OMB Approved No.: 1505-0269

Expiration Date: 10/31/2021

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United States Department of the Treasury

Homeowner Assistance Fund Plan 

For Participants with Allocations Under $5 million 

Introduction and Purpose

Welcome to the U.S. Treasury Department’s submission portal for the Homeowner Assistance Fund (HAF) Plan. 

In the HAF, an eligible entity (the “Participant”) is (1) a state, the District of Columbia, or U.S. territory; (2) the 

Department of Hawaiian Home Lands; (3) each Indian tribe (or, if applicable, the tribally designated housing entity of 

an Indian tribe) that was eligible for a grant under Title I of the Native American Housing Assistance and SelfDetermination Act of 1996 (25 U.S.C. 4111 et seq.) for fiscal year 2020; and (4) any Indian tribe that opted out of 

receiving a grant allocation under the Native American Housing Block Grants program formula in fiscal year 2020.

A HAF Participant may submit its HAF Plan using this portal only if the Participant’s HAF Allocation is less than $5 

million. Tribally Designated Housing Entities may submit a HAF Plan using this portal only if the submission is on 

behalf of HAF participants that have each been allocated less than $5 million in the HAF. If a HAF Participant has 

been allocated $5 million or more, a different template has been made available for larger allocations.

In the fields below, you will submit your HAF Plan, organized around the following plan elements:

• Homeowner Needs and Community Engagement

• Program Design 

• Performance Goals

• Readiness 

• Budget

After completing the form, please click on the DocuSign button to sign and submit the HAF Plan. 

Once the HAF Plan is submitted, Treasury will review the plan. Treasury may approve a HAF Plan in whole or in part. 

If Treasury identifies weaknesses in any elements of your HAF Plan, the Participant will be provided an opportunity to 

revise and resubmit those elements. Upon Treasury’s approval of the HAF Plan, Treasury will initiate steps to 

transmit the requested allocation amount. Treasury will evaluate HAF Plans as described in the HAF guidance, 

available at https://home.treasury.gov/system/files/136/HAF-Guidance.pdf. Please refer to the HAF guidance for 

definitions of terms used in this portal and additional information regarding the HAF.
OMB Approved No.: 1505-0269

Expiration Date: 10/31/2021

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Homeowner Needs and Community Engagement

What Quantitative Data Has Informed the Participant’s Planning?

Treasury will assess the extent to which a Participant has, in the course of its HAF planning process, relied on 

quantitative data and community input to inform the design of its HAF Plan. 

In its HAF planning process, has the Participant obtained quantitative data from mortgage servicers, private data 

providers, government entities, community-based organizations or other sources to inform its planning about how 

to target and best serve eligible homeowners with mortgage delinquencies, defaults, foreclosures?

 Yes

 No

If yes, please list and briefly describe each source of quantitative data.

Has the Participant requested and received input on its HAF planning process from tribal councils, community-based 

organizations, providers of housing counseling, or providers of legal assistance to homeowners facing foreclosure or 

displacement? Y/N

If yes, please list the tribal councils, community-based organizations, or providers, including each organization’s 

address and a website if available. 

Organization Name Address Web site

Example: ABC Housing 

Counseling Organization 

123 Housing Counseling Way, Town, State 

Zip Code

www.abccounselingorganization.org

Program Design

What are the Program Design Elements Through Which the Participant Will Deliver HAF Assistance to Eligible 

Homeowners?

A program design element is a specific activity or program, which is consistent with a qualified expense category,

under which a Participant will disburse HAF funds in accordance with the HAF Plan. Please note that multiple program 

design elements may fit under a single qualified expense category; for example, a mortgage assistance program that 

has different terms for federally backed mortgages and manufactured-home mortgages may constitute two separate 

program design elements, for which case the Participant provides a separate term sheet or other description for each 

Examples: 

• Data provided by Treasury – Treasury provided data, contributed by a number of federal agencies, including 

information on mortgage delinquencies and forbearances, breakdowns by demographic factors, and 

concentration among mortgage servicers.

• Data from on Mortgage Servicing – The Participant has entered into a data sharing agreement with 

Mortgage Data Company to obtain regularly updated data on mortgage delinquency among private-held 

mortgages.
OMB Approved No.: 1505-0269

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program design element. 

HAF participants must have at least one program design element intended to reduce mortgage delinquency among 

targeted populations. Treasury encourages HAF participants to consider program design elements that address 

homeownership preservation for targeted populations in areas where there is a sustained trend of increasing property 

taxes or utility costs, including for households that do not have mortgages. 

