Form 10-168c HPCA Part 3

United States Department of the Interior
National Park Service

Historic Preservation Certification Application
Use this three-part application to apply for certifications required for Federal historic preservation tax
incentives. Department of the Interior regulations (36 CFR Part 67) take precedence in the event of any
inconsistency with this application. Approval of applications for Federal historic preservation tax
incentives is conveyed only in writing by duly authorized officials of the National Park Service (NPS)
acting on behalf of the Secretary of the Interior. Approval of a project by other Federal, State, and local
agencies and organizations does not ensure approval by the Secretary of the Interior for Federal tax
purposes.
Applicants are strongly encouraged to contact their State Historic Preservation Office (SHPO) early in the
project planning process, to submit applications describing proposed work, and to receive approval from
the NPS before beginning rehabilitation work. Owners who undertake rehabilitation projects without
prior approval from the National Park Service do so at their own risk. In the event of any discrepancy
between the application form and supplementary materials submitted with it (such as architectural plans,
drawings, and specifications), the application form takes precedence. Photographs and other materials
sent with the application become the property of NPS and may be reproduced by it without permission.
Department of the Treasury, Internal Revenue Service (IRS) regulations govern all financial and other tax
matters relating to the rehabilitation tax credits (Treasury Regulation Section 1.48-12) and the tax
deduction for easement donations (Treasury Regulation Section 1.170A-14). Approval of historic
preservation certification applications by NPS does not mean that applications meet these IRS
requirements.

Federal Tax Incentives for Historic Preservation


20% income tax credit for the “certified rehabilitation” of a “certified historic structure.”
A “certified historic structure” is a building that is listed individually in the National Register of
Historic Places; or located in a “registered historic district” and certified by the Secretary of the
Interior as contributing to the historic significance of the district. A “registered historic district” is a
district listed in the National Register or a state or local district certified by the Secretary of the
Interior.
A “certified rehabilitation” is a rehabilitation of a certified historic structure that the Secretary of the
Interior has certified to the Secretary of the Treasury as being consistent with the historic character of
the structure and, where applicable, with the district in which the structure is located.



10% income tax credit for rehabilitation for non-residential use of non-historic buildings built before
1936.



Income and estate tax deductions for an easement donation on a “certified historic structure.”

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Only depreciable properties can qualify for the tax credits. For the tax deductions for easement donations,
the property need not be depreciable.

Before Applying
Consult an accountant, tax attorney, other tax advisor, or the IRS to determine whether these incentives
apply to your own tax and financial situation.
Make sure the project meets the “substantial rehabilitation” test and other IRS requirements.
Contact your State Historic Preservation Office (SHPO) for information and technical assistance.
Visit the program website. It includes program regulations, frequently asked questions, Standards and
Guidelines, sample applications, and much more.

Application Process
When to Apply
Apply at any time during the year.
Apply before starting rehabilitation work whenever possible.
The application parts may be sent separately or together, but if they are sent separately, Part 1 must
precede Part 2.

How to Apply
Send two copies of the application and accompanying materials to the SHPO.

Review Process
The SHPO reviews the application and forwards it to NPS with a recommendation. State
recommendations are generally followed, but by law all certification decisions are made by NPS on
behalf of the Secretary of the Interior. The NPS decision may differ from the recommendation of the
SHPO. NPS notifies the applicant of the decision, and provides a copy of all decisions to the IRS and the
SHPO.

Review Times
The review time for a complete application is generally 30 days at the SHPO and 30 days at the NPS.

Part 1—Evaluation of Significance

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Use Part 1 to request certification that a building:


contributes to the significance of a registered historic district and is thus a “certified historic
structure” for purposes of the 20% rehabilitation tax credit or for easement donation purposes.



does not contribute to the significance of a historic district, for purposes of the 10% rehabilitation
tax credit for non-historic buildings.

