OMB Approved No.: 1505-0269 

Expiration Date: 10/31/2021 

HOMEOWNER ASSISTANCE FUND 

U.S. DEPARTMENT OF THE TREASURY 

Financial Assistance Agreement 

Recipient Name and Address: 

[Recipient to provide] 

DUNS Number: [Recipient to provide] 

Taxpayer Identification Number: [Recipient to provide]

Section 3206 of the American Rescue Plan Act of 2021 authorizes the U.S. Department of the Treasury 

(Treasury) to mitigate financial hardships associated with the coronavirus pandemic by providing funds 

to eligible entities for the purpose of preventing homeowner mortgage delinquencies, defaults, 

foreclosures, loss of utilities or home energy services, and displacements of homeowners experiencing 

financial hardship after January 21, 2020, through qualified expenses related to mortgages and housing. 

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

hereto. 

Recipient: 

__________________________________________________ 

Name of Authorized Representative: 

Title: 

Date:

U.S. Department of the Treasury: 

__________________________________________________ 

Name of 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. 

PRIVACY ACT STATEMENT 

AUTHORITY: Solicitation of this information is authorized by the American Rescue Plan Act of 2021, Title III, Pub. L. 117-2. 

PURPOSE: Treasury is required by the American Rescue Plan Act of 2021 to identify eligible entities to provide homeowners assistance to individuals 

who qualify for relief under the Act. Eligible entities are state, territorial, and tribal governments, which will identify homeowners eligible for relief based 

on requirements under the Act. Treasury maintains contact information for authorized representatives and contact persons for the purpose of 

communicating with eligible entities regarding issues related to implementation of the Act. 

ROUTINE USES: The information you furnish may be shared in accordance with the routine uses outlined in the Treasury’s system of records notice, 

Treasury .017 - Correspondence and Contact Information, which can be found at 81 FR 78266 (Nov. 7, 2016). 

DISCLOSURE: Disclosure of this information to Treasury is required in order to comply with the requirements the American Rescue Plan Act of 

2021. Disclosure of this information is voluntary, however, grantees/recipients that do not disclose contact information will be unable to communicate 

with Treasury on issues related to their obligations under the Act and this may affect the status of their grant. 
HOMEOWNER ASSISTANCE FUND 

U.S. DEPARTMENT OF THE TREASURY 

Use of Funds. Recipient agrees that the funds disbursed under this award will only be used for 

the purposes set forth in section 3206 of the American Rescue Plan Act of 2021 (the HAF 

Statute) and the Guidance for the Homeowner Assistance Fund issued by Treasury on April 

14, 2021, as amended from time to time, and any other guidance issued by Treasury regarding 

the HAF (the Guidance). 

Reallocation of Funds. Recipient understands and agrees that any funds allocated by Treasury 

to Recipient that are not subsequently requested by and disbursed to Recipient may be 

reallocated by Treasury to other eligible entities, in accordance with the HAF statute. 

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

and ends on September 30, 2026. Recipient shall not incur any obligations to be paid with the 

funding from this award after such period of performance ends. 

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

related to this award. Recipient acknowledges that any such information required to be reported 

pursuant to this section may be publicly disclosed. 

Maintenance of and Access to Records. 

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

compliance with the HAF Statute and the Guidance. 

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, Regulations, and Guidance. 

a. Recipient agrees to comply with the HAF Statute and the Guidance. 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. 
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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. 

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 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, 

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. 
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d. Conflict of Interest. Recipient agrees that it will maintain in effect a conflict of interest 

policy consistent with 2 C.F.R. § 200.318(c) covering each activity funded under this 

award. Recipients and subrecipients shall disclose in writing to Treasury or the passthrough agency, as appropriate, any potential conflict of interest affecting the awarded 

funds in accordance with 2 C.F.R. § 200.112. 

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

with this award is a violation of federal criminal law and 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; or (2) that are 

determined by the Treasury Office of Inspector General to have been misused 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. 

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 
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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 (Apr. 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, 74 FR 51225 

(Oct. 1, 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.