THE TANGIBLE PERSONAL PROPERTY REPORT

THE TANGIBLE PERSONAL PROPERTY REPORT Tangible Personal Property Report SF- 428 Final Report SF-428- B Disposition Request/Report SF-428- C Supplemental Sheet SF-428S 1 PROGRAM INSTRUCTIONS PROGRAM INSTRUCTIONS Federal Reporting Changes; Financial Reports; SF 425; Cash Transactions; Expenditures; Tangible Personal Property Reports; SF 428 SF 429; Real Property; Facilities; Purchase; Construction; Major Renovation; Reporting ISSUANCE DATE 08/21/2017 08/21/2017 2 THE SF 428 3 1

SF 428 Instructions for Tangible Personal Property Report: SF-428 o This is a standard form to be used by awarding agencies to collect information related to tangible personal property (equipment and supplies) when required by a Federal financial assistance award. 4 SF 428 o The form consists of the cover sheet (SF-428) and three attachments to be used as required: Annual Report, SF428-A; Final (Award Closeout) Report, SF-428-B; and Disposition Request/Report, SF-428-C. o A Supplemental Sheet, SF-428S, may be used to provide detailed individual item information. 5 SF 428 Tangible personal property means property of any kind, except real property, that has physical existence. It includes equipment and supplies. It does not include copyrights, patents or securities. For convenience, throughout this form and its attachments, the term property will be synonymous with tangible personal property. The terms equipment and supplies will be used when referring to specific requirements. 6 2

SF 428 Property may be provided by the awarding agency or acquired by the recipient with award funds. Federally-owned property consists of items that were furnished by the Federal government. Recipients of Federal assistance awards may be required to provide Federal awarding agencies with information concerning property in their custody annually, at award closeout or when the property is no longer needed. 7 SF 428 Specific requirements will vary based on award provisions, the type of property (equipment or supplies) and whether the property is Federally-owned. This reporting form and its attachments are intended to assist recipients to provide necessary information when it is required. 8 SF 428 1.Federal Agency and Organization Element to Which Report is Submitted: HHS ADMINISTRATION FOR CHILDREN AND FAMILIES 2. Federal Grant or Other Identifying Number Assigned by Federal Agency: 0XCHXXXX 4. Recipient Organization (Name and complete address including zip code) 3. Recipient Organization (name and complete address including zip code): ABC, Inc. Head Start 2300 Jackson, St. Gary, IN 00000 6. Attachment (Check applicable) Annual Report (SF 428 A) _X_ Final (Award Closeout) Report (SF 428 B) X_ Disposition Report/Request (SF 428 C) Pages 3a. DUNS XXXXX of pages 3b. EIN XXXX 5. Recipient Account or Identifying Number Optional 7. Supplemental Sheet Yes No NOTE: If yes, the SF 428s maybe attached 9 3

SF 428 8. Comments: Closing the Project Period 9a. Typed or Printed Name and Title of Authorized Certifying Official Larry Evans Governing Body Chairman 9b. Signature of authorized Certifying Official Larry Evans 9c. Telephone (area code, number, extension) (555)555.5555 9d. Email address RP@abc.org 9e. Date report submitted (Month, Day, Year) 12/31/2012 10. Agency use only 10 TANGIBLE PERSONAL PROPERTY REPORT Final Report SF 428 B 11 Final Report SF 428 B General Instructions: o This Attachment is to be used by recipients when required to provide a final property report for closeout of Federal assistance awards. o The Attachment allows recipients to request specific disposition of Federally-owned property and acquired equipment. 12 4

Final Report SF 428 B The attachment also provides a means for calculating and transmitting appropriate compensation to the awarding agency for residual unused supplies. Requirements for final reporting are based on individual award provisions and the type of property. 13 Final Report SF 428 B Generally, at the end of a Federal assistance award, recipients are required to: a. submit a report of Federally-owned property. b. provide a listing of equipment items, with an acquisition cost of $5,000 or more, when the awarding agency has reserved the right to transfer title to the equipment to the Federal Government or a third party. 14 Final Report SF 428 B c. compensate the awarding agency for residual unused supplies with a total aggregate fair market value greater than $5,000 that are not needed for any other Federally sponsored programs or projects. 15 5

Final Report SF 428 B Federal Grant or Other Identifying Number Assigned by Federal Agency (Block 2 on SF 428). 0XCHXXXX 1. Report (Select all that apply) a. Federally owned Property (List on Supplemental Sheet SF 428S or recipient equivalent and complete Section 2a below.) b. _X Acquired Equipment with acquisition cost of $5,000 or more for which the awarding agency has reserved the right to transfer title (List on Supplemental Sheet SF 428S or recipient equivalent and complete Section 2b below.) c. _X Residual Unused Supplies with total aggregate fair market value exceeding $5,000 not needed for any other Federally sponsored programs or projects. (Complete Section 2c below) d. None of the above 16 Final Report SF 428 B 2. Complete relevant section(s) For Agency Use Only 2a. Federally owned Property (Select one or more.) (i) Request transfer to Award (ii) Request Federal Agency disposition instructions (iii) Other (Provide detail in Block 3 or attach request) Agency response to requested disposition of Federally owned property: (i) Recipient request approved denied (ii) Dispose in accordance with attached instructions. 17 Final Report SF 428 B 2b. Acquired Equipment (Select one or more.) (i) Request unconditional transfer of title with no further obligation to the Federal Government. (ii) X Request Federal Agency disposition instructions Note: If the awarding agency does not provide disposition instructions within 120 days the recipient may continue to use the equipment for Federally supported projects or dispose in accordance with the applicable property standards. Example: Equipment Disposal Agency response to requested disposition of acquired equipment:: (i) Recipient request approved denied (ii) Dispose in accordance with attached instructions Authorized Awarding Agency Official Signature: Date: Name: Phone Title: E mail 18 6

