Form HUD-52735 Indian Housing Plan

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

OMB Approval No. 2577-0218 (exp. 04/30/2008)

Indian Housing Plan

These forms meet the minimum requirements for an Indian Housing Plan (IHP) required
by the United States Department of Housing and Urban Development. In addition to
these minimum requirements, a tribe/ tribally designated housing entity (TDHE) may
elect to prepare a more comprehensive IHP. If a tribe/TDHE elects to prepare a more
comprehensive plan, the required elements of this IHP must still be submitted on the
prescribed HUD forms.

Page 1

form HUD-52735 (10/2002)

Indian Housing Plan
Under the Native American Housing Assistance and Self-Determination Act of 1996 (NAHASDA) (25 U.S.C. 4104 et seq.) HUD will provide grants, loan
guarantees, and technical assistance to Indian tribes and Alaskan Native villages for the development and operation of low-income housing in Indian
areas. Grants will be made to eligible recipients under the Indian Housing Block Grant Program. To be eligible for the grants, respondents must submit
an Indian Housing Plan which meets the minimum requirements of the Act, consult with residents, prepare Title VI application/certification, submit
performance reports, and maintain records for HUD monitoring and audit review.
Public reporting burden for this collection of information is estimated to average 120 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 will ensure that the information submitted complies with the requirements of the Act, approve/disapprove the IHP, and review and monitor the IHP.
Responses to this collection of information are mandatory to obtain a benefit. The information requested does not lend itself to confidentiality.
This agency may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB control number.

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form HUD-52735 (10/2002)

Please read the instructions on
back before completing this
cover sheet

Indian Housing Plan

Cover Sheet
1. Name and Address of Tribe (if only one tribe)

2. Name and Address of Tribal Contact Person (if only one tribe)

Telephone Number with Area Code (if only one tribe)

3. Name and Address of Tribally Designated Housing Entity (TDHE) (if applicable)

4. Name and Address of TDHE Contact Person

Telephone Number with Area Code

5. Type of Submission

8. Estimated Grant Amount

Original

6. Federal Fiscal Year 7. Grant Number

9. Actual Grant Amount

Amended

10.Enter the name and address of the tribe and the name, address, and telephone number of the tribal contact person for each tribe included in this IHP.
This information may be reported like this:
Name of Tribe

Address of Tribe

Tribal Contact Person

Address

Phone

11.Title of the Authorized Official submitting the IHP

Signature & Date:

X

For HUD
Use Only

Date IHP is received by HUD:

Time IHP is received by HUD:

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form HUD-52735 (10/2002)

Indian Housing Plan Cover Sheet Instructions
If the IHP is being submitted by a TDHE for more than one tribe,
leave lines 1 and 2 blank and provide this information in line 10.
1.
2.

Enter the name and address of the tribe for whom the IHP is
prepared.
Enter the name, telephone number, and address of the tribal
contact person. The tribal contact person is the person who is
best able to answer questions regarding the IHP. This information should be provided even if the IHP was prepared by a tribally
designated housing entity (TDHE).

3.

Complete the necessary information if the IHP is prepared by a
TDHE on behalf of a tribe(s).

4.

Enter the name, telephone number, and address of the TDHE
contact person. The TDHE contact person is the person who is
best able to answer questions regarding the IHP.

5.

Check to indicate if the IHP is an original submission or an
amended submission.

Page 4

6.

Enter the Federal fiscal year for which funding will be made
available for the IHP. For example, October 1, 1997 to September 30, 1998 is fiscal year 1998.

7.

Enter the HUD-assigned grant number.

8.

Enter the estimated grant amount expected to be received for the
1-year plan period.

9.

If the actual grant amount is not known at the time the IHP is
submitted, leave the actual grant amount line blank.

10. Enter the name of the tribe and the name, telephone number,
and address of the tribal contact person for each tribe included
in this IHP. The tribal contact person is the person who is best
able to answer questions regarding the IHP.
11. The cover sheet must be signed by an authorized official of the
tribe or TDHE submitting the plan.
For HUD use only: The date and time the plan is received by HUD will
be completed by Area Office of Native American Programs (ONAP) staff.

form HUD-52735 (10/2002)

Indian Housing Plan

Table of Contents
This Table of Contents is for use by tribes/TDHEs to identify the
location of the required elements of the Indian Housing Plan.
For each element listed, enter the page number where the
information can be found in the IHP.
PageNumber
Five Year Plan

One Year Plan

Mission Statement .............................................................................................................

__________

Goals and Objectives. .......................................................................................................

__________

Activities Plan ....................................................................................................................

__________

Goals and Objectives ........................................................................................................

__________

Statement of Needs ...........................................................................................................

__________

Table 1 - Statement of Needs ...........................................................................................

__________

Financial Resources .........................................................................................................

__________

Table 2 - Financial Resources ..........................................................................................

__________

Table 3 - Housing Profile ..................................................................................................

__________

Affordable Housing Resources including a description of:
The characteristics of the housing market. ................................................................

__________

The structure/coordination/cooperation with other entities ......................................

__________

The manner in which housing needs will be addressed ..........................................

__________

The manner in which 1937 Act housing will be protected/maintained ....................

__________

Existing/anticipated homeownership/rental programs .............................................

__________

Existing/anticipated housing rehabilitation programs ..............................................

__________

All other existing/anticipated housing assistance ....................................................

__________

Housing to be demolished or disposed of ................................................................

__________

Coordination with tribal and State welfare agencies ................................................

__________

The manner in which safety and resident involvement will be promoted ................

__________

Organizational capacity and key personnel that will carry out IHP activities ..........

__________

Performance Objectives ....................................................................................................

__________

Useful Life ..........................................................................................................................

__________

Model Activities ..................................................................................................................

__________

Tribal and Indian Preference ............................................................................................

