COVID-19 Relief Workout Agreement

OMB No. 0575-0189
Exp. 10/31/2021

SAMPLE
USDA RURAL DEVELOPMENT
“COVID-19 RELIEF WORKOUT AGREEMENT”
Project Name: ____________________________________________________________________
Borrower Name: ________________________________Borrower ID: ________________________
The Borrower asserts it was current on its loan account as of February 1, 2020 but is now experiencing a
financial hardship due, directly or indirectly, to the COVID–19 emergency. In order to prevent default, and
pursuant to the Coronavirus Aid, Relief, and Economic Security (CARES) Act (P.L. 116-136 and 7 CFR
§3560.453, Borrower submits the following:

Property is experiencing COVID-19 related financial hardship as follows (check at least one):
Tenants have expressed inability to pay rent (number) ___________
Urgent interim certifications must be performed (number) ____________
Property has experienced additional costs such as staff, technology, or maintenance due
to social distancing or COVID-19 (estimated amount to date) _______________
Other (describe)

Borrower is requesting deferral of the monthly debt service payment for _____ months,
beginning April 1, 2020 (not longer than 90 days). If the original deferral term is less than 90 days,
Borrower will submit an extension at least 15 days prior to the end of the original forbearance
term.
Borrower is requesting deferral of the monthly reserve deposit for _____ months, beginning April
1, 2020 (not longer than 90 days).
Borrower will not:
a.

Evict or initiate the eviction of a tenant from a dwelling unit located in or on the applicable
property solely for nonpayment of rent or other fees or charges until at least July 25, 2020

b. Charge any late fees, penalties, or other charges to a tenant described above for late payment
of rent until at least July 25, 2020.
Submitted by:

Approved by:

______________________________________
Borrower/Borrower’s Representative
Date

____________________________________
Rural Development Official
Date

According to the Paperwork Reduction Act of 1995, no persons are required to a collection of information unless it displays a valid OMB
control number. The valid OMB control number for this information is 0575-0189. The time required to complete this information collection is
estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information.