Final Report SF 428 B Example: Equipment Disposal 2c. Reportable Residual Unused Supplies (See Next Slide) (i) Sale proceeds or Estimate of current fair market value $ (ii) Percentage of Federal participation.. 100% (iii) Federal share. $ (iv) Selling and handling allowance..... $ (v) Amount remitted to the Federal Government $ 3. Comments: Requesting instruction to disposal of a 1995 Ford 36 passenger bus with a fair market value of $5,100.00 Agency use only: 19 Final Report SF 428 B Residual Unused Supplies Instructions Reportable Residual Unused Supplies. Indicate whether the supplies have been sold or if they will be retained for use solely on non Federally-funded projects. i. Enter the total amount of sales proceeds or an estimate of the current fair market value if the supplies will be retained. Note: Fair market value means the best estimate of the gross sales proceeds if the property were to be sold in a public sale. 20 Final Report SF 428 B ii. iii. Enter the percentage of Federal Government participation in the award under which the supplies were acquired. Enter the dollar amount of sales proceeds (or estimate of current fair market value) multiplied by the percentage of Federal Government participation listed in (ii). 21 7

Final Report SF 428 B Residual Unused Supplies Instructions iv. If the supplies were sold, enter the amount of selling and handling expenses. Enter zero if the supplies will be retained for use on non Federally funded projects. v. Enter the amount of the Federal share in (iii) less the selling and handling expense listed in (iv). Indicate in Block 3 how the funds are being returned to the government (e.g., attached check made out to the Awarding Agency/U.S. Treasury or electronic remission). 22 Final Report SF 428 B 2c. Reportable Residual Unused Supplies (i) Sale proceeds or _X Estimate of current fair market value $5500.00 (ii) Example: Residual Unused Supplies (ii) Percentage of Federal participation.. 100% (iii) Federal share. $5500.00 (iv) Selling and handling allowance..... $500.00 (v) Amount remitted to the Federal Government $5000.00 3. Comments: Reporting unused supplies Agency use only: 23 TANGIBLE PERSONAL PROPERTY REPORT Disposition Request/Report SF 428 C 24 8

Disposition Request/Report SF 428 C General Instructions: This Attachment is to be used by recipients when required to request disposition instructions or to report disposition of Federally-owned property or acquired equipment under Federal assistance awards at any time other than award closeout (i.e., during the award period or after closeout as long as the Federal government retains an interest in the item). 25 Disposition Request/Report SF 428 C Recipients provided Federally-owned property for use under Federal assistance awards are required to request disposition instructions from the awarding agency when the Federally-owned property is no longer needed for the authorized purpose. Recipients may be required to request disposition instructions for equipment acquired with award funds (acquired equipment) when an item is no longer needed for use on Federally-sponsored activities. 26 Disposition Request/Report SF 428 C Recipients may also be required to provide compensation to the awarding agency when acquired equipment is sold or retained for use on activities not sponsored by the Federal government. This attachment is intended to assist recipients in providing appropriate information to the awarding agency. 27 9

Disposition Request/Report SF 428 C Note: If the Federal awarding agency has exercised statutory authority to vest title to acquired equipment in the recipient with no further obligation to the Federal government, you are not required to request disposition instructions or to report disposition (i.e., sale or retention for non Federal use) of those items of equipment. 28 TANGIBLE PERSONAL PROPERTY REPORT Disposition Request/Report SF 428 C Federal Grant or Other Identifying Number Assigned by Federal Agency (Block 2 of SF 428): 0XCHXXXX 1. Request Disposition Instructions for: a. Federally owned Property (Select one or more and attach Supplemental Sheet SF 428S or recipient equivalent) (i) Request Federal Agency disposition instructions (ii) Other (Specify in Block 8 Comments or attach request) For Agency Use Only Agency response to requested disposition of Federally owned property: (i) Recipient request approved denied. (ii) Dispose in accordance with attached instructions. 29 TANGIBLE PERSONAL PROPERTY REPORT Disposition Request/Report SF 428 C b. Acquired Equipment with current fair market value of $5,000 or more (Select one or more and attach Supplemental Sheet SF 428S or recipient equivalent) (i) Request approval to trade in or sell to offset costs of replacement equipment (ii) X Request Federal Agency disposition instructions Agency response to requested disposition of acquired equipment: (i) Recipient request approved denied. (ii) Dispose in accordance with attached instructions. Authorized Awarding Agency Official Signature: Name: Date: Phone: Title: Email: 30 10

TANGIBLE PERSONAL PROPERTY REPORT Disposition Request/Report SF 428 C 2. Report Disposition by Sale or Retention a. Retention of acquired equipment for use on non Federally supported projects b. X Sale of acquired equipment (Attach Supplemental Sheet SF 428S or recipient equivalent and complete worksheet below) (i) Sale proceeds (or estimate of current fair market value) $5,000.00 (ii) (ii) Percentage of Federal participation. _100% (iii) Federal share.. $5,000.00 (iv) Selling and handling allowance...... $500.00 (v) Amount remitted to the Federal Government $4,500.00 31 TANGIBLE PERSONAL PROPERTY REPORT Disposition Request/Report SF 428 C 3. Report Loss, Destruction or Theft of Federally owned Property Loss, Destruction or Theft of Federally owned property (Attach Supplemental Sheet SF 428S or recipient equivalent and describe the circumstances in Block 4) 4. Comments 32 INVENTORY REQUIREMENT On December 9, 2011, Policies and Procedures for Designation Renewal of Head Start and Early Head Start grantees, became final. The regulation includes a provision that Head Start and Early Head Start grants move from indefinite project periods to five year project periods. All Head Start grants, regardless of competition status, are undergoing closeout as indefinite project periods are phased out and five year project periods begin. 33 11