Use Part 1 to request a preliminary determination:


of whether an individual building not yet listed in the National Register of Historic Places might
meet the National Register Criteria for Evaluation;



of whether a building in a potential historic district contributes to the significance of the district;



of whether a building outside the period or area of significance of a registered historic district
contributes to the significance of the district.

Part 1 is not needed if the property is a single building listed in the National Register of Historic Places,
since the property is already a “certified historic structure.”
However, for all other buildings, IRS regulations require an owner to request “certified historic structure”
designation for the building before the rehabilitation project is finished. If the building is located in a
registered historic district or is part of a National Register-listed property that has more than one building,
the owner must submit a Part 1 before the project is finished requesting that the building be designated a
“certified historic structure.” If the building is neither within a registered historic district nor individually
listed in the National Register, the owner must submit a Part 1 and begin the separate process of
requesting the SHPO to nominate the building or the district to the National Register.

Evaluating Part 1
Part 1 decisions are generally made on the appearance and condition of the property prior to
rehabilitation.
For buildings in historic districts, the information furnished with Part 1 applications must be sufficient:
(1) to document how the building relates to the district, and (2) to evaluate the historic character of the
building. Applicants should consult the National Register historic district nomination (on file at the SHPO
or at the local historical commission). Such requests will be reviewed for conformance with the Secretary
of the Interior’s Standards for Evaluating Significance within Registered Historic Districts.
Applications for preliminary determinations of individual listing will be evaluated using the National
Register Criteria found in 36 CFR Part 60. For buildings that are in potential historic districts or that are
outside the period or area of significance of a registered historic district, applications will be reviewed for
conformance with the Standards for Evaluating Significance within Registered Historic Districts.

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The Secretary of the Interior’s Standards for Evaluating Significance within Registered
Historic Districts.
1. A building contributing to the historic significance of a district is one which by location, design,
setting, materials, workmanship, feeling and association adds to the district's sense of time and place
and historical development.
2. A building not contributing to the historic significance of a district is one which does not add to the
district's sense of time and place and historical development; or one where the location, design,
setting, materials, workmanship, feeling and association have been so altered or have so deteriorated
that the overall integrity of the property has been irretrievably lost.
3. Ordinarily buildings that have been built within the past 50 years shall not be considered to
contribute to the significance of a district unless a strong justification concerning their historical or
architectural merit is given or the historical attributes of the district are considered to be less than 50
years old.

Completing Part 1 Form
First page of form: This page must be identical to the official form and must bear the owner’s original
signature. Other sections may be expanded as needed or continued on blank paper.
Description of Physical Appearance. Describe the major features of the building on both the exterior
and the interior. Describe the building in its present condition (before rehabilitation), not as it was when
first built nor as it will be after rehabilitation. Note the architectural style, exterior construction materials
(wood, brick, etc.), type of roof (flat, gable, hipped, etc.), number of stories, basic plan (rectangular,
irregular, L-shaped, etc.), and distinguishing architectural features (placement and type of windows,
chimneys, porches, decorative interior features or spaces). Describe changes made to the building since its
construction—for example, additions, porch enclosures, new storefronts, relocation of doors and
windows—and interior alterations. Describe other buildings on the property such as carriage houses,
barns, and sheds. (See "Special Considerations: Multiple Buildings".) Discuss how the building relates to
others in the district or neighborhood in terms of siting, scale, material, construction, and date.
Provide the construction date and date(s) of alterations. Give the source of the date. Check the appropriate
box if the building has been moved.
EXAMPLE - Building within a registered historic district: This three-story, flat-roofed, unpainted brick
building, rectangular in shape, was constructed in 1850. It features regularly-spaced arched windows on
the second and third floors (6 openings on the east elevation have been filled in over the years, exact date
unknown), 2-over-2 double-hung sash, and a prominent bracketed cornice. The first floor of the facade
has been altered: the existing storefront dates from ca. 1980. On the interior, the first floor is divided into
two principal spaces—a large commercial space in front and a smaller office behind. The front room was
greatly altered in the 1980's and contains no surviving historic fabric except for a simple wooden staircase
running along the party wall. A pressed metal ceiling is the most prominent feature in the rear office;
baseboards, paneled doors, and window and door surrounds also survive in this room. The upper floors
have two rooms each, identical in configuration to the first floor; these rooms retain their original
appearance, although they contain no architectural detailing of any kind (see photographs).
Statement of significance. Summarize how the building contributes to the significance of the district.
This summary should relate to the significance of the district (including the district's period of

