OMB Approved No.: 1505-0266

Expiration Date: 7/31/21

U.S. DEPARTMENT OF THE TREASURY

EMERGENCY RENTAL ASSISTANCE

Recipient name and address:

[Recipient to provide]

DUNS Number: [Recipient to provide]

Taxpayer Identification Number: [Recipient to 

provide]

Section 501(a) of Division N of the Consolidated Appropriations Act, 2021, Pub. L. No. 116-260

(Dec. 27, 2020) authorizes the Department of the Treasury (“Treasury”) to make payments to 

certain recipients to be used to provide emergency rental assistance. 

Recipient hereby agrees, as a condition to receiving such payment from Treasury, to the terms 

attached hereto.

__________________________________________________

Authorized Representative: 

Title: [To be signed by chief executive officer if recipient is a local government.]

Date signed:

 
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U.S. DEPARTMENT OF THE TREASURY

EMERGENCY RENTAL ASSISTANCE

Use of Funds. Recipient understands and agrees that the funds disbursed under this award 

may only be used for the purposes set forth in Section 501 of Division N of the Consolidated 

Appropriations Act, 2021, Pub. L. No. 116-260 (Dec. 27, 2020) (referred to herein as “Section 

501”). 

Repayment and reallocation of funds. 

a. Recipient agrees to repay excess funds to Treasury in the amount as may be determined 

by Treasury pursuant to Section 501(d). Such repayment shall be made in the manner and 

by the date, which shall be no sooner than September 30, 2021, as may be set by Treasury. 

b. The reallocation of funds provided by Section 501(d) shall be determined by Treasury and 

shall be subject to the availability of funds at such time. 

Availability of funds. 

a. Recipient acknowledges that, pursuant to Section 501(e), funds provided under this award

shall remain available only through December 31, 2021, unless, in the case of a reallocation 

made by Treasury pursuant to section 501(d), Recipient requests and receives from 

Treasury an extension of up to 90 days. 

b. Any such requests for extension shall be provided in the form and shall include such 

information as Treasury may require. 

c. Amounts not expended by Recipient in accordance with Section 501 shall be repaid to 

Treasury in the manner specified by Treasury.

Administrative costs. 

a. Administrative expenses of Recipient may be treated as direct costs, but Recipient may not 

cover indirect costs using the funds provided in this award, and Recipient may not apply 

its negotiated indirect cost rate to this award. 

b. The sum of the amount of the award expended on housing stability services described in 

Section 501(c)(3) and the amount of the award expended on administrative expenses

described in Section 501(c)(5) may not exceed 10 percent of the total award. 

Reporting. 

a. Recipient agrees to comply with any reporting obligations established by Treasury, 

including the Treasury Office of Inspector General, as relates to this award, including 

but not limited to: (i) reporting of information to be used by Treasury to comply with its 

public reporting obligations under section 501(g) and (ii) any reporting to Treasury and 

the Pandemic Response Accountability Committee that may be required pursuant to 

section 15011(b)(2) of Division B of the Coronavirus Aid, Relief, and Economic Security 

Act (Pub. L. No. 116-136), as amended by Section 801 of Division O of the Consolidated

Appropriations Act, 2021 (Pub. L. No. 116-260). Recipient acknowledges that any such 

information required to be reported pursuant to this section may be publicly disclosed. 

b. Recipient agrees to establish data privacy and security requirements as required by Section 

501(g)(4). 
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Maintenance of and Access to Records

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

with Section 501(c) regarding the eligible uses of funds.

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. 

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

Compliance with Applicable Law and Regulations. 

a. Recipient agrees to comply with the requirements of Section 501 and Treasury interpretive 

guidance regarding such requirements. Recipient also agrees to comply with all other 

applicable federal statutes, regulations, and executive orders, and Recipient shall provide 

for such compliance 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 and 

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. 
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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 

grounds of race, color, or national origin under programs or activities receiving 

federal financial assistance;

ii. The Fair Housing Act, Title VIII-IX of the Civil Rights Act of 1968 (42 U.S.C. § 3601 

et seq.), which prohibits discrimination in housing on the basis of race, color, 

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 handicap under any program or activity 

receiving or benefitting from federal 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. 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.

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

with this award may result in fines, imprisonment, 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 not repaid by Recipient as may be required by Treasury pursuant to Section 

501(d) 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. Interest, penalties, and administrative charges shall be charged on delinquent 

debts in accordance with 31 U.S.C. § 3717 and 31 C.F.R. § 901.9. Treasury will refer 

any debt that is more than 180 days delinquent to Treasury’s Bureau of the Fiscal 

Service for debt collection services.

c. Penalties on any debts shall accrue at a rate of not more than 6 percent per year or 

such other higher rate as authorized by law. Administrative charges, that is, the costs 

of processing and handling a delinquent debt, shall be determined by Treasury.
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d. Funds for payment of a debt must not come from other federally sponsored programs. 

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 constitute 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 as a reprisal for disclosing information to any of the list 

of persons or entities provided below 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; and/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 (April 8, 1997), Recipient should and 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, 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.