INVENTORY REQUIREMENT Grantee inventories must be submitted to the responsible awarding agency (ACF). Standard Property Reporting Forms SF-428S and SF-429 Cover Page and Attachment A may be used to report this information in a consistent format. 34 INVENTORY REQUIREMENT Inventories of Supplies by Location and Room and Equipment/Inventory (SF-428 Cover, SF-428A, and SF-428S) Supplies by Location and Room Include an inventory of supplies by location and room. Normally this type of inventory request is made at the completion of a project or program (see 45 CFR 75.320(d)(2) however, in order to have a comprehensive inventory picture of your agency ACF is requesting this information as part of transaction. 35 INVENTORY REQUIREMENT For the supplies inventory please include items such as o classroom furniture and fixtures, o computers, both desktop and lap top, o video and teleconference items, o cameras, o smart boards and o playground items. 36 12

INVENTORY REQUIREMENT Equipment Inventory Include a copy of your last equipment inventory which was reconciled to your agency's equipment records: see 45 CFR 75.320(d)(2). Include a list of all vehicles purchased using Head Start funds, including make, model, year, capacity, and condition of each vehicle. 37 INVENTORY REQUIREMENT Federally Owned Property Inventory (SF-429 Cover, SF-429A) Include your current inventory of Federally Owned Property see 45 CFR 75.319. Include all facilities in which the Federal Government has a federal interest. Also, include all facilities where Federal Funds were used to complete major renovations, as well as facilities with long term lease agreement (exceeds 5 year term or remaining). 38 TANGIBLE PERSONAL PROPERTY REPORT Supplemental Sheet SF 428S 39 13

Supplemental Sheet SF 428S A. General Instructions This is a standard form to be used by recipients to provide detailed individual item information in connection with required reports of tangible personal property under Federal assistance awards. 40 Instructions for Tangible Personal Property Report: SF 428S GP or ACQ. Enter GP if the item is Federally-owned property. o Note: Federally-owned property consists of items furnished by the Federal Government for use on the award identified in Block 1 or Column a. o Enter ACQ if the item was acquired with award funds 41 Instructions for Tangible Personal Property Report: SF 428S Identification Number. Enter the o manufacturer s serial number, o model number, o Federal stock number, o national stock number, or o other identification number 42 14

Instructions for Tangible Personal Property Report: SF 428S Cond. Code. Enter the applicable condition code from the following list: Code Description o 1 Excellent. Property that is in new condition or unused condition and can be used immediately without modification or repairs. o 4Usable. Property which shows some wear, butcanbe used without significant repair. 43 Instructions for Tangible Personal Property Report: SF 428S o 7 Repairable. Property which is unusable in its current condition but can be economically repaired. o XSalvage.Property which has value in excess of its basic material content, butrepair or rehabilitation is impractical and/or uneconomical. o SScrap.Property which has no value except for its basic material content. 44 Instructions for Tangible Personal Property Report: SF 428S Disp. Req. Indicate the type of disposition requested for each item by entering the corresponding number from Block 2 of the Final Report Attachment or Block 1 of the Disposition Request/Report Attachment. Not required for Annual Report Attachments. 45 15

Supplemental Sheet SF 428S EQUIPMENT Federal Grant or Other Identifying Number Assigned by Federal Awarding Agency (Block 2 of SF 428) 0XCHXXXX (PART I) Attachment Type: Annual Report (SF 428 A) X Disposition Report/Request (SF 428 C) X Final (Award Closeout) Report (SF 428 B Award Number (a) OXCHXXXX/32 GP or ACQ (b) GP: Federal Property ACQ: means Acquired Description of Item (c) Identification Number (d) 32 Passenger Bus XXXXXXXX 46 TANGIBLE PERSONAL PROPERTY REPORT Supplemental Sheet SF 428S EQUIPMENT Attachment Type (Part II) _X Annual Report Final (Award Closeout) Report Disposition Request/Report Page Of Pages Acq. Date (e) Cond. Code (f) Acq. Cost (g) Disp. Req. (h) 12/31/2015 4 $10,000.00 N/A 47 Supplemental Sheet SF 428S RESEDIUAL INVENTOY UNUSED SUPPLIES Federal Grant or Other Identifying Number Assigned by Federal Awarding Agency (Block 2 of SF 428) (PART I) Award Number (a) GP or ACQ (b) Description of Item (c) 260 CASES OF CONSTRUCTIONPAPER : COSTS $3200.00 30 PLAY GROUNDS SWINGS: $3200.00 Identificatio n Number (d) 48 16

TANGIBLE PERSONAL PROPERTY REPORT Supplemental Sheet SF 428S RESEDIUAL INVENTOY UNUSED SUPPLIES Attachment Type (Part II) _X Annual Report Final (Award Closeout) Report Disposition Request/Report Page Of Pages Acq. Date (e) Cond. Code (f) Acq. Cost (g) Disp. Req. (h) TOTAL $6400.00 49 Supplemental Sheet SF 428S RESEDIUAL INVENTOY USED SUPPLIES Federal Grant or Other Identifying Number Assigned by Federal Awarding Agency (Block 2 of SF 428) (PART I) Award Number (a) GP or ACQ (b) Description of Item (c) 15 BICYCLES 18 STOVES 50 SWINGS 25 CUBBIES 8 KIDNEY TABLES Identification Number (d) 50 TANGIBLE PERSONAL PROPERTY REPORT Supplemental Sheet SF 428S RESEDIUAL INVENTOY USED SUPPLIES Attachment Type (Part II) _X Annual Report Final (Award Closeout) Report Disposition Request/Report Page Of Pages Acq. Date (e) Cond. Code (f) Acq. Cost (g) Disp. Req. (h) 51 17

