OMB Approved No.:1505-0271 

Expiration Date: 11/30/2021

U.S. DEPARTMENT OF THE TREASURY

CORONAVIRUS STATE FISCAL RECOVERY FUND

Recipient name and address: 

[Recipient to provide]

DUNS Number: [Recipient to provide]

Taxpayer Identification Number: [Recipient to 

provide]

Assistance Listing Number: 21.027

Section 602(b) of the Social Security Act (the Act), as added by section 9901 of the American Rescue Plan 

Act (ARPA), Pub. L. No. 117-2 (March 11, 2021), authorizes the Department of the Treasury (Treasury) 

to make payments to certain recipients from the Coronavirus State Fiscal Recovery Fund.

As a condition to receiving such payment from Treasury, the authorized representative below hereby 

(i) certifies that the recipient named above requires the payment to be made pursuant to section 602(b) 

of the Act in order to carry out the activities listed in section 602(c) of the Act and (ii) agrees to the terms 

attached hereto.

Section 603(b)(2) of the Act authorizes Treasury to make payments to States for the State to distribute 

to nonentitlement units of local government within the State in accordance with section 603(b)(2). The 

authorized representative below hereby agrees to use such payment from Treasury to make payments to 

such nonentitlement units of local government in accordance with Section 603(b) of the Act and 

Treasury’s implementing regulations and guidance.

Section 603(b)(3)(B)(ii) of the Act authorizes Treasury to make payments to States, in the case of an 

amount to be paid to a county that is not a unit of general local government, for the State to distribute to 

units of general local government within such county in accordance with Section 603(b)(3)(B)(ii) of the 

Act. To the extent applicable, the authorized representative below hereby agrees to use any such 

payment from Treasury to make payments to such units of general local government in accordance with 

Section 603(b) of the Act and Treasury’s implementing regulations and guidance.

Recipient:

__________________________________________________

Authorized Representative: 

Title: 

Date signed:

U.S. Department of the Treasury:

__________________________________________________

Authorized Representative: 

Title: 

Date:

PAPERWORK REDUCTION ACT NOTICE

The information collected will be used for the U.S. Government to process requests for support. The estimated burden associated with 

this collection of information is 15 minutes per response. Comments concerning the accuracy of this burden estimate and suggestions 

for reducing this burden should be directed to the Office of Privacy, Transparency and Records, Department of the Treasury, 1500 

Pennsylvania Ave., N.W., Washington, D.C. 20220. DO NOT send the form to this address. An agency may not conduct or sponsor, and 

a person is not required to respond to, a collection of information unless it displays a valid control number assigned by OMB.
2

U.S. DEPARTMENT OF THE TREASURY

CORONAVIRUS STATE FISCAL RECOVERY FUND

AWARD TERMS AND CONDITIONS

Use of Funds. 

a. Recipient understands and agrees that the funds disbursed under this award may only be used in 

compliance with section 602(c) of the Social Security Act (the Act) and Treasury’s regulations 

implementing that section and guidance. 

b. Recipient will determine prior to engaging in any project using this assistance that it has the 

institutional, managerial, and financial capability to ensure proper planning, management, and 

completion of such project.

Period of Performance. The period of performance for this award begins on the date hereof and ends 

on December 31, 2026. As set forth in Treasury’s implementing regulations, Recipient may use award 

funds to cover eligible costs incurred during the period that begins on March 3, 2021, and ends on 

December 31, 2024. 

Reporting. Recipient agrees to comply with any reporting obligations established by Treasury as they 

relate to this award.

Maintenance of and Access to Records

a. Recipient shall maintain records and financial documents sufficient to evidence compliance with 

section 602(c), Treasury’s regulations implementing that section, and guidance issued by Treasury 

regarding the foregoing.

b. The Treasury Office of Inspector General and the Government Accountability Office, or their 

authorized representatives, shall have the right of access to records (electronic and otherwise) of 

Recipient in order to conduct audits or other investigations.

c. Records shall be maintained by Recipient for a period of five (5) years after all funds have been 

expended or returned to Treasury, whichever is later. 

Pre-award Costs. Pre-award costs, as defined in 2 C.F.R. § 200.458, may not be paid with funding 

from this award. 

Administrative Costs. Recipient may use funds provided under this award to cover both direct and 

indirect costs. 