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significance) as identified in the National Register nomination or district documentation. This statement
of significance should also relate to the Secretary of the Interior's Standards for Evaluating Significance
within Registered Historic Districts. Is it similar to other buildings in the district in scale, building
materials, style, and period of construction? Note important figures from the past associated with the
building, any former uses, and the name of the architect or builder, if known.
EXAMPLE - Building within a registered historic district: The district is an intact grouping of
architecturally significant commercial and industrial buildings constructed between 1850 and 1915 that
display a variety of styles and types of architectural ornamentation popular during this era. The district is
also significant as an early manufacturing and distribution center, which led to the city's growth as one of
the largest cities in the state. Industrial growth in the late 19th and early 20th centuries required the
construction of larger buildings and several still exist within the boundaries of the district (see
photographs). This modest three-story building is typical in appearance and history of the majority of the
buildings in the district. It was originally built for manufacturing buttons, but was converted into a store
with offices above during the 1880's when wholesaling grew as an important new activity in the district.
The building is similar to its neighbors in size, scale, materials, and style.

Send with the Part 1 Form
Photographs and photo key. Send photographs of the property as it appears before rehabilitation.
Include the building’s site and environment, all of the building’s sides, all major interior spaces and
features, and representative secondary spaces and features. Photographs must be numbered, dated, and
labeled with the property name, the view and a brief description of what is shown. Include a photo key
plan—that is, a floor plan and, if applicable, a site plan showing numbered photographs and arrows
showing the view.
Map. Send a map of the historic district, with the building location highlighted. If the application
describes a property with more than one building, the map must show each structure.

Special Considerations – Part 1
Certain situations may require applicants to do additional research or provide additional information.
More information is available on the website on each of these, and applicants should consult this
additional guidance on these topics.
Certifications of non-significance. A certification of non-significance is a determination that a building
does not contribute to the significance of a district. This certification is needed when a building is located
in a historic district and the owner wishes to claim the 10% tax credit for rehabilitation of non-historic
buildings. The application must demonstrate that the building lacks or has lost the characteristics that
contributing buildings in the district possess. The application must show how the building compares to
others in the neighborhood and the district. The documentation must address changes since the building’s
construction. Good photographs are essential; historic photographs should also be provided if possible.
When certification of non-significance is requested for deteriorated or damaged buildings, it may be
necessary to submit a structural engineer's report and additional information to document the deterioration
or structural damage.
Moved buildings. Moving a building into or within a historic district can jeopardize its ability to
contribute to the significance of the district. For a building that has been moved or will be moved, the Part
1 must document: 1) the effect of the move on the building's appearance (any proposed demolition,