__________

Percentage of Planning and Administration ....................................................................

__________

Minimal Funding ................................................................................................................

__________

Method of Payment ...........................................................................................................

__________

Environmental Review - Expression of Intent (Optional) .................................................

__________

Standard Certification of Compliance ...............................................................................

__________

Tribal Certification .............................................................................................................

__________

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form HUD-52735 (10/2002)

Five Year Indian Housing Plan
Respond to each of the elements requested in the 5-year plan section of the IHP. In addition to text, information may be presented in the form
of charts, tables, maps, etc.
The 5-Year Plan section of the Indian Housing Plan must contain, with respect to the 5-year period beginning with the fiscal year for which
the plan is submitted, the following information:
1. Mission Statement. A general statement of the mission of the
Indian tribe to serve the needs of the low-income families in the
jurisdiction of the Indian tribe (as defined in the regulation under
Indian Area) during the 5-year period.
2. Goals and Objectives. A statement of the goals and objectives of
the Indian tribe to enable the tribe to serve the needs identified in
the mission statement.

3. Activities Plan. An overview of the activities planned during the
period including an analysis of the manner in which the activities
will enable the tribe to meet its mission, goals, and objectives.

One Year Indian Housing Plan
Respond to each of the elements requested in the 1-year plan section of the IHP. In addition to text, information may be presented in the form
of charts, tables, maps, etc. If a particular section does not apply because the tribe/TDHE will not carry out a specified activity, enter NA.
The 1-Year Plan section of the Indian Housing Plan must contain information, relating to the upcoming fiscal year for which assistance
is to be made available, including the following:
1. Goals and Objectives. A statement of the goals and objectives
to be accomplished during the period that are measurable as
determined by the tribe/TDHE.
2. Statement of Needs. A statement of the housing needs of the
low-income Indian families residing in the jurisdiction of the
Indian tribe, and outside the jurisdiction where tribal needs
require consideration, and the means by which such needs will
be addressed during the 1-year period, including a description
of:
a. the estimated housing needs and the need for assistance for
the low-income Indian families in the jurisdiction, and outside the jurisdiction where tribal needs require consideration, including a description of the manner in which the
geographical distribution of assistance is consistent with the
geographical needs and needs for various categories of
housing assistance; and
b. the estimated housing needs for all Indian families in the
jurisdiction.
3. Financial Resources. An operating budget for the recipient
including:
a. an identification and a description of the financial resources
reasonably available to the recipient to carry out the purposes
of NAHASDA, including an explanation of the manner in which
amounts made available will leverage additional resources;
and
b. the uses to which such resources will be committed, including eligible and required affordable housing activities under
title II of NAHASDA and administrative expenses.
4. Affordable Housing Resources. A statement of the affordable
housing resources currently available and to be made available
during the period, including a description of:
a. the significant characteristics of the housing market in the
jurisdiction, including the availability of housing from other
public sources, private market housing, and the manner in
which such characteristics influence the decision of the recipient to use grant amounts to be provided under NAHASDA for
rental assistance, production of new units, acquisition of existing
units, or rehabilitation of units;
b. the structure, coordination, and means of cooperation between the recipient and any other governmental entities in the
development, submission, or implementation of housing plans,
including a description of the involvement of private, public,
and nonprofit organizations and institutions, and the use of loan
guarantees under section 184 of the Housing and Community
Development Act of 1992, and other housing assistance provided
by the Federal Government for Indian tribes, including loans,
grants, and mortgage insurance;
c. the manner in which the plan will address the needs identified
pursuant to the Statement of Needs Section in paragraph 2;

Page 6

d. the manner in which the recipient will protect and maintain the
viability of housing owned and operated by the recipient that
was developed under a contract between the Secretary and an
Indian housing authority pursuant to the United States Housing Act of 1937;
e. any existing and anticipated homeownership programs and
rental programs to be carried out during the period, and the
requirements and assistance available under such programs;
f. any existing and anticipated housing rehabilitation programs necessary to ensure the long-term viability of the
housing to be carried out during the period, and the requirements and assistance available under such programs;
g. all other existing or anticipated housing assistance provided
by the recipient during the period, including transitional
housing, homeless housing, college housing, supportive
services housing, and the requirements and assistance
available under such programs;
h. any housing to be demolished or disposed of, a timetable for
such demolition or disposition, and any other information
required by the Secretary with respect to such demolition or
disposition including a financial analysis regarding the
proposed demolition/disposition;
i. the manner in which the recipient will coordinate with tribal
and State welfare agencies to ensure that residents of such
housing will be provided with access to resources to assist
in obtaining employment and achieving self-sufficiency;
j. the requirements established by the recipient to promote the
safety of residents of such housing, facilitate the undertaking
of crime prevention measures, allow resident input and
involvement, including the establishment of resident organizations, and allow for the coordination of crime prevention
activities between the recipient and tribal and local law
enforcement officials; and
k. the entity that will carry out the activities under the plan,
including the organizational capacity and key personnel of the
entity.
5. Performance Objectives. In accordance with 24 CFR 1000.504,
performance objectives are to be developed by each recipient
and included in this 1-year plan. Performance objectives are
criteria by which the recipient will monitor and evaluate its
performance; provide quantitative measurements by which the
recipient will gauge its performance; and determine the impact
and benefit the grant beneficiary derives from the accomplishments obtained under the plan. For example, if in the IHP, the
recipient indicates it will build new houses, the performance
objective may be the completion of the homes within a certain
time period and within a certain budgeted amount, and measure
the numbers of tribal members and families served.

form HUD-52735 (10/2002)

Table 1

Statement of Needs
Name of Tribe:

Name of TDHE: (if applicable)

Grant Number:

Federal Fiscal Year:

Tribal/TDHE Program Year:

Indian Area:

Part I: Tribal Profile for Indian Area

All Indians in the Indian Area
All Income Levels
Low-Income
123456789012345
column b
column c
123456789012345

column a

123456789012345
123456789012345
123456789012345
123456789012345

1. Total Indian Population
2. Number of Indian Families
3. Number of Elderly Indian Families
4. Number of Near-Elderly Indian Families (optional)
5. Number of Indian Families Living in Substandard Housing
6. Number of Indian Families Living in Over-Crowded Conditions
Part II: Tribal Profile for Indian Area (Optional)

All Income Levels

Low-Income

Type of Housing

Existing Housing

column a

column b

Unmet Needs for
All Indian Families
column c

7.