SUBMISSION Grantees are required to provide Tangible Personal Property Report SF-428 and SF-428B, and if needed, SF-428S, not later than 90 days after the close of the project period. Grantees are to scan and upload completed copies of the SF-428 reports to the specified folders in the Grant Notes section of Grant Solutions. 52 THE REAL PROPERTY STATUS REPORT SF 429 How to complete the SF-429: Attachment A (General Reporting); Attachment B (Request to Acquire, Improve or Furnish) and Attachment C (Disposition Request) 53 DEFINITIONS (Repeat) Acquisition Cost of Real Property: means the cost of the asset including the cost to put it in place. Conservation Easement: means a voluntary agreement between a land owner and an organization that says here are the reserved rights and here are the extinguished rights. o Reserved rights could be the right to sell the property or the right to give it away. o An extinguished right could be the right to subdivide (or to divide a large property into many small lots). 54 18

DEFINITIONS (Repeat) Encumber: means to burden with a legal claim (as a mortgage) Parcel: A plot of land, usually a division of a larger area. Real Property: means land, including land improvements, structures and appurtenances (right-of-way) thereto, excluding movable machinery and equipment. 55 SF 429 Cover Page SF-429 Cover Page must accompany all reports and requests. o The cover page provides recipient (grantee) information. Include the SF- 429 cover page when submitting each form. 56 REAL PROPERTY STATUS REPORT SF 429 (COVER PAGE) 1. Federal Agency and Organizational Element to Which Report is Submitted: 1. Federal Agency and Organizational Element: HHS ADMINISTRATION FOR CHILDREN AND FAMILIES Page: of : Pages 2. Federal Grant(s) or Other Identifying Number(s) Assigned by Federal Agency(ies): 0XWHXXXX 3. Recipient Organization (name and complete address including zip code): ABC, Inc. Head Start 2300 Jackson, St. Gary, IN 00000 4a. DUNS Number: XXXXX 4b. EIN: XXXX 5. Recipient Account or Identifying Number: Optional 7. Report End Date (MM/DD/YYYY): 12/31/2016 6. Contact Person for this Report: Name: Mike Jones Phone: (555)555.5555 Email: RP@abc.org Fax: (555)555.5551 8. Real Property Status Report Attachments: [check the applicable block(s)]: X : Attachment A (General Reporting) attached X : Attachment B (Request to Acquire, Improve or Furnish) attached X : Attachment C (Disposition Request) attached 57 19

REAL PROPERTY STATUS REPORT SF 429 9. (COVER Comments PAGE) (attach additional sheets if necessary): Provide any special notes or comments regarding the real property being reported or the report itself in this block. Do Not include issues related to General Reporting; Request to Acquire, Improve or Furnish or Disposition Request If a negative report (no change in real property status) is being submitted for all parcels of real property, enter the term Negative inthisblock. If there have been changes with some but not all parcels of real property, identify the parcels with negative status in this block (as follows: Negative status for the following Properties: ) and provide the related attachment(s) for each parcel with changes to report. 10. Certification: I certify to the best of my knowledge and belief that all information presented in this report is true, correct and complete and constitutes a material representation of fact upon which the Federal government may rely. 58 11a. Typed or Printed Name and Title of Authorized Certifying Official: NAME: Larry Evans TITLE: Governing Body Chairman The authorized certifying official must sign here certifying to the facts presented in the report. A copy of the governing body s authorization for the certifying official to sign official documents on behalf of their organization as an official representative must be on file in the recipient s office. 11c. Telephone (area code, number, extension): (555)555.5555 11d. Email Address: RP@abc.org 11b. Signature of Authorized Certifying Official: Larry Evans 11e. Date Report Submitted (MM/DD/YYYY): 01/03/2017 12. Agency use only 59 Real Property Status Report ATTACHMENT A (General Reporting) SF 429 A 60 20

SF 429 A General Reporting SF-429-A General Reporting must be submitted annually on the same date the grantee s annual SF-425 Federal Financial Report for the budget period is due. o A separate Attachment A is required for every parcel of real property subject to a federal interest as defined in 45 CFR 1305.2. 61 Real Property Status Report ATTACHMENT A (General Reporting) SF 429 A Real Property Details. Provide the requested information in subsections 13 through 18 of Attachment A for each parcel of real property being reported. Use a separate sheet to report information on each parcel of real property under the Federal Financial Assistance award identified in section 2. If a section does not apply, enter N/A. Below is a summary of the required information to be provided for each subsection of Attachment A: 13. Period and type of Federal Interest (MM/DD/YYYY): From: 12/23/2016 To: 12/22/2046 X_ Acquisition X_ Renovation X_ Construction X_ Government Furnished Property Enter the period, established in the award document, during which Federal interest in the real property begins (i.e., From) and ends (i.e., To) using (MM/DD/YYYY) format. [ex., From: 03/23/2005 To: 03/22/2025]. This period may exceed the grant award performance period in those instances where Federal interest continues beyond the end of the current award. In some instances the end date for the period of Federal interest may not be defined by a specific date. If that is the case, enter the beginning date along with a statement to indicate the planned or uncertain end date (ex. From: 03/23/2005 To: Expiration of Federal Interest ). 62 14a. Description of Real Property. Describethetypeofrealpropertybeing reported (i.e., land, building, etc.) and provide a useful description of the real property (i.e., building number 17 at the National Research Center, Chapel Hill, NC). If the real property is being renovated or altered, also describe the nature of the work (i.e., major renovation of building 17, wing c). 14b. Address of Real Property. Enter the legal description and complete address for each parcel of real property being reported including the street, city, state, county/parish, country, zip code, and physical location if an address is not available o (i.e., latitude, longitude, o lot number, parcel number, etc.). NEXT SLIDE INCLUDES MORE DETAIL REGARDING THE ADDRESS NOTE: PARCEL NUMBER 13 DIGTIT NUMBER THAT A COMMUNITY S TAX ASSESSOR ASSIGNS. Also, indicate zoning information related to the real property (i.e., mixed use, residential, commercial, etc.). 63 21

