials were suitably stored at the site of the development as of (date)(mnvdd/yyyy)
Name of Owner By (Authorized Representative) Title Date
onviction may Test in chiminal and/or civil penalties. SC. SO. ,
form HUD-51004 (01/201)
2)
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