Part III: Current Status and Future Needs

8. Rental
Housing

9. Homeowner
Housing

Unmet Needs for
Low-Income Indian Families
column d

a. Number of Units
b. Number of Units Needing Rehabilitation
a. Number of Units
b. Number of Units Needing Rehabilitation

10. Supportive Service Housing (# of units)
11. College Housing (# of units)
12. Transitional Housing (# of units)
13. Homeless Housing (# of beds)
Part IV: Other Current Status and Future Needs (Optional)
14.
Data Source:

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form HUD-52735 (10/2002)

Instructions: Table 1: Statement of Needs
Complete the table in accordance with the instructions below.
Table Heading
Enter the name of the tribe for whom the table is prepared and the
name of the tribally designated housing entity (TDHE) if the IHP
is prepared by a TDHE on behalf of the tribe. Enter the HUD
assigned tribal grant number for the Federal fiscal year for which
the table is prepared and the Federal fiscal year for which
assistance is to be made available. For example, October 1, 1997
to September 30, 1998 is Federal fiscal year 1998. Enter the
starting date of the tribal/TDHE designated program year (mm/dd/
yyyy).
Describe the Indian area which the data in the table represents.
The Indian area is the area within which an Indian tribe operates
affordable housing programs or the area in which a TDHE is
authorized by one or more Indian Tribes to operate affordable
housing programs.
Definitions:
The following definitions are to be used when
completing Table 1.
Low-income family: A low-income family is a family whose
income does not exceed 80 percent of the median income for the
area, as determined by the Secretary with adjustments for smaller
and larger families, except that the Secretary may establish
income ceilings higher or lower than 80 percent of the median for
the area on the basis of the findings of the Secretary or the agency
that such variations are necessary because of prevailing levels of
construction costs or unusually high or low family incomes.
Family: The term family includes, but is not limited to, a family
with or without children, an elderly family, a near-elderly family, a
disabled family, a single person, as determined by the Indian tribe.
Median income: The definition of median income, with respect
to an Indian area, is the greater of the median income for the
Indian area, which the Secretary shall determine; or the median
income for the United States.
Elderly family: The term elderly family means a family whose
head (or his or her spouse), or whose sole member, is an elderly
person (at least 62 years of age). Such terms include 2 or more
elderly persons living together, and 1 or more such persons living
with 1 or more persons determined under the Indian housing plan
for the agency to be essential to their care or well-being.
Near-elderly family: The term near-elderly family means a family
whose head (or his or her spouse), or whose sole member, is a
near-elderly person (at least 55 years of age and less than 62
years of age). Such terms include 2 or more near-elderly persons
living together, and 1 or more such persons living with 1 or more
persons determined under the Indian housing plan for the agency
to be essential to their care or well-being.
The following definitions may be adopted by the tribe/THDE or the
tribe/THDE may develop its own definitions.
Substandard housing: Substandard housing is a housing unit
that is dilapidated; does not have operable indoor plumbing; does
not have a usable flush toilet inside the unit for the exclusive use
of a family; does not have a usable bathtub or shower inside the
unit for the exclusive use of a family; does not have electricity, or
has inadequate or unsafe electrical service; does not have a safe
or adequate source of heat; should, but does not, have a kitchen;
or has been declared unfit for habitation by an agency or unit of
government.
Dilapidated housing: A dilapidated housing unit is a unit that
does not provide safe and adequate shelter, and in its present
condition endangers the health, safety, or well-being of a family;
or a unit that has one or more critical defects, or a combination of

Page 8

intermediate defects in sufficient number or extent to require
considerable repair or rebuilding. The defects may involve original construction, or they may result from continued neglect or lack
of repair or from serious damage to the structure.
Overcrowded conditions: Overcrowded means households
with more than 1.01 persons per room.
Units needing rehabilitation: Units in need of rehabilitation are
units which fail to meet the tribe’s/TDHE’s housing quality standards (HQS). The tribe’s/TDHE’s HQS must be at least as
stringent as those used for the Section 8 program (see 24 CFR
982.401) unless the Area ONAP approves less stringent standards based on a determination that local conditions make the use
of the Section 8 standards infeasible. Any less stringent standards
must still, however, provide:
1. that the house is safe, in a physically sound condition with
all systems performing their intended design functions;
2. a livable home environment;
3. an energy efficient building and systems which incorporate
energy conservation measures;
4. adequate space and privacy for all intended household
members.
Supportive service housing: Supportive service housing is
housing, including housing units and group quarters, that has a
supportive environment and includes a planned supportive service component. A planned supportive service component includes services provided to residents of supportive service housing for the purpose of facilitating the independence of residents.
Examples of services include case management, medical or
psychological counseling and supervision, child care, transportation, and job training.
College housing: College housing is housing, the primary
purpose of which is to provide housing for students who are
attending post high school educational facilities.
Transitional housing: Transitional housing is housing, the
purpose of which is to facilitate the movement of homeless
individuals and families to permanent housing within 24 months.
Homeless housing: Homeless housing is any facility, the primary purpose of which is to provide temporary or transitional
shelter for the homeless in general or for specific populations of
the homeless.
Part I: Tribal Profile for Indian Area
The information required in Part I relates to Indian persons and
families.
Column a: Person and Family Categories: This column lists
selected categories for data collection. Line 1 requests information in terms of persons and lines 2-6 requests information in
terms of families.
Columns b and c should include all Indians in the Indian area.
Column b: All Income Levels: Enter the requested information for
Indians at all income levels including low-income.
Column c: Low-Income: Enter the requested information for lowincome Indians. This column is a subset of column b and therefore, the numbers entered in this column should never be greater
than those entered in column b.
Line 1: Total Indian Population: Enter the total number of
Indian persons.

