Historic Preservation Certifications, 36 CFR Part 67

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 10-168 HPCA Part 1 - Evaluation of Significance (Individuals)	Form and Instruction	Modified	Available
Form 10-168c HPCA - Part 3 (private sector employing consultants)	Form and Instruction	Removed	Available
Form 10-168c HPCA - Part 3 (individuals employing consultants)	Form and Instruction	Removed	Available
Form 10-168b HPCA - Amendments (private sector employing consultants)	Form and Instruction	Removed	Available
Form 10-168b HPCA - Amendments (Individuals employing consultants)	Form and Instruction	Removed	Available
Form 10-168a HPCA - Part 2 (private sector employing individuals)	Form and Instruction	Removed	Repair queued
Form 10-168a HPCA - Part 2 (Individuals employing consultants)	Form and Instruction	Removed	Available
Form 10-168 Historic Preservation Certification Application - Part I (private sector employing consultants)	Form and Instruction	Removed	Available
Form 10-168 Historic Preservation Certification Application - Part I (Individuals employing consultants)	Form and Instruction	Removed	Repair queued
Form 10-168e HPCA SHPO Review & Recommendation Sheet Rehabilitation - Amendments	Form	Modified	Available
Form 10-168e HPCA SHPO Review & Recommendation Sheet Rehabilitation Part 3	Form	Modified	Available
Form 10-168e HPCA SHPO Review & Recommendation Sheet Rehabilitation Part 2	Form	Modified	Available
Form 10-168d HPCA SHPO Review and Recommendation Sheet - Significance/Part 1	Form	Modified	Available
Form 10-168c HPCA Part 3 - Request for Certification of Completed Work (Private Sector)	Form and Instruction	Modified	Available
Form 10-168b HPCA Amendment / Advisory Determination (Private Sector)	Form and Instruction	Modified	Available
Form 10-168a HPCA Part 2 - Description of Rehabilitation (Private Sector)	Form and Instruction	Modified	Available
Form 10-168c HPCA Part 3 - Request for Certification of Completed Work (Individuals)	Form and Instruction	Modified	Available
Form 10-168b HPCA Amendment / Advisory Determination (Individuals)	Form and Instruction	Modified	Available
Form 10-168a HPCA Part 2 - Description of Rehabilitation (Individuals)	Form and Instruction	Modified	Available
Form 10-168 HPCA Part 1 - Evaluation of Significance (Private Sector)	Form and Instruction	Modified	Available
1024-0009 30-day FRN Published 07262016 81143 48842 2016-17701.pdf	Supplementary Document	Uploaded 2016-07-26	Available
1024-0009 SSA Final 07202016.docx	Supporting Statement A	Uploaded 2016-07-20	Available
HPCA 60-day FRN 01132016 81008 1640 2016-00500.pdf	Supplementary Document	Uploaded 2016-04-14	Available
36CFR67.pdf	Supplementary Document	Uploaded 2013-03-06	Available
information collection.1024-0009.IRC sec170.pdf	Supplementary Document	Uploaded 2009-09-10	Available
information collection.1024-0009.IRC sec47.pdf	Supplementary Document	Uploaded 2009-06-23	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43757	HPCA Part 1 - Evaluation of Significance (Individuals)	Form and Instruction	Modified
206167	Certification of Historic Districts		Modified
206166	Certification of Statutes		Modified
206165	HPCA - Part 3 (private sector employing consultants)	Form and Instruction	Removed
206164	HPCA - Part 3 (individuals employing consultants)	Form and Instruction	Removed
206163	Appeals (private sector employing consultants)		Removed
206162	HPCA - Amendments (private sector employing consultants)	Form and Instruction	Removed
206161	HPCA - Amendments (Individuals employing consultants)	Form and Instruction	Removed
206157	HPCA - Part 2 (private sector employing individuals)	Form and Instruction	Removed
206156	HPCA - Part 2 (Individuals employing consultants)	Form and Instruction	Removed
206153	Historic Preservation Certification Application - Part I (private sector employing consultants)	Form and Instruction	Removed
206151	Historic Preservation Certification Application - Part I (Individuals employing consultants)	Form and Instruction	Removed
206061	Appeals (Private Sector)		Modified
206060	Appeals (individuals)		Modified
206059	HPCA SHPO Review & Recommendation Sheet Rehabilitation - Amendments	Form	Modified
206058	HPCA SHPO Review & Recommendation Sheet Rehabilitation Part 3	Form	Modified
206057	HPCA SHPO Review & Recommendation Sheet Rehabilitation Part 2	Form	Modified
206056	HPCA SHPO Review and Recommendation Sheet - Significance/Part 1	Form	Modified
190590	HPCA Part 3 - Request for Certification of Completed Work (Private Sector)	Form and Instruction	Modified
190589	HPCA Amendment / Advisory Determination (Private Sector)	Form and Instruction	Modified
190588	HPCA Part 2 - Description of Rehabilitation (Private Sector)	Form and Instruction	Modified
190587	HPCA Part 3 - Request for Certification of Completed Work (Individuals)	Form and Instruction	Modified
190586	HPCA Amendment / Advisory Determination (Individuals)	Form and Instruction	Modified
190584	HPCA Part 2 - Description of Rehabilitation (Individuals)	Form and Instruction	Modified
190549	HPCA Part 1 - Evaluation of Significance (Private Sector)	Form and Instruction	Modified