Where an address is not available, or more precision is required, geographic coordinates may be used. Locational data should be recorded with a Global Positioning System (GPS) device set to NAD 83, or WGS 84 datum using either of the following coordinate reference systems: United States National Grid (USNG) using the full grid zone designation and a minimum of eight digits. Decimal degrees latitude and longitude, with at least 6 decimal places and a minus ( ) toshowwest longitude or south latitude. 64 14c. Land Acreage or Square Units: Enter the size of the land or the size of the land on which the real property is located in terms of measured acreage or square units (i.e., 1.5 acres, 0.8 sq. km., etc.). Enter Amount: 30 acres Identify the unit of measure. Use only one option, either acres, square kilometers, square feet, or square meters. Select units: _X_ Acres Square Feet Square Kilometers Square Meters 14d. Gross and Usable Square Footage/Meters (i.e., of building, house, etc.): Enter the gross and usable square footage/meters for each structure (i.e., of the building, house, etc.) being reported. Enter Amounts: Gross 27,000 Usable _25,000 Identify the unit of measure. Select only one, either square feet or square meters. Select Units: _X_ Square Feet Square Meters 65 14e. EXAMPLE I 66 22

14e. Real Property Ownership Type(s): _X A. Owned B. Co Owned C. Fee Simple D. Corporate E. Joint Tenancy F. Partnership G. Limited Liability Partnership H. Co Operative I. Government Furnished Property J. Other (Describe): Check the applicable box(es) to indicate the real property ownership type(s). If more than one type is applicable, check all that apply. If the ownership types listed do not apply, check J. Other and describe the ownership arrangement. Example of Other: Conservation Easement 14f. Real Property Cost: $4,000,000.00 Share Percentage 80%: Federal Share: $ $4,000,000.00 [80%] Non Federal Share: $ $1,000,000.00 [20%] Total (Federal and Non Federal Share): $5,000,000.00 [100%] Enter the total cost of the real property acquired (purchase price only) or improved, including the following data. If multiple Federal agencies are contributing to the acquisition or improvement of the real property, attach a separate sheet to identify each agency and their contribution using the following format: 67 1. Amount provided by the Federal government (i.e., Federal Share of Property Cost based on the Federal share of the total cost of the program or project), 2. Share percentage provided by the Federal government (i.e., Federal Share Percentage of Property Cost based on the Federal share of the total cost of the program or project), 3. Amount provided by the recipient or other non Federal entities (i.e., non Federal Share of Property Cost), 4. Share percentage provided by the non Federal entities, (i.e., non Federal Share Percentage of Property Cost), 5. Total cost (i.e., Sum of Federal and non Federal Share of the Property Cost), and Total share percentage (i.e., sum of share percentages of Federal and non Federal Share of the Property 6. Cost must equal 100%). 68 EXAMPLE I: SINGE FEDERAL FUNDING SOURCE HEAD START OR EARLY HEAD START PROGRAM DESCRIPTION AMOUNT SHARE PERCENTAGE Amount/Share percentage $4,000,000.00 80% provided by the Federal government Amount/Share percentage $1,000,000.00 20% provided by the recipient or other non Federal entities (i.e., non Federal Share of Property Cost) Total cost/share percentage $5,000,000.00 100% 69 23

14e. EXAMPLE II 70 14e. Real Property Ownership Type(s): A. Owned B. Co Owned C. Fee Simple D. Corporate E. Joint Tenancy X_ F. Partnership G. Limited Liability Partnership H. Co Operative I. Government Furnished Property J. Other (Describe): Check the applicable box(es) to indicate the real property ownership type(s). If more than one type is applicable, check all that apply. If the ownership types listed do not apply, check J. Other and describe the ownership arrangement. Example of Other: Conservation Easement 14f. Real Property Cost: $2,500,000.00 Share Percentage 50%: Federal Share: $ $2,500,000.00 [50%] Non Federal Share: $ $2,500,000.00 [50%] Total (Federal and Non Federal Share): $5,000,000.00 [100%] Enter the total cost of the real property acquired (purchase price only) or improved, including the following data. If multiple Federal agencies are contributing to the acquisition or improvement of the real property, attach a separate sheet to identify each agency and their contribution using the following format: 71 EXAMPLE II: MULTIPLE FEDERAL FUNDING SOURCE HEAD START OR EARLY HEAD START PROGRAM DESCRIPTION AMOUNT SHARE PERCENTAGE Amount/Share percentage $500,000.00 10% provided by the Federal government Amount/Share percentage $125,000.00 2.5% provided by the recipient or other non Federal entities (i.e., non Federal Share of Property Cost) Total cost/share percentage $625,000.00 12.5% 72 24