form HUD-52735 (10/2002)

Line 2: Number of Indian Families: Enter the total number of
Indian families.
Line 3: Number of Elderly Indian Families: Enter the total
number of elderly Indian families.
Line 4: Number of Near-Elderly Indian Families: Enter the
total number of near-elderly Indian families. This
information is optional.
Line 5: Number of Indian Families Living in Substandard
Housing: Enter the number of Indian families who are
currently living in substandard housing.
Line 6: Number of Indian Families Living in Over-Crowded
Conditions: Enter the number of Indian families who
are currently living in overcrowded housing.
Part II: Tribal Profile for Indian Area (Optional)
Part II is optional and allows tribes/TDHEs to provide information
pertaining to any category of persons or families that they believe
should be included in Table 1.
Column a: Person and Family Categories: Enter tribal/TDHE
selected categories of persons or families. A definition of each
category must be included as an attachment to this table.
Columns b and c: The instructions for these columns are the same
as Part I except columns a, b, and c can represent Indians and
non-Indians as determined by the categories selected.
Line 7: Enter the tribal/TDHE selected categories of persons
and/or families. For example, non-Indians to be served
under NAHASDA. (use as many lines as necessary
numbered 7a, 7b, 7c, etc. An attachment may be used
if needed.)
Part III: Current Status and Future Needs
The information required in Part III relates to Indian persons and
families.
Column a: Type of Housing: This column lists selected housing
categories.
Column b: Existing Housing: Enter the number of existing housing
units (or beds in the case of homeless housing) in the Indian area
for each housing category described on lines 8-13.
Column c: Unmet Needs for All Indian Families: Enter the number
of new housing units (or beds in the case of homeless housing)
needed for all Indian families for each housing category described
on lines 8-13.
Column d: Unmet Needs for Low-Income Indian Families: Enter
the number of new housing units (or beds in the case of homeless
housing) needed for low-income Indian families for each housing
category described on lines 8-13. This column is a subset of
column c. Therefore, the numbers entered in this column should
never be greater than those entered in column c.

Page 9

Line 8a: Rental Housing-Number of Units: Enter the number
of rental housing units including units that were
developed under the 1937 Housing Act or are privately owned (include tribal housing) that are occupied or vacant. However, do not include supportive
service housing, college housing, transitional housing, or homeless housing. These categories of
housing are listed on lines 10-13.
Line 8b: Rental Housing-Number of Units Needing Rehabilitation: Enter the number of rental housing units
(from those entered in line 8a) that are in need of
rehabilitation.
Line 9a: Homeowner Housing-Number of Units: Enter the
number of owner occupied housing units (occupied
or vacant) including Turnkey III and Mutual Help
housing developed under the 1937 Housing Act, and
privately owned housing.
Line 9b: Homeowner Housing-Number of Units Needing Rehabilitation: Enter the number of owner housing
units (from those entered in line 9a) that are in need
of rehabilitation.
Line 10: Supportive Service Housing: Enter the number of
supportive service housing units.
Line 11: College Housing: Enter the number of college housing units.
Line 12: Transitional Housing: Enter the number of transitional housing units.
Line 13: Homeless Housing: Enter the number of homeless
housing in terms of beds.
Part IV: Other Current Status and Future Needs (Optional)
Part IV is optional and allows tribes/TDHEs to provide information
pertaining to any category of housing that they believe should be
included in Table 1. Additional information describing local
circumstances and concerns may be included when the tribe
determines it appropriate to the IHP.
Column a: Types of Housing: Enter tribal/TDHE selected types of
housing. For example, elderly housing. A definition of each
category must be included as an attachment to this table.
Columns b, c, and d: The instructions for these columns are the
same as Part III.
Line 14: Enter the tribal/TDHE selected types of housing as
described in column a above (use as many lines as
necessary numbered 14a, 14b, 14c, etc. An attachment may be used if needed.)
Data Source: Describe the sources of data for the information
contained in the table.

form HUD-52735 (10/2002)

Table 2

Financial Resources
Name of Tribe:

Name of TDHE: (if applicable)

Grant Number:

Federal Fiscal Year:

Type of Submission:

Tribal/TDHE Program Year:

Original

Amended

Part I: Sources of Funds for NAHASDA Activities
Sources of Funds
column a

Planned Amount
column b

1. HUD Resources
a. NAHASDA Block Grant
b. NAHASDA Program Income
c. NAHASDA Title VI
d. Section 184 Loan Guarantee
e. Indian Community Development Block Grant
f. Drug Elimination Grants and Drug Technical Assistance
g. Prior Year Funds
h. Other
2. Existing Program Resources
a. 1937 Housing Act Programs
b. Other HUD Programs
3. Other Federal or State Resources
a. BIA Home Improvement Program
b. Other
4. Private Resources
a. Tribal Contributions for affordable housing
b. Financial Institution
c. Other
5. Other
6. Total Resources
Page 10

form HUD-52735 (10/2002)

Table 2 Financial Resources Continued

Part II: Allocation of Funds for NAHASDA Activities
Activity
column a

Budgeted Amount
column b

Planned
Number of Units
column c

Number of Families
column d

7. Indian Housing Assistance
a. Modernization (1937 Housing Act)
b. Operating (1937 Housing Act)
8. Development
1. Construction of new units
a. Rental