ICR Details

OMB Control No: 1024-0009	ICR Reference No: 201604-1024-001
Status: Historical Active	Previous ICR Reference No: 201502-1024-001
Agency/Subagency: DOI/NPS	Agency Tracking No:
Title: Historic Preservation Certifications, 36 CFR Part 67
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/05/2017
	Date Received in OIRA: 07/26/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2020	36 Months From Approved	01/31/2017
Responses	11,150	0	9,848
Time Burden (Hours)	169,451	0	82,418
Cost Burden (Dollars)	3,973,359	0	11,497,474

---

Abstract: Sections 47 and 170(h) of the Internal Revenue Code require the Secretary of the Interior to certify to the Secretary of the Treasury whether (1) properties are historic structures, and (2) rehabilitation work on such properties is consistent with their historic character. These certifications are necessary for applicants to receive a Federal income tax credit for rehabilitation (sec. 47), or an income tax deduction for charitable contributions for conservation purposes (sec. 170(h)).

---

Authorizing Statute(s): US Code: 26 USC 170 Name of Law: Qualified Conservation Contributions
   US Code: 26 USC 47 Name of Law: Qualified Rehabilitated Buildings
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 1640	01/13/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 48842	07/26/2016
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 16

table that charts list of burden

IC Title	Form No.	Form Name
Certification of Statutes
Certification of Historic Districts
HPCA SHPO Review and Recommendation Sheet - Significance/Part 1	10-168d	HPCA State Historic Preservation Office Review & Recommendation Sheet - Significance Part I
HPCA SHPO Review & Recommendation Sheet Rehabilitation Part 2	10-168e	HPCA SHPO Review & Recommendation Sheet Rehabilitation Part 2
HPCA SHPO Review & Recommendation Sheet Rehabilitation Part 3	10-168e	HPCA SHPO Review & Recommendation Sheet Rehabilitation Part 3
HPCA SHPO Review & Recommendation Sheet Rehabilitation - Amendments	10-168e	HPCA SHPO Review & Recommendation Sheet Rehabilitation - Amendments
Appeals (individuals)
Appeals (Private Sector)
HPCA - Part 2 (private sector employing individuals)	10-168a	HPCA Part 2
HPCA - Amendments (private sector employing consultants)	10-168b	HPCA Amendment
HPCA Part 1 - Evaluation of Significance (Individuals)	10-168	HPCA Part 1
HPCA Part 2 - Description of Rehabilitation (Individuals)	10-168a	HPCA Part 2 - Description of Rehabilitation
Historic Preservation Certification Application - Part I (Individuals employing consultants)	10-168	HPCA Part 1
Appeals (private sector employing consultants)
Historic Preservation Certification Application - Part I (private sector employing consultants)	10-168	HPCA Part 1
HPCA - Part 3 (individuals employing consultants)	10-168c	HPCA Part 3
HPCA - Part 2 (Individuals employing consultants)	10-168a	HPCA Part 2
HPCA - Part 3 (private sector employing consultants)	10-168c	HPCA Part 3
HPCA Part 2 - Description of Rehabilitation (Private Sector)	10-168a	HPCA Part 2 - Description of Rehabilitation
HPCA Amendment / Advisory Determination (Private Sector)	10-168b	HPCA Amendment / Advisory Determination
HPCA Amendment / Advisory Determination (Individuals)	10-168b	HPCA Amendment / Advisory Determination
HPCA Part 1 - Evaluation of Significance (Private Sector)	10-168	HCPA Part 1 - Evaluation of Significance
HPCA Part 3 - Request for Certification of Completed Work (Private Sector)	10-168c	HPCA Part 3 - Request for Certification of Completed Work
HPCA Part 3 - Request for Certification of Completed Work (Individuals)	10-168c	HPCA Part 3 - Request for Certification of Completed Work
HPCA - Amendments (Individuals employing consultants)	10-168b	HPCA Amendment

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	11,150	9,848	0	980	322	0
Annual Time Burden (Hours)	169,451	82,418	0	10,045	76,988	0
Annual Cost Burden (Dollars)	3,973,359	11,497,474	0	803,110	-8,327,225	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The total number of responses, 11,150, represents an increase of 1,302 responses from the 2013 submission of 9,848 responses. Application activity has increased year to year over this period. The new total number of responses is the result of using the projected number of applications for FY16, based on FY16 activity to date (an estimated 2% increase over FY15 actual responses for approved/certified applications), in order to obtain the most accurate estimate possible. In addition, the costs of paying a contractor to complete paperwork were previously reported as a non-burden hour cost. In November, 2015, OMB notified the NPS that we should discontinue counting the cost of paying a contractor to complete paperwork as a non-burden hour cost. Therefore, this submission was adjusted and the changes are categorized as adjustments to comply with OMB’s directive.

---

Annual Cost to Federal Government: $3,620,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 07/26/2016

---