Please identify each qualified expense category in which the Participant will offer a program design element by 

checking the boxes below.

 mortgage payment assistance;

 financial assistance to allow a homeowner to reinstate a mortgage or to pay other housing-related costs related to 

a period of forbearance, delinquency, or default;

 mortgage principal reduction, including with respect to a second mortgage provided by a nonprofit or government 

entity;

 facilitating mortgage interest rate reductions;

 payment assistance for homeowner’s utilities, including electric, gas, home energy, and water;

 payment assistance for homeowner’s internet service, including broadband internet access service, as defined in 

47 CFR 8.1(b);

 payment assistance for homeowner’s insurance, flood insurance, and mortgage insurance; 

 payment assistance for homeowner’s association fees or liens, condominium association fees, or common 

charges;

 payment assistance for down payment assistance loans provided by nonprofit or government entities;

 payment assistance for delinquent property taxes to prevent homeowner tax foreclosures;

 measures to prevent homeowner displacement, such as home repairs to maintain the habitability of a home or 

assistance to enable households to receive clear title to their properties.

For each program design element that the Participant will offer, the Participant is required to upload a term sheet or 

other description that, at a minimum, provides the following information regarding that program design element. 

Term sheets for all of Participant’s HAF programs may be uploaded together as one document.

• Brief description – Explain how the funds will be used (e.g., what type of homeowner expense the funds will 

be used for). If applicable, describe how the funds may be used in combination with other assistance 

programs (e.g., loan servicer loss-mitigation programs). 

• Maximum amount of assistance per homeowner - Specify the maximum amount of assistance that each 

homeowner will be eligible to receive under the program design element.

• Eligibility criteria and documentation requirements – Explain all homeowner, mortgage, property, or other

eligibility criteria for the program design element (other than the mandatory eligibility requirements set forth 

in the HAF guidance). In addition, list any documentation that will be required from homeownersto establish 

such eligibility. Provide a justification for each additional eligibility or documentation requirement beyond 

those required under the HAF guidance, including an explanation of how the Participant determined that 

such requirement will not create barriers to participation for eligible households. 

• Form of assistance – Indicate whether the funds will be provided in the form of grants, forgivable loans, or 

other assistance. If the funds will be provided through forgivable loans, specify the terms for forgiveness. If 

the Participant proposes to provide the assistance in a form other than grants or forgivable loans, provide 

the reasoning for the proposed terms. If the Participant proposes to establish a home repair program, explain 

all criteria that will be used to determine whether a homeowner is eligible for the program (e.g., contractor 

licensing, repair contract requirements, zoning).
OMB Approved No.: 1505-0269

Expiration Date: 10/31/2021

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• Payment requirements – Indicate to whom payments will be made (e.g., to homeowners or to a third party) 

and any additional requirements there may be to complete a payment (e.g., bulk payment requirements for 

payees, method of determining amount of payment).

A HAF participant may elect to revise its HAF Plan over time to add or subtract program design elements. Does the 

Participant anticipate adding additional program design elements to this HAF Plan within one year of this submission? 

 Yes

 No

Documentation of Homeowner Income

Homeowners are eligible to receive amounts allocated to a HAF participant under the HAF only if they have incomes 

equal to or less than 150% of the area median income or 100% of the median income for the United States, whichever 

is greater. In addition, not less than 60% of amounts made available to each HAF participant must be used for qualified 

expenses that assist homeowners having incomes equal to or less than 100% of the area median income or equal to 

or less than 100% of the median income for the United States, whichever is greater. The HAF guidance describes 

permissible ways for HAF participants to determine homeowner income.

Under the HAF guidance, one permissible approach for determining income is for (1) the household to provide a 

written attestation as to household income and (2) the HAF participant to use a reasonable fact-specific proxy for 

household income, such as reliance on data regarding average incomes in the household’s geographic area. Will the 

Participant allow income to be determined in this way? 

 Yes

 No

If yes, please describe the fact-specific proxy or proxies to be used for the income determination.

TEXT BOX

Under the HAF guidance, HAF participants may provide waivers or exceptions to this documentation requirement as 

reasonably necessary to accommodate extenuating circumstances, such as disabilities, practical challenges related to 

the pandemic, or a lack of technological access by homeowners; in these cases, the HAF participant is still responsible 

for making the required determination regarding household income and documenting that determination. Will the 

Participant allow applicants to request such waivers or exceptions? 

 Yes

 No

Eligible Mortgage Types

Please indicate which of the following mortgage types are eligible to be assisted under one or more of the 

Participant’s program design elements 

First Mortgages

Second Mortgages 
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Reverse Mortgages (Home Equity Conversion Mortgages, Single-Purposes Reverse Mortgages, or Proprietary 

Reverse Mortgages)

Loans Secured by Manufactured Housing (secured by real estate or a dwelling)

Contracts for Deed or Land Contract (if it is a credit transaction secured by a consensual security interest in the 

dwelling)

If the Participant excludes any of the forgoing mortgage types from one or more program design elements, explain 

the exclusion.