EXAMPLE II: MULTIPLE FEDERAL FUNDING SOURCE FEDERAL FUNDED HOUSING PROGRAM DESCRIPTION AMOUNT SHARE PERCENTAGE Amount/Share percentage $2,000,000.00 40% provided by the Federal government Amount/Share percentage $2,375,000.00 47.5% provided by the recipient or other non Federal entities (i.e., non Federal Share of Property Cost) Total cost/share percentage $4,375,000.00 87.5% 73 14g. Has a deed, lien, covenant, or other related documentation been recorded to establish Federal interest in this real property? _X Yes No N/A Check either yes or no to indicate if the documentation has been recorded. If the awarding agency has not imposed the requirement to record Federal interest in the real property, check NA. If yes (unless previously reported), describe the instrument used (i.e., deed, lien, covenant, etc.) and enter the date (01/04/2007) and jurisdiction (Arlington, VA County Clerk s office, Deed book #54987, page 234) in which it was recorded. The recordation of Federal interest in real property must be reported by no later than the next scheduled reporting date after the real property has been acquired, improved or donated, or as directed by the awarding agency in the award document. The recipient must maintain records of the recordation of Federal interest in real property and make such records available upon the request of the Federal government. 74 14h. Has Federally required insurance coverage been secured for this real property? _X_ Yes No Check either yes or no to indicate if Federally required insurance has been secured for the real property. The recipient must maintain records of the insurance coverage that has been secured for the real property and make the records available upon the request of the Federal government. Note: Recipients must provide insurance coverage for any real property acquired under a Federal financial assistance award that is, at a minimum, equivalent to insurance coverage that the recipient provides for other real property they own. 75 25

14i. Are there any Uniform Relocation Act (URA) requirements applicable to this real property? _X_ Yes No If the acquisition or development of the real property involved the movement of any person permanently from real property or the movement of personal property from real property directly because of acquisition, rehabilitation, or demolition for an activity undertaken with Federal assistance, the Uniform Relocation Act (URA) requirements may apply. Indicate if the Act applies by checking yes or no. If the Act does apply, the recipient must maintain records of compliance and make such information available upon the request of the Federal government. The Uniform Relocation Act states To provide for uniform and equitable treatment of persons displaced from their homes, businesses, or farms by Federal and federally assisted programs and to establish uniform and equitable land acquisition policies for Federal and federally assisted programs. 76 14j. Are there any environmental compliance requirements related to the real property? _X_ Yes No If yes, describe them (attach additional sheets if necessary): Example: Asbestos exposure to the children and staff in the last 12 months. The agency has eliminated the risk of asbestos exposure, by removing all such products in the facility. The recipient must maintain records of compliance with all environmental requirements related to the real property and make such information available upon the request of the Federal government. 77 14k. In accordance with the National Historic Preservation Act (NHPA), does the property possess historic significance, and/or is it listed or eligible for listing in the National Register of Historic Places? Yes _X No If yes, describe them (attach additional sheets if necessary): In accordance with Section 106 of the National Historic Preservation Act (NHPA), does the property possess historic significance, and/or is it listed or eligible for listing in the National Register of Historic Places? Describe any historical significance, National Register of Historic Places listing or eligibility for such listing, related to the real property. Note, any property listed in, or eligible for listing in the National Register of Historic Places is considered historic. 78 26

Section 106 protections also extend to properties that possess significance but have not yet been listed or formally determined eligible for listing. The National Historic Preservation Act (NHPA) states the spirit and direction of the Nation are founded upon and reflected in its historic heritage; the historical and cultural foundations of the Nation should be preserved as a living part of our community life and development; and historic properties significant to the Nationʹs heritage are being lost or substantially altered, often inadvertently, with increasing frequency. 79 15. Has a significant change occurred with the real property, or is there an anticipated change expected during the next reporting period? Yes _X_ No Check the applicable block to indicate either yes or no. If a significant change has occurred (or is anticipated to occur during the next reporting period), such as a major building renovation or remodeling, damage to the real property due to an act of God (flood, hurricane, earthquake, etc.) or other significant change that would affect the value of the property, describe the change. Attach additional sheets if necessary. Note: If a significant change has occurred, 14f. should be recalculated to reflect the change in Federal interest, if any. 80 16. Real Property Disposition Status: Check the appropriate block (A F) to indicate the type of disposition status being reported, if any. _X A. Sold B. Transferred to different award C. Used in other Federally sponsored project/program D. Transferred title E. Retained Title F. N/A i. If the Federal agency provided the recipient with disposition instructions to sell or retain title to the real property, enter the amount of funds owed to the Federal government. Enter the amount of funds owed to the Federal government as compensation for the Federal interest in the real property if the awarding agency either directed the recipient to sell or granted them permission to retain title to the real property. $200,000.00 81 27

ii. If applicable, enter the amount of any net proceeds from the sale of the real property and describe how the proceeds were distributed. If applicable, enter the amount of any net proceeds from the sale of the real property and indicate if they were returned to the Federal government, used as an offset toward the cost of acquiring replacement real propertyfortheprojectorprogram,orusedtooffset the original cost of the real property if the award is still active. If not applicable enter NA. 82 iii. If the Federal agency directed the recipient to transfer title to the real property, enter the amount of funds the Federal agency owes. If the recipient was directed to transfer title to either the Federal agency or to a third party identified by the Federal agency, enter the amount of funds the Federal agency owes the recipient as compensation for their interest in the real property (i.e., the percentage of the recipient s participation in the project cost multiplied by the fair market value of the real property at the time of disposition). 83 17. Indicate the cumulative energy consumption for the previous 12 months: Cumulative Energy Use may be obtained from the facility utility bills or outreach to the utility provider. Depending on the locality, the bill may include only the current month or may include the total for the 12 months prior and post project completion. When the grantee is one tenant in a multi tenant facility AND separate utility metering is not in place, pro rata estimating is appropriate The anticipated energy consumption, post completion for new construction and renovation projects, should be available in the project plan. Use of the Portfolio Manager tool, a free application, is encouraged for the tracking of energy consumption data. (http://www.energystar.gov/index.cfm?c=evaluate_performance.bu s_portfoliomanager) A. Electric (kwh)_12000 or (Btu) B. Petroleum (Gal) 10,000 C. Natural Gas (cu ft) D. Other (Specify) 84 28