2. Acquisition
3. Rehabilitation
1. Construction of new units

b. Homeownership 2. Acquisition
3. Rehabilitation
9. Housing Services
10. Housing Management Services
11. Crime Prevention and Safety
12. Model Activities (specify below)
a.
13. Planning and Administration
14. Reserves
15. Other
16. Total

Page 11

form HUD-52735 (10/2002)

Instructions: Table 2: Financial Resources
The allocation of resources should be consistent with the statement of needs in the IHP including Table 1. Complete the table
in accordance with the instructions below.
Table Heading
Name of tribe: Enter the name of the tribe for whom the table is
prepared.
TDHE Name (if applicable): Enter the name of the tribally
designated housing entity (TDHE) if the IHP is prepared by a
TDHE on behalf of the tribe.
Grant Number: Enter the HUD assigned tribal grant number for
the Federal fiscal year for which the table is prepared.
Federal Fiscal Year: Enter the Federal fiscal year for which
assistance is to be made available. For example, October 1, 1997
to September 30, 1998 is federal fiscal year 1998.
Tribal/TDHE Program Year: Enter the starting date of the tribal/
TDHE designated program year (mm/dd/yyyy).
Type of Submission: Enter an “X” if this table is an original
submission. Enter an “X” if this table amends a prior submission.
Part I: Sources of Funds for NAHASDA Activities
In part I of Table 2, list only the sources of funds and related dollar
amounts that will be used for NAHASDA eligible activities.
NAHASDA eligible activities are listed in Part II of this table.
If the exact amount of funds reasonably expected to be made
available during the plan period is not known at the time the IHP
is prepared, estimate amounts as accurately as possible.
Column a: Sources of Funds: This column lists selected sources
of funds that may be used for NAHASDA activities. No data is
required to be entered in this column unless a tribe/TDHE elects
to include funding sources that are not already listed.
Column b: Planned Amount: Enter the amount of funds that are
expected to be received during the period of time covered by the
1-year plan that will be used for NAHASDA eligible activities.
Line 1a: NAHASDA Block Grant: Enter the amount of
NAHASDA block grant funds expected to be received during the period covered by 1-year plan.
Line 1b: NAHASDA Program Income: Enter the amount of
NAHASDA program income that is expected to be
received during the period covered by the 1-year
plan. Program income is defined in the final rule.
Line 1c: NAHASDA Title VI: Enter the amount of NAHASDA
Title VI funds expected to be received during the
period covered by the 1-year plan.
Line 1d: Section 184 Loan Guarantee: Enter the amount of
Section 184 Loan Guarantee funds expected to be
reserved during the period covered by the 1-year
plan.
Line 1e: Indian Community Development Block Grant: Enter
the amount of Indian Community Development Block
Grant funds expected to be received during the
period covered by the 1-year plan which will be used
for NAHASDA eligible activities.
Line 1f: Drug Elimination Grants and Drug Technical Assistance: Enter the amount of Drug Elimination Grant
and Drug Technical Assistance funds expected to be
received during the period covered by the 1-year
plan which will be used for NAHASDA eligible activities.

Page 12

Line 1g: Prior Year Funds: Enter the amount of NAHASDA
funds from previous years that have not been programmed in a previous IHP, and are available for use
during the period covered by the 1-year plan. No
data is required on this line for the first year of
NAHASDA.
Line 1h: Other: In column a, enter the name(s) of HUD
programs that are not listed above, but for which
funds are expected to be received during the period
covered by the 1-year plan and are to be used for
NAHASDA eligible activities. In column b, enter the
amount of funds expected to be received.
Line 2a: 1937 Housing Act Programs: Enter the amount of
unobligated funds from the programs listed below.
Remaining funds from the programs listed below will
be incorporated into the NAHASDA program as of
October 1, 1997, and will be governed by NAHASDA
rules.
1937 Housing Act Programs:
Comprehensive Improvement Assistance Program
Comprehensive Grant Program
Development Programs
Operating Subsidy and Cash Reserves
Homebuyer Equity
Proceeds From Sale
Line 2b: Other HUD Programs: Enter the amount of unobligated funds from the programs listed below.
HOPE
HOME
Youthbuild
Economic Development Supportive Services
Family Investment Centers
Section 8 Rental Assistance/Renewals
Emergency Shelter Grants
Line 3a: BIA Home Improvement Program: Enter the amount
of BIA Home Improvement Program funds expected
to be received during the period covered by the 1year plan which will be used for NAHASDA eligible
activities.
Line 3b: Other: In column a, enter the name(s) of other
federal or state resources that are not listed above,
but for which funds are expected to be received
during the period covered by the 1-year plan and are
to be used for NAHASDA eligible activities. In
column b, enter the amount of funds expected to be
received.
Line 4a: Tribal Contributions for affordable housing: Enter
the amount of tribal contributions expected to be
received during the period covered by the 1-year
plan which will be used for NAHASDA eligible activities.
Line 4b: Financial Institution: Enter the amount of funds
expected to be received from financial institutions
(banks, mortgage companies, credit unions, etc.)
during the period covered by the 1-year plan which
will be used for NAHASDA eligible activities. Do not
include the amount of funds expected to be received
under NAHASDA Title VI or Section 184. Funds from
these sources will be listed in lines 1c and 1d,
respectively.
Line 4c: Other: In column a, enter the name(s) of other
private resources that are not listed above, but for
which funds are expected to be received during the
period covered by the 1-year plan and are to be used
for NAHASDA eligible activities. In column b, enter
the amount of funds expected to be received.
form HUD-52735 (10/2002)

Line 5:

Other: In column a, enter any other funding source
that is not listed above, but for which funds are
expected to be received during the period covered by
the 1-year plan and are to be used for NAHASDA
eligible activities. In column b, enter the amount of
funds expected to be received.

