HUD-52860-G Retention Part 200 Addendum

Retention Part 200 Addendum HUD-52860-G

U.S. Department of Housing and Urban Development Office of Public and Indian Housing

OMB Approval No. 2577-0075 (exp. 08/31/2023)

Public reporting burden for this collection of information is estimated to average 2 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.  Comments regarding the accuracy of this burden estimate and any suggestions 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. 2577-0075. HUD may not conduct or sponsor, and an applicant is not required to respond to a collection of information unless it displays a currently valid OMB control number. Do not send this form to the above address. Responses to the collection are necessary for HUD to review applications for removals of public housing property under 2 CFR 200.311 (PIH Notice 2016-20 or subsequent notice); and eminent domain (PIH Notice 2012-8, or subsequent notice). HUD will use this information to review Public Housing Authority (PHA) requests, as well as to track removals for other record keeping requirements. Please refer to the instructions for guidance on completing this form. There is no personal information contained in this application. Information on activities and expenditures of grant funds is public information and is generally available for disclosure. Recipients are responsible for ensuring confidentiality when disclosure is not required.

Note: This form requests general information only and PHAs are required to submit an additional addendum for the specific type of proposed removal. This form in addition to the applicable addendum are collectively known as the SAC application since these applications are processed by HUD’s Special Applications Center (SAC). PHAs are required to submit this information through the Inventory Removals Submodule of the Inventory Management System/PIH Information Center (IMS/PIC) system (or a later electronic system prescribed by HUD).

Section 1. Why Property Is No Longer Needed for Public Housing.

Attach a statement describing why the public housing real property is no longer needed for public housing purposes. See PIH Notice 2016-20 (or any successor notice) and 2 CFR 200.311(c)(1).

Section 2. Estimate of HUD’s Percentage of Participation

Estimate of HUD’s percentage of participation in the cost of the original purchase (plus costs of any improvements, include subsequent modernization)	$
Attach explanation of how amount was determined, in accordance with the formula outlined in PIH Notice 2016-20 (or any successor notice) and 2 CFR 200.311(c)(1).

Section 3. Intent to Compensate HUD or Request an Exception to Compensation

1. Is the PHA planning on compensating HUD for HUD’s percentage of participation?	Yes No
2. Is the PHA requesting that HUD grant an exception to the compensation requirement?	Yes No
If the PHA is requesting that HUD grant an exception to the compensation requirement, attach a statement of the proposed future use that justifies an exception in accordance with PIH Notice 2016-20 (or successor notice).

PHA Certification for Retention Part 200 Application
I/We, the undersigned, certify under penalty of perjury that the information provided above is true and correct. WARNING: Anyone who knowingly submits a false claim or makes a false statement is subject to criminal and/or civil penalties, including confinement for up to 5 years, fines, and civil and administrative penalties. (18 U.S.C. §§ 287, 1001, 1010, 1012, 1014; 31 U.S.C. §3729, 3802).
Name of Authorized Official
Title
Signature
Date

Instructions: - Form HUD-52860-G

This information is required as a supplement to the form HUD-52860 for all SAC applications that involve requests from PHAs to retain certain Public Housing Property free from HUD’s interest in the property under the Annual Contribution Contracts (ACC) and Declarations of Trust (DOT) in accordance with 2 CFR 200.311(c)(1) and PIH Notice 2016-20 (or any successor or substitute notice or other guidance that HUD may issue). All capitalized terms in this form shall have the meaning of the terms in that notice.

This information is required when PHAs propose to retain public housing property free from ACC and DOT restrictions. HUD will use this information to determine whether to permit retention, as well as to track removals for other record keeping requirements. Responses to this collection of information are regulatorily required to obtain a benefit. The information requested does not lend itself to confidentiality. PHAs are required to submit this information electronically to HUD through this Inventory Removals Submodule of the IMS/PIC system (or a later electronic system prescribed by HUD).

This form supplements the HUD-52860 and is required when PHAs propose removal actions of public real housing property in the form of retentions in accordance with PIH Notice 2016-20. PHAs must complete this form and upload it as (along with the required supporting documentation) as part of their SAC applications submitting electronically through IMS/PIC (or a replacement system). PHAs should refer PIH Notice 2016-20 for additional guidance on completing this form.

Section 1: Why Property Is No Longer Needed for Public Housing.

See PIH Notice 2016-20 (or any successor notice) and 2 CFR 200.311(c)(1).

Section 2. Estimate of HUD’s Percentage of Participation

See PIH Notice 2016-20 (or any successor notice) and 2 CFR 200.311(c)(1).

Section 3. Intent to Compensate HUD or Request an Exception to Compensation

See PIH Notice 2016-20(or any successor notice) and 2 CFR 200.311(c)(1).

Provide attachments as needed.

All attachments must reference the Page 1 of 2 form HUD-52860-G (04/2018)

Section and line number to which they apply.