Cost Sharing. Cost sharing or matching funds are not required to be provided by Recipient.

Conflicts of Interest. Recipient understands and agrees it must maintain a conflict of 

interest policy consistent with 2 C.F.R. § 200.318(c) and that such conflict of interest policy is 

applicable to each activity funded under this award. Recipient and subrecipients must disclose in 

writing to Treasury or the pass-through entity, as appropriate, any potential conflict of interest 

affecting the awarded funds in accordance with 2 C.F.R. § 200.112.
3

Compliance with Applicable Law and Regulations. 

a. Recipient agrees to comply with the requirements of section 602 of the Act, regulations adopted by 

Treasury pursuant to section 602(f) of the Act, and guidance issued by Treasury regarding the 

foregoing. Recipient also agrees to comply with all other applicable federal statutes, regulations, 

and executive orders, and Recipient shall provide for such compliance by other parties in any 

agreements it enters into with other parties relating to this award.

 

b. Federal regulations applicable to this award include, without limitation, the following:

i. Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal 

Awards, 2 C.F.R. Part 200, other than such provisions as Treasury may determine are 

inapplicable to this Award and subject to such exceptions as may be otherwise provided by 

Treasury. Subpart F – Audit Requirements of the Uniform Guidance, implementing the 

Single Audit Act, shall apply to this award.

ii. Universal Identifier and System for Award Management (SAM), 2 C.F.R. Part 25, pursuant 

to which the award term set forth in Appendix A to 2 C.F.R. Part 25 is hereby incorporated 

by reference. 

iii. Reporting Subaward and Executive Compensation Information, 2 C.F.R. Part 170, pursuant 

to which the award term set forth in Appendix A to 2 C.F.R. Part 170 is hereby incorporated 

by reference. 

iv. OMB Guidelines to Agencies on Governmentwide Debarment and Suspension 

(Nonprocurement), 2 C.F.R. Part 180, including the requirement to include a term or 

condition in all lower tier covered transactions (contracts and subcontracts described in 2 

C.F.R. Part 180, subpart B) that the award is subject to 2 C.F.R. Part 180 and Treasury’s 

implementing regulation at 31 C.F.R. Part 19.

v. Recipient Integrity and Performance Matters, pursuant to which the award term set forth in 

2 C.F.R. Part 200, Appendix XII to Part 200 is hereby incorporated by reference.

vi. Governmentwide Requirements for Drug-Free Workplace, 31 C.F.R. Part 20. 

vii. New Restrictions on Lobbying, 31 C.F.R. Part 21. 

viii. Uniform Relocation Assistance and Real Property Acquisitions Act of 1970 (42 U.S.C. §§ 

4601-4655) and implementing regulations.

ix. Generally applicable federal environmental laws and regulations.

c. Statutes and regulations prohibiting discrimination applicable to this award include, without 

limitation, the following:

i. Title VI of the Civil Rights Act of 1964 (42 U.S.C. §§ 2000d et seq.) and Treasury’s 

implementing regulations at 31 C.F.R. Part 22, which prohibit discrimination on the basis 

of race, color, or national origin under programs or activities receiving federal financial 

assistance;

ii. The Fair Housing Act, Title VIII of the Civil Rights Act of 1968 (42 U.S.C. §§ 3601 et seq.), 
4

which prohibits discrimination in housing on the basis of race, color, religion, national 

origin, sex, familial status, or disability;

iii. Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. § 794), which prohibits 

discrimination on the basis of disability under any program or activity receiving federal 

financial assistance;

iv. The Age Discrimination Act of 1975, as amended (42 U.S.C. §§ 6101 et seq.), and Treasury’s 

implementing regulations at 31 C.F.R. Part 23, which prohibit discrimination on the basis 

of age in programs or activities receiving federal financial assistance; and

v. Title II of the Americans with Disabilities Act of 1990, as amended (42 U.S.C. §§ 12101 et 

seq.), which prohibits discrimination on the basis of disability under programs, activities,

and services provided or made available by state and local governments or instrumentalities 

or agencies thereto.