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proposed changes in foundations, etc.); 2) the setting and environment of the proposed site; 3) the effect
of the move on the historic and visual character of the district; 4) the method for moving the building. The
application must also include photographs of the previous and proposed environments, including sites,
adjacent buildings, and streetscapes. For buildings individually listed in the National Register, the
procedures in 36 CFR Part 60 must be followed before the move, or the buildings will be removed from
the National Register, will not be considered certified historic structures, and will have to be renominated
for listing.
Properties less than 50 years old. Properties less than 50 years old are generally considered not to
contribute to the significance of a district and are ordinarily excluded from individual listing in the
National Register. Standard 3 of the Secretary of the Interior's Standards for Evaluating Significance
within Registered Historic Districts requires that to be certified as contributing to the district, such
properties must have exceptional historic or architectural merit or the district must encompass significant
qualities and characteristics that are less than 50 years old. Documentation for these properties must
explain how the property meets the requirements. (For information on the individual listing of properties
less than 50 years old, refer to National Register Bulletin No.22, How to Evaluate and Nominate Potential
National Register Properties That Have Achieved Significance within the Last 50 Years.)
Multiple buildings. Some historic properties have more than one building. In these cases, Part 1 must
describe all the buildings on the property, even those that will not undergo rehabilitation. This
requirement applies to properties listed individually in the National Register and to properties in historic
districts. The Part 1 must describe each building and its significance, and state whether it is a candidate
for certification of significance or non-significance. The application must contain photographs of each
building and a sketch map or site plan of the entire property. If the buildings were functionally related
historically, the decisions regarding the certification of the rehabilitation will be based on the
rehabilitation of the entire property, and not on each individual component.
Preliminary Determinations. Applications for preliminary determinations must contain substantially the
same level of documentation as National Register nominations, as specified in 36 CFR Part 60 and NPS
instructions for completing National Register nominations. An application for a preliminary determination
for individual listing must show how the building meets the National Register Criteria for Evaluation. An
application for a building in a potential historic district must describe the district and document how the
district meets the criteria and how the building contributes to the significance of that district. An
application for a preliminary determination for a building in a registered historic district that is outside the
period or area of significance of the district must justify the expanded significance of the district and how
the building contributes to the significance of the district. Preliminary determinations are not binding
upon the NPS, and become final only when the building or district is listed in the National Register, or for
buildings outside the period or area of significance of a registered historic district, when the district
documentation is formally amended.

Part 2—Description of Rehabilitation
Part 2 describes rehabilitation work to be undertaken on the building, and must be completed by all
applicants seeking the Federal income tax credit for the rehabilitation of historic buildings. Applicants are
strongly encouraged to submit applications describing proposed work and to receive approval from the
NPS prior to the start of work. Owners who undertake rehabilitation projects without prior approval from
the National Park Service do so at their own risk.

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Evaluating Part 2
Proposed work will be evaluated using 36 CFR 67.7 and the Secretary of the Interior’s Standards for
Rehabilitation. Conformance with the Standards will be made on the basis of the application
documentation and other available information by evaluating the property as it existed prior to the start of
the rehabilitation work, regardless of when the property becomes or became a certified historic structure.
The Standards apply to both interior and exterior work, and the NPS reviews the entire rehabilitation
project, including any attached, adjacent or related new construction. The Standards are applied in a
reasonable manner, taking into consideration economic and technical feasibility, and certification is based
on whether the overall project meets the Standards. To be certified, a rehabilitation project must be
determined to be consistent with the historic character of the building and, where applicable, the district in
which it is located.
The Secretary's Standards for Rehabilitation take precedence over other regulations and codes in
determining whether the rehabilitation project is consistent with the historic character of the property and,
where applicable, the district in which it is located.