18. Remarks. Enter any explanations deemed necessary or information required by the Federal agency including any remarks that the recipient would like to make to address issues that are not addressed elsewhere in this report. Attach additional sheets if necessary. _ 85 Real Property Status Report No Property Attachment A (SF 429A) 86 SF 429 A No Property SF-429-A No Property must be submitted annually on the same date the grantee s annual SF-425 Federal Financial Report for the budget period is due. o A separate Attachment A is required when there is no real property. 87 29

Real Property Status Report ATTACHMENT A (General Reporting) SF 429 A Real Property Details. Provide the requested information in subsections 13 through 18 of Attachment A for each parcel of real property being reported. Use a separate sheet to report information on each parcel of real property under the Federal Financial Assistance award identified in section 2. If a section does not apply, enter N/A. Below is a summary of the required information to be provided for each subsection of Attachment A: 13. Period and type of Federal Interest (MM/DD/YYYY): From: To: Acquisition Renovation Construction Government Furnished Property Enter the period, established in the award document, during which Federal interest in the real property begins (i.e., From) and ends (i.e., To) using (MM/DD/YYYY) format. [ex., From: 03/23/2005 To: 03/22/2025]. This period may exceed the grant award performance period in those instances where Federal interest continues beyond the end of the current award. In some instances the end date for the period of Federal interest may not be defined by a specific date. If that is the case, enter the beginning date along with a statement to indicate the planned or uncertain end date (ex. From: 03/23/2005 To: Expiration of Federal Interest ). 88 14a. Description of Real Property. Describethetypeofrealpropertybeing reported (i.e., land, building, etc.) and provide a useful description of the real property (i.e., building number 17 at the National Research Center, Chapel Hill, NC). If the real property is being renovated or altered, also describe the nature of the work (i.e., major renovation of building 17, wing c). 14b. Address of Real Property. Enter the legal description and complete address for each parcel of real property being reported including the street, city, state, county/parish, country, zip code, and physical location if an address is not available (i.e., latitude, longitude, lot number, parcel number, etc.). N/A Also, indicate zoning information related to the real property (i.e., mixed use, residential, commercial, etc.). 89 14c. Land Acreage or Square Units: Enter the size of the land or the size of the land on which the real property is located in terms of measured acreage or square units (i.e., 1.5 acres, 0.8 sq. km., etc.). Enter Amount: Identify the unit of measure. Use only one option, either acres, square kilometers, square feet, or square meters. Select units: Acres Square Feet Square Kilometers Square Meters 14d. Gross and Usable Square Footage/Meters (i.e., of building, house, etc.): Enter the gross and usable square footage/meters for each structure (i.e., of the building, house, etc.) being reported. Enter Amounts: Gross Usable Identify the unit of measure. Select only one, either square feet or square meters. Select Units: Square Feet Square Meters 90 30

14e. Real Property Ownership Type(s): A. Owned B. Co Owned C. Fee Simple D. Corporate E. Joint Tenancy F. Partnership G. Limited Liability Partnership H. Co Operative I. Government Furnished Property J. Other (Describe): Check the applicable box(es) to indicate the real property ownership type(s). If more than one type is applicable, check all that apply. If the ownership types listed do not apply, check J. Other and describe the ownership arrangement. Example of Other: Conservation Easement 14f. Real Property Cost: Share Percentage Federal Share: $ [%] Non Federal Share: $ [%] Total (Federal and Non Federal Share): [%] 91 14g. Has a deed, lien, covenant, or other related documentation been recorded to establish Federal interest in this real property? Yes No N/A Check either yes or no to indicate if the documentation has been recorded. If the awarding agency has not imposed the requirement to record Federal interest in the real property, check NA. 92 14h. Has Federally required insurance coverage been secured for this real property? Yes No Check either yes or no to indicate if Federally required insurance has been secured for the real property. The recipient must maintain records of the insurance coverage that has been secured for the real property and make the records available upon the request of the Federal government. Note: Recipients must provide insurance coverage for any real property acquired under a Federal financial assistance award that is, at a minimum, equivalent to insurance coverage that the recipient provides for other real property they own. 93 31

14i. Are there any Uniform Relocation Act (URA) requirements applicable to this real property? Yes No If the acquisition or development of the real property involved the movement of any person permanently from real property or the movement of personal property from real property directly because of acquisition, rehabilitation, or demolition for an activity undertaken with Federal assistance, the Uniform Relocation Act (URA) requirements may apply. Indicate if the Act applies by checking yes or no. If the Act does apply, the recipient must maintain records of compliance and make such information available upon the request of the Federal government. 94 14j. Are there any environmental compliance requirements related to the real property? Yes No If yes, describe them (attach additional sheets if necessary): The recipient must maintain records of compliance with all environmental requirements related to the real property and make such information available upon the request of the Federal government. 95 14k. In accordance with the National Historic Preservation Act (NHPA), does the property possess historic significance, and/or is it listed or eligible for listing in the National Register of Historic Places? Yes No If yes, describe them (attach additional sheets if necessary): In accordance with Section 106 of the National Historic Preservation Act (NHPA), does the property possess historic significance, and/or is it listed or eligible for listing in the National Register of Historic Places? Describe any historical significance, National Register of Historic Places listing or eligibility for such listing, related to the real property. Note, any property listed in, or eligible for listing in the National Register of Historic Places is considered historic. 96 32