Line 6:

Total Resources: Enter the total amount of all
resources by adding lines 1 through 5.

Part II: Allocation of Funds for NAHASDA Activities
Column a: Activity: This column lists the NAHASDA Eligible
Activities. If model activities are to be undertaken as part of the
1-year plan, they must be identified on line 12.
Column b: Budgeted Amount: Enter the amount of funds to be
budgeted for each NAHASDA activity. This number should
include direct program costs, e.g., program materials and contract costs associated with the eligible activity.
Staff and
overhead costs directly related to carrying out affordable housing
activities can be determined to be eligible costs of the affordable
housing activity or considered administration or planning (line 13)
at the discretion of the recipient.
Column c: Number of Units: Enter the number of units to be
completed for each activity which shows a budgeted amount in
column b.
Column d: Number of Families: Enter the number of families that
will be assisted through each activity which shows a budgeted
amount in column b.
Line 7a: Modernization: Enter the requested information for
modernization activities for housing previously developed or operated pursuant to a contract between
the Secretary and an Indian housing authority. (1937
Housing Act units)
Line 7b: Operating: Enter the requested information for operation activities for housing previously developed or
operated pursuant to a contract between the Secretary and an Indian housing authority. (1937 Housing
Act units)
Line 8:

Development: This line is a heading for lines 8a and
8b.

Line 8.a.1: Rental-Construction of new units: Enter the requested information for the construction of new
rental units.
Line 8.a.2: Rental-Acquisition: Enter the requested information for the acquisition of new rental units.

resident management corporations, energy auditing, activities related to the provision of self-sufficiency and other services, and other services related
to assisting owners, tenants, contractors, and other
entities, participating or seeking to participate in
other housing activities assisted pursuant to section
202 of NAHASDA.
Line 10: Housing Management Services: Enter the requested
information for housing management services. Housing management services include the provision of
management services for affordable housing, including preparation of work specifications, loan processing, inspections, maintenance, tenant selection, management of tenant-based rental assistance,
and management of affordable housing projects.
Line 11: Crime Prevention and Safety: Enter the requested
information for crime prevention and safety activities. Crime prevention and safety activities include
the provision of safety, security, and law enforcement measures and activities appropriate to protect
residents of affordable housing from crime. Costs
for crime prevention and safety apply to 1937 Housing Act assisted units as well as other units.
Line 12: Model Activities (specify below): Housing activities
under model programs are activities that are designed to carry out the purposes of NAHASDA. Note:
Model activities must be approved by the Secretary.
Listing a model activity on this table does not constitute Secretarial approval.
Line 12a: Enter the name of the model activity in column a. In
columns b, c, and d, enter the requested information
for the model activity. (use as many lines as necessary numbered 12a, 12b, 12c, etc.)
Line 13: Planning and Administration: Enter the requested
information for planning and administration. Planning and administration are defined in the Final Rule.
Line 14: Reserves: If the tribe/TDHE plans to reserve any of
its funds for use in future years, enter the amount in
column b.
Line 15: Other: Any other use of funds should be identified
here and a description of the activity should be
included as an attachment to Table 2.
Line 16: Total: Enter the totals of lines 7 through 15.

Line 8.a.3: Rental-Rehabilitation: Enter the requested information for the rehabilitation of rental units.
Line 8.b.1: Home Ownership-Construction of new units: Enter
the requested information for the construction of
new homeownership units.
Line 8.b.2: Home Ownership-Acquisition: Enter the requested
information for the acquisition of homeownership
units.
Line 8.b.3: Home Ownership-Rehabilitation: Enter the requested information for the rehabilitation of
homeownership units.
Line 9:

Housing Services: Enter the requested information
for housing services. Housing services include the
provision of housing-related services for affordable
housing, such as housing counseling in connection
with rental or homeownership assistance, establishment and support of resident organizations and

Page 13

form HUD-52735 (10/2002)

Table 3

Housing Profile
Name of Tribe:

Name of TDHE: (if applicable)

Grant Number:

Federal Fiscal Year:

Tribal/TDHE Program Year:

Part I: 1937 Housing Act Inventory Under Management
Housing Inventory

Number of Units
(Subtotal)
column b

column a

Number of Units
(Total)
column c

1. Mutual Help Units Under Management as of September 30
2. Low Rent Units Under Management as of September 30
3. Turnkey III Units Under Management as of September 30
4. Total Beginning 1937 Housing Act Inventory
a. Mutual Help
5. Units Planned to be
Demolished or
Disposed of During
Plan Period

b. Low Rent
c. Turnkey III
d. Total

(

)

(

)

a. Mutual Help
6. Units Planned to be
Conveyed During Plan
Period

b. Low Rent
c. Turnkey III
d. Total

7. Total Planned Ending 1937 Housing Act Inventory as of Sept. 30
Part II: 1937 Housing Act Inventory in the Development Pipeline
8. Mutual Help Units in the Pipeline as of September 30
9. Low Rent Units in the Pipeline as of September 30
10. Total Units in Pipeline as of September 30
Part III: Section 8 Vouchers and Certificates
11. Section 8 Vouchers and Certificates as of September 30
Part IV: NAHASDA Units
12. Total NAHASDA Units as of September 30

Page 14

form HUD-52735 (10/2002)