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The Secretary of the Interior's Standards for Rehabilitation
The following Standards, codified in 36 CFR 67.7, are applied in a reasonable manner,
taking into consideration economic and technical feasibility:
1. A property shall be used for its historic purpose or be placed in a new use that requires
minimal change to the defining characteristics of the building and its site and environment.
2. The historic character of a property shall be retained and preserved. The removal of historic
materials or alteration of features and spaces that characterize a property shall be avoided.
3. Each property shall be recognized as a physical record of its time, place, and use. Changes that
create a false sense of historical development, such as adding conjectural features or
architectural elements from other buildings, shall not be undertaken.
4. Most properties change over time; those changes that have acquired historic significance in
their own right shall be retained and preserved.
5. Distinctive features, finishes, and construction techniques or examples of craftsmanship that
characterize a historic property shall be preserved.
6. Deteriorated historic features shall be repaired rather than replaced. Where the severity of
deterioration requires replacement of a distinctive feature, the new feature shall match the old
in design, color, texture, and other visual qualities and, where possible, materials.
Replacement of missing features shall be substantiated by documentary, physical, or pictorial
evidence.
7. Chemical or physical treatments, such as sandblasting, that cause damage to historic materials
shall not be used. The surface cleaning of structures, if appropriate, shall be undertaken using
the gentlest means possible.
8. Significant archeological resources affected by a project shall be protected and preserved. If
such resources must be disturbed, mitigation measures shall be undertaken.
9. New additions, exterior alterations, or related new construction shall not destroy historic
materials that characterize the property. The new work shall be differentiated from the old and
shall be compatible with the massing, size, scale, and architectural features to protect the
historic integrity of the property and its environment.
10. New additions and adjacent or related new construction shall be undertaken in such a manner
that if removed in the future, the essential form and integrity of the historic property and its
environment would be unimpaired.

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Completing the Part 2 Form
First page of form. This page must be identical to the official form and must bear the owner’s original
signature. Other sections may be expanded as needed or continued on blank paper.
Detailed Description of Rehabilitation Work. Include information relevant to the application of 36
CFR 67.7 and the Secretary of the Interior’s Standards for Rehabilitation, which the NPS uses to evaluate
the proposed work. Describe all work that will be undertaken on the property, not simply work for which
the tax credit will be sought. Describe each feature and the work that will be done on it. Begin with site
work, followed by the exterior, including new construction, and then the interior. Give the photograph or
drawing numbers that show the feature, and the marked photographs or drawing numbers showing the
proposed work, or the specification page numbers describing the work. For phased projects: In the Part 2,
outline the work to be done in each phase; fully describe all work in those phases for which detailed
information is available. Submit Amendments providing full details for work in later phases as they
become available.
Examples

Number 1

Feature

Facade brick

Date of feature

ca. 1880

Describe existing feature and its condition

Hard pressed red brick with butter joints in good condition. Mortar mostly sound, but deteriorated and missing
around downspout at east end of facade. Some graffiti at first floor

Photo numbers

3, 6

Drawing numbers

_____________

Describe work and impact on feature

Will selectively hand clean deteriorated joints and repoint with mortar and joint width to match existing (see spec.
pp. 33-35); chemically clean graffiti from first floor piers (see spec. pp. 30-31).

Number 2

Feature

Main staircase

Date of feature

ca. 1880

Describe existing feature and its condition

Original stair exists between 1st and 3rd floors. Some balusters missing and treads worn. Later stair from 3rd to 8th
floors.
Photo numbers

9, 10

Drawing numbers

A-12

Describe work and impact on feature

Replace missing balusters with matching pieces. Sand and varnish banisters and balusters. Replace treads as needed.
Sand and paint stairs. Retain later stair as is.

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Send with the Part 2 Form
Photographs and photo key. Send photographs showing the interior and the exterior before
rehabilitation. Include the building’s site and environment, all of the building’s sides, all major interior
spaces and features, and representative secondary spaces and features, including areas where no work is
proposed. Photographs should be numbered, dated, and labeled with the property name, the view and a
brief description of what is shown. Include a photo key plan—that is, a floor plan and, if applicable, a site
plan showing numbered photographs and arrows showing the view.
Architectural drawings or sketches showing the existing conditions and the proposed rehabilitation
work and any new additions or new construction. Include floor plans and, where necessary, sections and
elevations. Drawings must be of sufficient size that all dimensions and notes are clearly legible. For small
projects, sketches may suffice. Drawings must be numbered and keyed to the application narrative.