Outreach

Will the Participant engage in outreach through partnerships with organizations that focus primarily on serving 

homeowners earning incomes below 100% of area median income or socially disadvantaged individuals and that have 

the capacity to engage targeted communities in a culturally and linguistically relevant manner to encourage the 

submission of applications for HAF resources from targeted populations?

 Yes

 No

If yes, please indicate whether the community outreach efforts will include partnerships with organizations that 

primarily target the following populations:

 member of a group that has been subjected to racial or ethnic prejudice or cultural bias within American society;

 resident of a majority-minority Census tract; 

 resident of a U.S. territory, Indian reservation, or Hawaiian Home Land;

 homeowners that reside in persistent poverty counties;

 individual with limited English proficiency.

Please indicate in which languages, in addition to English, community outreach efforts to targeted populations will 

be undertaken:

 Spanish

 Chinese

 Vietnamese

 Korean

 Tagalog

 Russian

 Arabic

 Haitian Creole

 other _______________________
OMB Approved No.: 1505-0269

Expiration Date: 10/31/2021

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Housing Counseling and Legal Services

Will the Participant facilitate access for eligible households to housing counseling or legal services?

 Yes

 No

If yes, please identify below the providers of housing counseling or legal services that have indicated to the Participant 

that they are willing and able to support homeowners receiving assistance under the Participant’s HAF programs.

Provider 

Name

Provider 

Address

Provider Website Provider Primarily 

Serves LMI

Households

Provider 

Addresses 

Impacts of 

Housing 

Discrimination

Example: ABC 

Housing 

Counseling 

Organization 

123 Housing 

Counseling 

Way, Town, 

State Zip 

Code

www.abccounselingorganization.org CHECK BOX CHECK BOX

Please indicate all of the languages, in addition to English, in which HAF related outreach or communications 

activities will be undertaken:

 Spanish;

 Chinese

 Vietnamese

 Korean

 Tagalog

 Russian

 Arabic

 Haitian Creole

 other _______________________

What Efforts will be Made to Address Barriers to HAF Program Participation for Potentially Eligible Homeowners, 

Including Those with Limited English Proficiency or Who are Disabled?

Targeted outreach may be needed to reach homeowners who are likely to experience barriers to access, including 

persons with limited English proficiency and those with disabilities.

Indicate all of the languages, in addition to English, in which the Participant’s HAF application and other program 

documents will be made available:

 Spanish

 Chinese

 Vietnamese

 Korean

 Tagalog

 Russian
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 Arabic

 Haitian Creole

 other _______________________

Will the Participant’s HAF applications and other program documents be provided in forms that are accessible to 

persons with disabilities?

 Yes

 No

Please explain any other efforts being undertaken by the Participant to facilitate access to HAF resources by 

potentially eligible homeowners that are likely to experience barriers to their access? (optional)

Performance Goals

Treasury will consider the goals and benchmarks the Participant proposes to use to measure the effectiveness of its 

programs, including whether those goals address the homeowner needs identified by the Participant, the extent to 

which the goals are disaggregated by key homeowner characteristics as appropriate for the jurisdiction, and whether 

they include a goal focused on reducing mortgage delinquency.

Please describe Participant’s goals and benchmarks for each of its programs with the following program design 

elements.

Program Design Element Metrics of Success Goal

Mortgage payment assistance

Allow homeowners to reinstate 

mortgages or pay other housingrelated costs

Mortgage principal reduction

Facilitating mortgage interest rate 

reductions

Payment assistance for 

homeowner’s utilities (e.g., 

electric, gas, home energy, and 

water)

Payment assistance for 

homeowner’s internet service (e.g., 

broadband)

Payment assistance for 

homeowner’s, flood, and mortgage 

insurance

Payment assistance for 

homeowner’s association fees or 

liens, condominium association 

fees, or common charges
OMB Approved No.: 1505-0269

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Payment assistance for down 

payment assistance loans provided 

by nonprofit or government entities

Payment assistance for delinquent 

property taxes to prevent 

homeowner tax foreclosures

Measures to prevent homeowner 

displacement

Examples of metrics of success:

• Number of home losses avoided due to HAF funds.

• Number of tax-related delinquencies paid off.

Examples of goals:

• Prevent 500 home losses within 24 months

• Prevent the replacement of 100 homeowners by paying off delinquent property taxes

Readiness

Staffing, Systems and Contractors

Treasury seeks information regarding the Participant’s organizational capacity to implement its HAF Plan.

Does the Participant anticipate needing to hire additional staff to implement this HAF Plan?

 Yes

 No

Does the Participant anticipate significant information technology system upgrades to implement this HAF Plan? 

 Yes

 No

Does the Participant have policies or procedures that govern the implementation of each HAF program design 

element described in this HAF Plan? 