Instructions: Table 3: Housing Profile
Complete the table in accordance with the instructions below.
Table Heading
Name of Tribe: Enter the name of the tribe for whom the table is
prepared.
Name of TDHE (if applicable): Enter the name of the tribally
designated housing entity (TDHE) if the IHP is prepared by a TDHE
on behalf of the tribe.
Grant Number: Enter the HUD assigned tribal grant number for the
Federal fiscal year for which the table is prepared.
Federal Fiscal Year: Enter the Federal fiscal year for which assistance is to be made available. For example, October 1, 1997 to
September 30, 1998 is federal fiscal year 1998.
Tribal/TDHE Program Year: Enter the starting date of the tribal/TDHE
designated program year (mm/dd/yyyy).
Column a: Housing Inventory: Column a lists housing inventory
including 1937 Housing Act units, Section 8 Vouchers and Certificates, and NAHASDA units.
Column b: Number of Units (Subtotal): Enter the subtotal amount for
the number of units as requested.
Column c: Number of Units (Total): Enter the total amount for the
numbers of units as requested.
Part I: 1937 Housing Act Inventory Under Management
Line 1: Mutual Help Units Under Management as of September 30:
Enter the number of Mutual Help units which are/were owned or
operated pursuant to an Annual Contributions Contract (ACC) and
under management as of September 30 of the Federal fiscal year
preceding the Federal fiscal year that funding will be received for this
1-year plan. For example, October 1, 1997 to September 30, 1998
is Federal fiscal year 1998. If a tribe’s 1-year plan will cover the period
of time from October 1, 1997 to September 30, 1998, the number of
Mutual Help units entered on this line should be the number of units
as of September 30, 1997.
Line 2: Low Rent Units Under Management as of September 30:
Enter the number of Low Rent units which are/were owned or
operated pursuant to an ACC and under management as of September 30 of the Federal fiscal year preceding the Federal fiscal year that
funding will be received for this 1-year plan. For example, October
1, 1997 to September 30, 1998 is Federal fiscal year 1998. If a tribe’s
1-year plan will cover the period of time from October 1, 1997 to
September 30, 1998, the number of Low Rent units entered on this
line should be the number of units as of September 30, 1997.
Line 3: Turnkey III Units Under Management as of September 30:
Enter the number of Turnkey III units which are/were owned or
operated pursuant to an Annual Contributions Contract ACC and
under management as of September 30 of the Federal fiscal year
preceding the Federal fiscal year that funding will be received for this
1-year plan. For example, October 1, 1997 to September 30, 1998
is Federal fiscal year 1998. If a tribe’s 1-year plan will cover the period
of time from October 1, 1997 to September 30, 1998, the number of
Turnkey III units entered on this line should be the number of units
as of September 30, 1997.
Line 4: Total beginning 1937 Housing Act Inventory: Enter the total
of lines 1 through 3.
Line 5a: Mutual Help Units Planned to be Demolished or Disposed
of During Plan Period: Enter the number of Mutual Help units
planned to be demolished or disposed of during the 1-year plan
period. Do not include conveyed units.
Line 5b: Low Rent Units Planned to be Demolished or Disposed of
During Plan Period: Enter the number of Low Rent units planned to
be demolished or disposed of during the 1-year plan period. Do not
include conveyed units.

Page 15

Line 5c: Turnkey III Units Planned to be Demolished or Disposed of
During Plan Period: Enter the number of Turnkey III units planned
to be demolished or disposed of during the 1-year plan period. Do
not include conveyed units.
Line 5d: Total: Enter the total of lines 5a through 5c.
Line 6a: Mutual Help Units Planned to be Conveyed During Plan
Period: Enter the number of Mutual Help units planned to be
conveyed to homebuyers during the 1-year plan period.
Line 6b: Low Rent Units Planned to be Conveyed During Plan
Period: Enter the number of Low Rent units planned to be conveyed
to tenants during the 1-year plan period.
Line 6c: Turnkey III Units Planned to be Conveyed During Plan
Period: Enter the number of Turnkey III units planned to be conveyed
to homebuyers during the 1-year plan period.
Line 6d: Total: Enter the total of lines 6a through 6c.
Line 7: Total Planned Ending 1937 Housing Act Inventory as of
September 30: Enter the total of line 4 minus lines 5d and 6d. This
is the estimated total assisted housing stock which is owned or
operated pursuant to an ACC and under management by a tribe/
TDHE at the end of the Federal fiscal year for which funding will be
received for this 1-year plan.
Part II: 1937 Housing Act Inventory in the Development Pipeline
Line 8: Mutual Help Units in the Pipeline as of September 30: Enter
the number of Mutual Help units which are in the development
pipeline (planned or under construction) as of September 30 of the
Federal fiscal year preceding the Federal fiscal year that funding will
be received for this 1-year plan. For example, October 1, 1997 to
September 30, 1998 is Federal fiscal year 1998. If a tribe’s 1-year
plan will cover the period of time from October 1, 1997 to September
30, 1998, the number of Mutual Help units entered on this line should
be the number of units as of September 30, 1997.
Line 9: Low Rent Units in the Pipeline as of September 30: Enter the
number of Low Rent units which are in the development pipeline
(planned or under construction) as of September 30 of the Federal
fiscal year preceding the Federal fiscal year that funding will be
received for this 1-year plan. For example, October 1, 1997 to
September 30, 1998 is Federal fiscal year 1998. If a tribe’s 1-year
plan will cover the period of time from October 1, 1997 to September
30, 1998, the number of Low Rent units entered on this line should
be the number of units as of September 30, 1997.
Line 10: Total Units in Pipeline as of September 30: Enter the total
of lines 8 and 9.
Part III: Section 8 Vouchers and Certificates
Line 11: Section 8 Vouchers and Certificates as of October 1: Enter
the total number of Section 8 Vouchers and Certificates approved for
the tribe/TDHE as of September 30 of the Federal fiscal year
preceding the Federal fiscal year that funding will be received for this
1-year plan. For example, October 1, 1997 to September 30, 1998
is Federal fiscal year 1998. If a tribe’s 1-year plan will cover the period
of time from October 1, 1997 to September 30, 1998, the number of
Section 8 Vouchers and Certificates entered on this line should be
the number of units as of September 30, 1997.
Part IV: NAHASDA Units
Line 12: Total NAHASDA Units as of October 1: Enter the total
number of units that have been completed (are occupied or are ready
for occupancy) with NAHASDA funds as of September 30 of the
Federal fiscal year preceding the Federal fiscal year that funding will
be received for this 1-year plan. For example, October 1, 1997 to
September 30, 1998 is Federal fiscal year 1998. If a tribe’s 1-year
plan will cover the period of time from October 1, 1997 to September
30, 1998, the number of NAHASDA units entered on this line should
be the number of units as of September 30, 1997. No data is required
on this line for the first year of NAHASDA.

form HUD-52735 (10/2002)

Other Submissions:
Recipients of NAHASDA funds are required to prepare and submit
the following information:
1.

