Emergency Rental Assistance Acceptance of Terms

OMB Approved No. 1505-0266

Expiration Date: MM/DD/YYYY

U.S. Department of the Treasury
EMERGENCY RENTAL ASSISTANCE

Eligible grantee name and address: [Eligible grantee to provide]

DUNS Number: [Eligible grantee to provide] Taxpayer Identification Number: [Eligible grantee to provide]

Section 501(a) of Division N of the Consolidated Appropriations Act, 2021, Pub. L. No. [ ] (Dec. 27, 2020) authorizes the Department of the Treasury (“Treasury”) to make payments to certain eligible grantees to be used to provide emergency rental assistance.

Eligible grantee 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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