 Yes

 No

If no, is a policy and procedure in development for each HAF program design element described in this HAF 

Plan?

 Yes

 No

Will the Participant use HAF funds to assist eligible households through a program that was operational before the 

Participant first received HAF funds?

 Yes

 No

If yes, has the documentation for that pre-existing program been adapted to HAF requirements (please 

answer yes if the pre-existing program already complied with HAF program requirements)? 
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 Yes

 No

Will the Participant use any third-party contractor or partner to conduct program administration (such as reviewing 

applications, determining eligibility, processing payments, conducting reporting, and reviewing compliance) forsome 

or all of the Participant’s HAF programs?

 Yes

 No

If yes, has the Participant entered into all necessary arrangements with all of the third-party contractors or 

partners that will conduct program administration? 

 Yes

 No

Please provide a brief description of how the Participant has used any HAF funds it has already received.

Budget

Budgeting of HAF Funds by Program Design Element

Specify the amounts of HAF funds that the Participant proposes to allocate to each of the following program design 

elements, if offered: 

Amount ($0.00)

Mortgage Payment Assistance 

Mortgage Reinstatement

Mortgage Principal Reduction 

Facilitate Mortgage Interest Rate Reduction

Payment Assistance for Homeowners Utilities 

Payment Assistance for Homeowner’s Internet Service 

Payment Assistance for Homeowner’s Insurance

Payment Assistance for HOA fees or liens

Payment Assistance for Down Payment Assist. Loans

Payment Assistance for Delinquent Property Taxes

 

Other measures to prevent homeowner displacement 

 

Please explain how the Initial HAF allocation has been utilized.
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Sub-total: 

(Enter sum of amounts entered) 

Counseling or Legal Services

The Participant may allocate up to 5% of its HAF funds for counseling or educational efforts by housing counseling 

agencies approved by the Department of Housing and Urban Development or a tribal government, or legal services, 

target to households eligible to be served with funding from the HAF related to foreclosure prevention or 

displacement.

Specify the Participant’s allocations for the following:

 Amount ($0.00)

 Counseling or Educational Services 

 Legal Services

Sub-total: 

(Enter sum of amounts entered) 

Reimbursement of Funds Expended After January 21, 2020

As described in the HAF guidance, HAF funds may be used for reimbursement of certain expenses between January 

21, 2020 and the date when the first HAF funds are disbursed by the HAF participant under the HAF for a qualified 

expense (with certain limitations, as set forth in the HAF guidance).

If the Participant is seeking reimbursement for any previous expenses, please specify the expenses and amounts 

below, providing sufficient detail for Treasury to determine whether the expense is within the definition of “qualified 

expenses” in the HAF guidance:

 Amount ($0.00)

Expense Type

Sub-total: 

(Enter sum of amounts entered) 

Allocation of Administrative Expenses

As described in the HAF guidance, up to 15% of a HAF participant’s allocation may be used for administrative 

expenses. If the participant proposes to use HAF funds for administrative expenses, please specify the proposed 

expenses and amounts below, providing sufficient detail for Treasury to determine whether the expense is within the 

definition of “qualified expenses” in the HAF guidance:

Expense Type Amount ($0.00)
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Sub-total: 

(Enter sum of amounts entered) 

Points of Contact

Please identify up to three contacts for the Participant- a primary contact, a designated point of contact for 

reporting, and an additional contact. 

Primary Contact 

Name: ____________________________________________________ 

Agency/Office: _____________________________________________

E-mail: ____________________________________________________

Phone Number: ____________________________________________ 

Reporting Contact 

Name: ____________________________________________________ 

Agency/Office: _____________________________________________

E-mail: ____________________________________________________

Phone Number: _____________________________________________

Additional Contact 

Name: ____________________________________________________ 

Agency/Office: _____________________________________________

E-mail: ____________________________________________________

Phone Number: _____________________________________________ 

Authorized Official Information

Authorized Official Name: ____________________________________________________ 

Authorized Official’s Email Address: ____________________________________________

Authorized Official’s Title: ____________________________________________________
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Application Certification

I (the undersigned) certify that the information provided in the HAF submission is accurate and complete after 

reasonable inquiry of people, systems, and other information available to the HAF Participant. The HAF participant 

and I acknowledge that any materially false, fictitious, or fraudulent statement or representation (or concealment or 

omission of material fact) in this submission may be the subject of criminal prosecution under the False Statements 

Accountability Act of 1996, as amended, 18 U.S.C. § 1001 and also may subject me and HAF Participant to civil 

penalties and/or administrative remedies for false claims or otherwise, (including 31 U.S.C. §3729 et seq.). I am an 

authorized representative of HAF Participant with authority to make the above certifications and representations on 

behalf of the HAF Participant.

Name of HAF Participant 

Name and Title of Certifying Official 

Name Telephone

 

Title Email

 

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