Useful Life: Sections 205(a)(2) and 209 of NAHASDA requires that housing remain affordable. Each recipient will
determine the “useful life” period for its units. The useful life
of each assisted housing unit in each development must be
described. This information may be described here or in the
affordable housing resources section of the 1-year plan.

2.

Model Housing Activities: Recipients are required to submit
proposals to operate model housing activities or other housing programs as defined in NAHASDA sections 201(b)(2) and
202(6) for non low-income families. Assistance to non lowincome Indian families must be in accordance with the Final
Rule. If a model housing activity is to be undertaken during
the 1-year plan period, proposals may be included here, in the
affordable housing resources section of the 1-year plan, as an
amendment to the IHP, or by special request to HUD at any
time. All proposals must be approved by the Secretary prior
to beginning any model housing activity.

3.

4.

Planning and Administration: In accordance with the Final
Rule, state the percentage of annual grant funds which will be
used for planning and administrative purposes. If the amount
is over 20 percent of the annual grant amount, HUD approval
is required.

5.

Minimal Funding: As stated in the Final Rule, the first year of
NAHASDA participation, a tribe whose allocation is less than
$50,000 under the need component of the formula shall have
its need component of the grant adjusted to $50,000. Certify
here that there is a need for funding.

6.

Method of Payment: In accordance with the Final Rule, state
the method of payment the tribe/THDE will use to request its
grant funds.

Tribal and other Indian Preference: Section 201(b)(4) of
NAHASDA allows preference for tribal members and other
Indian families. If preference will be given to tribal members
or other Indian families, the preference policy must be described. This information may be provided here or in the
affordable housing resources section of the 1-year plan.

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form HUD-52735 (10/2002)

Native American Housing Assistance and SelfDetermination Act
Environmental Review - Expression of Intent
To facilitate the completion of environmental review responsibilities under the Indian Housing Block Grant program, this
Expression of Intent will provide HUD with information
needed to assist the tribe in completion of these activities and
to schedule resources needed to complete environmental review responsibilities. Environmental reviews are completed
for individual activities included in the Indian Housing Plan.
The tribe can choose to complete the environmental review for
some or all activities and can decide at a later date to change its
decision.
The tribe plans to assume the status of a Federal official
under the National Environmental Policy Act of 1969
and the other provisions of law listed in 24 CFR 58.5
insofar as the provisions of the Act and such other
provisions of law apply to the Indian tribe's proposed
program pursuant to 24 CFR part 58.
The tribe plans to request HUD to fulfill environmental
review responsibilities stated above pursuant to 24 CFR
part 50.
The tribe plans to work with HUD and provide information
and studies to HUD to allow HUD to fulfill environmental
review responsibilities stated above pursuant to 24 CFR
part 50.
The tribe plans to assume the responsibilities stated above
except for the following listed activities for which it will
request HUD to fulfill the environmental review responsibilities.

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form HUD-52735 (10/2002)

Native American Housing Assistance and
Self-Determination Act
Indian Housing Plan
Standard Certification of Compliance
This certification is for use with the Indian Housing Plan
(IHP). If the IHP is prepared and submitted by a Tribally
Designated Housing Entity on behalf of a tribe, it must be
accompanied by a tribal certification from the recognized
tribal government covered under the IHP.
In accordance with the applicable statutes, the recipient
certifies that:
(A)it will comply with title II of the Civil Rights Act of
1968 in carrying out this Act, to the extent that such
title is applicable, and other applicable Federal statutes;
The following certifications will only apply where applicable based on program activities
(B) it will maintain adequate insurance coverage for
housing units that are owned and operated or assisted
with grant amounts provided under the Native American Housing and Self-Determination Act of 1996
(the Act), in compliance with such requirements as
may be established by the Secretary;
(C) policies are in effect and are available for review by
the Secretary and the public governing the eligibility,
admission, and occupancy of families for housing
assisted with grant amounts provided under the Act;
(D)policies are in effect and are available for review by
the Secretary and the public governing rents charged,
including the methods by which such rents or
homebuyer payments are determined, for housing
assisted with grant amounts provided under the Act;
and
(E) policies are in effect and are available for review by
the Secretary and the public governing the management and maintenance of housing assisted with grant
amounts provided under the Act.
Signature of Authorized Official

Date

X
Title

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form HUD-52735 (10/2002)

Native American Housing Assistance and SelfDetermination Act
Indian Housing Plan Tribal Certification
This certification is for use with the Indian Housing Plan (IHP)
when a Tribally Designated Housing Entity (TDHE) prepares
the IHP on behalf of an Indian tribe. This certification must be
executed by the recognized tribal government covered under
the IHP.
The recognized tribal government of the grant beneficiary
certifies that:
(1) it had an opportunity to review the IHP and has authorized the submission of the IHP by the housing entity; or
(2) it has delegated to such TDHE the authority to submit an
IHP and amendments to the IHP on behalf of the tribe
without prior review by the tribe.

Signature of Authorized Official

Date

X
Title

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form HUD-52735 (10/2002)