Special Rehabilitation Concerns
Several treatments can be especially problematic. The Guidelines for Rehabilitating Historic Buildings
accompanying the Secretary of the Interior's Standards for Rehabilitation provide further guidance on
these and other treatments. Owners should take care to address these concerns when undertaking work in
any of these areas.
Storefront alterations. Justify changes to storefronts and provide photographs of the areas to be altered.
Document the date of construction of the existing storefront and its condition. If a historical treatment is
planned, provide the evidence on which the proposed new storefront designs are based. Owners are
strongly discouraged from introducing a storefront or new design element that alters the character of the
structure and its relationship with the street or that causes destruction of significant historic material.
New heating, ventilating, and air-conditioning (HVAC) systems. Indicate what effect the new equipment
and ductwork will have on the historic building. New systems should not run across windows or introduce
an “unfinished” character to finished interior spaces. Installation of systems that cause damage to the
historic building material or visual loss of character may result in denial of certification.
New windows. If replacement is proposed, indicate the condition of existing windows (sash, glazing,
muntins, etc.) and the reasons for replacement. Photographs and window surveys must be provided as
evidence of severe deterioration; provide data on the cost of repairing existing windows versus installing
replacements. Owners are strongly encouraged to retain and repair historic windows. Tinted glass often
causes a change in character and may result in denial of certification. Where replacement of existing
windows appears justified by supporting documentation and where the windows are an integral part of the
building's design and character, replacement sash should match the original in size, pane configuration,
color, trim details, and planar and reflective qualities, and, in most cases, materials. Scaled drawings
comparing the existing windows with the replacement windows should be provided.
Interior partitions, trim, and finishes. Document existing condition of the interior. Indicate both historic
and non-historic walls. Show walls to be removed or altered. Note whether trim and wall and ceiling
finishes will be affected. Owners are strongly discouraged from changing historic floor plans
unnecessarily and from exposing masonry surfaces unless this condition is supported by historical
evidence.

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Exterior masonry cleaning. Owners are strongly encouraged to clean masonry only when necessary to
halt deterioration or to remove graffiti and stains. Indicate the condition of each material to be cleaned.
Specify what the cleaning is intended to accomplish (soot removal, paint removal, etc.) and what process
is to be used. When chemical systems are to be employed, specify the product to be used, and provide
specifications for the product application. For instance, information for cleaning involving chemical
processes should include products to be used and water pressure in pounds per square inch (psi). Provide
material to show that method selected will not harm the masonry. Summarize results of test patches, and
include close-up color photographs of masonry surfaces before and after cleaning as evidence.
Exterior masonry repair. Indicate deteriorated areas and describe repair method proposed. Provide
evidence that repointing mortar will match the historic in composition (i.e., ratio of lime, cement, sand
and any additives), color, texture, and tooling. Owners are encouraged to repoint only those portions of
the masonry that require repair.
New additions and new construction. New additions may substantially alter the appearance and form of
historic structures, and may cause denial of certification. Similarly, new construction, including site work,
may affect the relationship of a structure to its site, change the historic landscape, or otherwise damage
the historic character of the property. Owners are strongly encouraged to obtain NPS approval before
undertaking projects involving new additions or new construction.

Amendments
Use an Amendment Sheet to amend an application submitted previously (Part 1, 2, or 3), or to request an
advisory determination as to whether a completed phase of a phased rehabilitation project meets the
Secretary of the Interior's Standards for Rehabilitation.

Completing the Amendment Form
First page of form. Page 1 of the form must be identical to the official form and must bear the owner's
original signature.
To amend a previously submitted application: In the space provided, briefly describe—or list—changes to
the original application. Describe in detail in attachments if necessary.
To request a determination on a completed phase of a phased project: In the space provided, list work
items completed in the phase, and give the phase completion date. Continue in attachments if necessary.
Note: IRS rules require phasing plans to be set forth before a project begins. See the IRS regulations for
information on meeting this requirement.

Part 3—Request for Certification of Completed Work
Use the Part 3 form to request approval of an entire completed rehabilitation work. For a completed
phase of a project, use an Amendment Sheet. The completed project may be inspected by an authorized
representative of the Secretary of the Interior to determine if the work meets the “Standards for
Rehabilitation.”

