Fillable Form Hud-52850 - Annual Lead-Based Paint (Lbp) Activity Report printable pdf download

U.S. Department of Housing

Annual

OMB Approval No. 2577-0157 (Exp. 11/30/2008)

and Urban Development

Lead-Based Paint (LBP)

Office of Public and Indian Housing

Activity Report

Public reporting burden for this collection of information is estimated to average 1 hour 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.

This agency may not

conduct or sponsor, and a person is not required to respond to, a collection of information unless that collecton displays a valid OMB control number.

The Lead-Based Paint Poisoning Prevention Act, (42 U.S.C. 4821-4846) requires Housing Agencies to randomly sample their pre-1978 developments for

the presence of Lead-Based Paint. Congress directed HUD to establish an adequate management information system for measuring and reporting HAs

use of funds designated for lead paint testing and abatement. The information will be used by HUD to ensure statutory and regulatory compliance with

the Act, to respond to Congressional inquiries and to monitor HAs’ LBP activities. Responses to the collection of information are mandatory. The

information requested does not lend itself to confidentiality.

Name of Housing Authority

Housing Authority Code

(Enter data for up to ten seperate developments below - For additional developments, if needed, use the form on the back)

Reporting Period From (mm/dd/yyyy)

Development Code with Suffix

Total number of family units in Development

EBLs

(1)

Number of children identified with an EBL

(2)

Number of units with EBLs

(3)

Average number of days to perform testing

(4)

Number of times EBL resulted in abatement or relocation

Testing

(5)

Number of units actually tested

(6)

Number of tested units with LBP hazards

(7)

Total amount of all funds expended for testing

(8)

Total amount of MOD funds expended for testing

Abatement

(9)

Number of units planned to be abated

(10) Number of units actually abated

(11) Total amount of all funds expended for abatement

(12) Total amount of MOD funds expended for abatement

Development Code with Suffix

Total number of family units in Development

EBLs

(1)

Number of children identified with an EBL

(2)

Number of units with EBLs

(3)

Average number of days to perform testing

(4)

Number of times EBL resulted in abatement or relocation

Testing

(5)

Number of units actually tested

(6)

Number of tested units with LBP hazards

(7)

Total amount of all funds expended for testing

(8)

Total amount of MOD funds expended for testing

Abatement

(9)

Number of units planned to be abated

(10) Number of units actually abated

(11) Total amount of all funds expended for abatement

(12) Total amount of MOD funds expended for abatement

I hereby certify that all the information stated herein, as well as any information provided in the accompaniment herewith, is true and accurate.

Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)

Executive Director of PHA (Signature and Date)

form HUD-52850 (8/97)

Note: If the Housing Authority has performed any LBP activities and incurred any cost related to acquisition under the

ref. Handbook 7487.1

development program, provide the above information on a separate activity report form. Previous edition is obsolete