Remedial Actions. In the event of Recipient’s noncompliance with section 602 of the Act, other 

applicable laws, Treasury’s implementing regulations, guidance, or any reporting or other program 

requirements, Treasury may impose additional conditions on the receipt of a subsequent tranche of 

future award funds, if any, or take other available remedies as set forth in 2 C.F.R. § 200.339. In the 

case of a violation of section 602(c) of the Act regarding the use of funds, previous payments shall be 

subject to recoupment as provided in section 602(e) of the Act and any additional payments may be 

subject to withholding as provided in sections 602(b)(6)(A)(ii)(III) of the Act, as applicable.

Hatch Act. Recipient agrees to comply, as applicable, with requirements of the Hatch Act (5 U.S.C. 

§§ 1501-1508 and 7324-7328), which limit certain political activities of State or local government 

employees whose principal employment is in connection with an activity financed in whole or in part 

by this federal assistance.

False Statements. Recipient understands that making false statements or claims in connection with 

this award is a violation of federal law and may result in criminal, civil, or administrative sanctions, 

including fines, imprisonment, civil damages and penalties, debarment from participating in federal

awards or contracts, and/or any other remedy available by law.

Publications. Any publications produced with funds from this award must display the following 

language: “This project [is being] [was] supported, in whole or in part, by federal award number 

[enter project FAIN] awarded to [name of Recipient] by the U.S. Department of the Treasury.”

Debts Owed the Federal Government.

a. Any funds paid to Recipient (1) in excess of the amount to which Recipient is finally determined 

to be authorized to retain under the terms of this award; (2) that are determined by the 

Treasury Office of Inspector General to have been misused; or (3) that are determined by 

Treasury to be subject to a repayment obligation pursuant to sections 602(e) and 603(b)(2)(D) 

of the Act and have not been repaid by Recipient shall constitute a debt to the federal 

government.

b. Any debts determined to be owed the federal government must be paid promptly by Recipient. 

A debt is delinquent if it has not been paid by the date specified in Treasury’s initial written 

demand for payment, unless other satisfactory arrangements have been made or if the 

Recipient knowingly or improperly retains funds that are a debt as defined in paragraph 14(a). 

Treasury will take any actions available to it to collect such a debt. 
5

Disclaimer.

a. The United States expressly disclaims any and all responsibility or liability to Recipient or third

persons for the actions of Recipient or third persons resulting in death, bodily injury, property

damages, or any other losses resulting in any way from the performance of this award or any

other losses resulting in any way from the performance of this award or any contract, or

subcontract under this award.

b. The acceptance of this award by Recipient does not in any way establish an agency relationship

between the United States and Recipient.

Protections for Whistleblowers. 

a. In accordance with 41 U.S.C. § 4712, Recipient may not discharge, demote, or otherwise

discriminate against an employee in reprisal for disclosing to any of the list of persons or entities 

provided below, information that the employee reasonably believes is evidence of gross

mismanagement of a federal contract or grant, a gross waste of federal funds, an abuse of authority

relating to a federal contract or grant, a substantial and specific danger to public health or safety,

or a violation of law, rule, or regulation related to a federal contract (including the competition for

or negotiation of a contract) or grant. 

b. The list of persons and entities referenced in the paragraph above includes the following: 

i. A member of Congress or a representative of a committee of Congress; 

ii. An Inspector General; 

iii. The Government Accountability Office; 

iv. A Treasury employee responsible for contract or grant oversight or management; 

v. An authorized official of the Department of Justice or other law enforcement agency; 

vi. A court or grand jury; or 

vii. A management official or other employee of Recipient, contractor, or subcontractor who

has the responsibility to investigate, discover, or address misconduct.

c. Recipient shall inform its employees in writing of the rights and remedies provided under this 

section, in the predominant native language of the workforce.

Increasing Seat Belt Use in the United States. Pursuant to Executive Order 13043, 62 FR 19217 

(Apr. 18, 1997), Recipient should encourage its contractors to adopt and enforce on-the-job seat belt 

policies and programs for their employees when operating company-owned, rented or personally 

owned vehicles.

Reducing Text Messaging While Driving. Pursuant to Executive Order 13513, 74 FR 51225 (Oct. 6, 

2009), Recipient should encourage its employees, subrecipients, and contractors to adopt and enforce 

policies that ban text messaging while driving, and Recipient should establish workplace safety 

policies to decrease accidents caused by distracted drivers.