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Completing Part 3
First page of form. Page 1 of the form must be identical to the official form and must bear the owner's
original signature.
On page 2, list all additional owners with their addresses and Social Security or Taxpayer ID Numbers;
continue on additional sheets as necessary.

Send with the Part 3 Form
Send photographs taken after completion of the rehabilitation work showing the same views as in the Part
2. Photographs should be numbered, dated, and labeled. Include a photo key plan featuring numbered
photographs and arrows showing the view.

Review Fees
NPS charges a fee for reviewing Part 2 and Part 3 applications according to the fee schedule published on
the program website. Do not send payment until requested to do so by NPS. Review of Part 2 and Part 3
applications does not start until payment has been received.

For More Information
See the program website: www.nps.gov/history/hps/tps/tax/ for more information on the historic
preservation tax incentives, including:


Program regulations (National Park Service/Department of the Interior regulations 36 CFR Part
67; Internal Revenue Service/ Department of the Treasury regulations 26 CFR Parts 1 and 602).



The Secretary of the Interior's Standards for Rehabilitation and accompanying Guidelines.



Advice and technical information on a variety of rehabilitation issues.



The IRS Connection, including IRS requirements and frequently asked questions about the
financial side of the tax incentives.



An on-line database for application status checks.

For printed copies of many of these materials, contact the SHPO or the NPS.
Contact your SHPO for information regarding state incentives for historic preservation.

Contact Us

National Park Service
www.nps.gov/history/hps/tps/tax/
e-mail: [email protected]
202-513-7270

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State Historic Preservation Offices
www.ncshpo.org/

Recordkeeping Requirements
Acting on behalf of the Secretary of the Interior, the National Park Service provides the Internal Revenue
Service with copies of all decisions regarding this application for Federal income tax incentives for
Historic Preservation. Applicants are therefore advised to keep all records relating to the application in
accordance with the time periods established by the IRS.

Privacy Act And Paperwork Reduction Act Notice
The information requested in this application is being collected through the State Historic Preservation
Offices to enable the Secretary of the Interior to evaluate the historic significance of structures located in
historic districts, and to evaluate the rehabilitation of such structures. The primary use of this information
by the Secretary of the Interior will be to certify to the Secretary of the Treasury that the applicant is
eligible for Federal tax incentives, or that the applicant is not eligible for such incentives. Response to this
request is required to obtain a benefit. This application is used by the Internal Revenue Service to confirm
that applicants for the tax incentives have obtained the certifications concerning historic structures and
rehabilitations required by law. Collection of owners’ Social Security Numbers (SSNs) or Taxpayers
Identification Numbers (TINs) is authorized by Internal Revenue Code section 6109. SSNs/TINs are
protected and are not disclosed by NPS to any other parties other than to the Internal Revenue Service, or
to the U.S. Department of Justice in the case of an investigation. Other information collected is subject to
disclosure.
Public reporting burden for this form—including the time for reviewing instructions, gathering and
maintaining data, and completing and reviewing the form—is estimated to average 27 hours per response
for Part 1; 51 hours per response for Part 2; 17 hours for an Amendment/Phase Advisory, and 14 hours
per response for Part 3. (Time estimates for completing the forms are based on the average rehabilitation
project—one with rehabilitation expenses of approximately $4 million. Over half of all projects are for
rehabilitations costing less than $1 million, and applications for these properties can reasonably be
expected to take less time.) Comments regarding this burden estimate or any aspect of this form may be
made to the Chief, Technical Preservation Services, National Park Service, 1201 “Eye” St., NW,
Washington, D.C. 20005. A Federal agency may not conduct or sponsor, and a person is not required to
respond to a collection of information unless it displays a currently valid OMB control number. OMB
has approved this application and has assigned it control number 1024-0009.

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