15. Has a significant change occurred with the real property, or is there an anticipated change expected during the next reporting period? Yes No Check the applicable block to indicate either yes or no. If a significant change has occurred (or is anticipated to occur during the next reporting period), such as a major building renovation or remodeling, damage to the real property due to an act of God (flood, hurricane, earthquake, etc.) or other significant change that would affect the value of the property, describe the change. Attach additional sheets if necessary. Note: If a significant change has occurred, 14f. should be recalculated to reflect the change in Federal interest, if any. 97 16. Real Property Disposition Status: Check the appropriate block (A F) to indicate the type of disposition status being reported, if any. A. Sold B. Transferred to different award C. Used in other Federally sponsored project/program D. Transferred title E. Retained Title F. N/A i. If the Federal agency provided the recipient with disposition instructions to sell or retain title to the real property, enter the amount of funds owed to the Federal government. Enter the amount of funds owed to the Federal government as compensation for the Federal interest in the real property if the awarding agency either directed the recipient to sell or granted them permission to retain title to the real property. 98 ii. If applicable, enter the amount of any net proceeds from the sale of the real property and describe how the proceeds were distributed. If applicable, enter the amount of any net proceeds from the sale of the real property and indicate if they were returned to the Federal government, used as an offset toward the cost of acquiring replacement real propertyfortheprojectorprogram,orusedtooffset the original cost of the real property if the award is still active. If not applicable enter NA. 99 33

iii. If the Federal agency directed the recipient to transfer title to the real property, enter the amount of funds the Federal agency owes. If the recipient was directed to transfer title to either the Federal agency or to a third party identified by the Federal agency, enter the amount of funds the Federal agency owes the recipient as compensation for their interest in the real property (i.e., the percentage of the recipient s participation in the project cost multiplied by the fair market value of the real property at the time of disposition). 100 17. Indicate the cumulative energy consumption for the previous 12 months: Cumulative Energy Use may be obtained from the facility utility bills or outreach to the utility provider. Depending on the locality, the bill may include only the current month or may include the total for the 12 months prior and post project completion. When the grantee is one tenant in a multi tenant facility AND separate utility metering is not in place, pro rata estimating is appropriate The anticipated energy consumption, post completion for new construction and renovation projects, should be available in the project plan. Use of the Portfolio Manager tool, a free application, is encouraged for the tracking of energy consumption data. (http://www.energystar.gov/index.cfm?c=evaluate_performance.bu s_portfoliomanager) A. Electric (kwh) or (Btu) B. Petroleum (Gal) C. Natural Gas (cu ft) D. Other (Specify) 101 18. Remarks. Enter any explanations deemed necessary or information required by the Federal agency including any remarks that the recipient would like to make to address issues that are not addressed elsewhere in this report. Attach additional sheets if necessary. No Property for which to Report 102 34

Real Property Status Report ATTACHMENT B (Request to Acquire, Improve or Furnish) SF 429 B 103 SF 429 B Request to Acquire, Improve, or Furnish SF-429-B Request to Acquire, Improve, or Furnish must be submitted along with the additional information required by 45 CFR 1303 Subpart E whenever a grantee is seeking ACF approval to use Head Start funds to engage in purchase, construction, or major renovation of facilities as defined in 45 CFR 1305.2. 104 SF 429 B Request to Acquire, Improve, or Furnish o Information included in SF-429-B can be cross-referenced if also required by 45 CFR 1303 Subpart E. o A request to acquire property includes the use of Head Start funds to engage in all purchase activities defined in 45 CFR 1305.2, including payments made in satisfaction of a mortgage or other loan agreement. 105 35

Real Property Status Report ATTACHMENT B (Request to Acquire, Improve or Furnish) SF 429 B Real Property Details. Complete the applicable information in subsections 13a. through 15. of Attachment B for each parcel of real property for which the recipient is requesting the authority to acquire, improve, or be provided as Government Furnished Property (GFP). This attachment should only be used if the applicable program authority or budget allows recipients to acquire, improve or furnish real property. Use a separate sheet for each parcel of real property under the Federal financial assistance award identified in section 2. With the exception of 15, all sections are required to be completed for all requests. Below is a summary of the required information to be provided for each subsection of Attachment B: 106 13a. Description of Real Property. Describethetypeofrealproperty being reported (i.e., land, building, etc.) and provide a useful description of the real property (i.e., building number 17 at the National Research Center, Chapel Hill, NC). If the real property is being renovated or altered, also describe the nature of the work (i.e., major renovation of building 17, wing c). 13b. Address of Real Property. Enter the legal description and complete address for each parcel of real property being reported including the street, city, state, county/parish, country, zip code, and physical location if an address is not available (i.e., latitude, longitude, lot number, parcel number, etc.). NEXT SLIDE INCLUDES MORE DETAIL REGARDING THE ADDRESS NOTE: PARCEL NUMBER13 DIGTIT NUMBER THAT A COMMUNITY S TAX ASSESSOR ASSIGNS. Also, indicate zoning information related to the real property (i.e., mixed use, residential, commercial, etc.). 107 Where an address is not available, or more precision is required, geographic coordinates may be used. Locational data should be recorded with a Global Positioning System (GPS) device set to NAD 83, or WGS 84 datum using either of the following coordinate reference systems: United States National Grid (USNG) using the full grid zone designation and a minimum of eight digits. Decimal degrees latitude and longitude, with at least 6 decimal places and a minus ( ) toshowwest longitude or south latitude. 108 36