Request for Reallocated Funds

EMERGENCY RENTAL ASSISTANCE PROGRAM

U.S. DEPARTMENT OF THE TREASURY

Request for Reallocated Funds

The undersigned entity (the “ERA Grantee”) received its full allocation of funds for the delivery of emergency rental assistance (“ERA”) in accordance with section 501 of division N of the Consolidated Appropriations Act, 2021 (the “Act”). The ERA Grantee hereby requests an additional $ of ERA funds from any amounts the U.S. Department of the Treasury (“Treasury”) makes available for reallocation under section 501(d) of the Act.

Treasury has published guidance, available on its website, setting forth the procedures for the reallocation of ERA funds under the Act. In accordance with the guidance, the ERA Grantee hereby certifies that:

1. it has obligated at least 65% of its total ERA award funds under the Act (the “ERA1 Award”) as of the date below; and

2. its jurisdiction has a demonstrated need for the ERA funds requested above and the capacity to use those funds pursuant to applicable requirements by September 30, 2022.

The ERA Grantee acknowledges that any funds remaining from its ERA1 Award must be obligated by September 30, 2022, and such funds not obligated or expended at that time must be returned to Treasury as part of the award closeout process pursuant to 2 C.F.R. 200.344(d). As permitted by the Act, the ERA Grantee hereby requests that Treasury extend the deadline for obligating any reallocated funds received pursuant to this request to December 29, 2022.

[ERA GRANTEE] By: [Official’s Name] [Official’s Title]

Date: , 202

PAPERWORK REDUCTION ACT NOTICE: The information collected will be used for the U.S. Government to determine the reallocation of emergency rental assistance funds. The estimated burden associated with this collection of information is 75 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 section 501 of division N of the Consolidated Appropriations Act, 2021 (the “Act”)

PURPOSE: The Act requires Treasury to allocate funds to eligible grantees for the delivery of emergency rental assistance to eligible households. Eligible grantees include State, Local governments, U.S. Territories, Tribes, or Tribally Designated Housing Entities (TDHEs), as applicable, and the Department of Hawaiian Home Lands. Treasury maintains contact information for authorized representatives and contact persons of the ERA grantees for the purpose of communicating with ERA grantees regarding the administration of their award under 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 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 which may affect the status of their award.

EXHIBIT A

Obligation Report

Treasury has published guidance, available on its website, setting forth the procedures for the reallocation of ERA funds under the Act. As described in the guidance, Treasury considers ERA funds to be obligated if (i) the funds have actually been spent providing financial assistance and housing stability services for eligible households; (ii) the funds are needed to pay for assistance promised in a commitment letter issued to induce a landlord to enter a rental agreement with an eligible household under Treasury’s ERA FAQ #35; or (iii) subject to certain conditions, the grantee has, as part of the grantee’s ERA program administration, entered into a binding agreement or funding commitment requiring the grantee to disburse the funds to a third party for eligible purposes. In addition, Treasury will consider 10% of each grantee’s total award amount as having been obligated for administrative costs regardless of the grantee’s actual expenditures, commitments, or obligations.

Please provide information on this Exhibit A only regarding the ERA Grantee’s use of funds from the ERA1 Award authorized by the Act – not regarding its use of funds under an ERA award authorized by the American Rescue Plan Act of 2021 (“ERA2”).

Consistent with Treasury’s reallocation guidance, the undersigned hereby represents and certifies to Treasury that:

As of [insert date], the ERA Grantee has obligated its ERA1 Award funds as follows:

Enter 10% of total ERA1 Award amount for administrative costs:	$
Enter total of all other amounts obligated by ERA Grantee as of the date hereof:	$
Total amount obligated:	$

EXHIBIT B

Evidence of Demonstrated Need

To receive reallocated ERA funds, an ERA grantee must confirm there is a demonstrated need for the assistance within its jurisdiction. In support of its request, the ERA Grantee must submit the following monthly projections.

These projections should include expenditures and activities under both section 501 of the Act (“ERA1”) and section 3201 of the American Rescue Plan Act of 2021 (“ERA2”). When projecting the amount of assistance to be provided to eligible households, assume the funds requested in the opening paragraph of this form will be available beginning December 1, 2021.

November 2021
Number of unique households that will be assisted
Amount of assistance to eligible households expended	$
Number of applications submitted

December 2021
Number of unique households that will be assisted
Amount of assistance to eligible households expended	$
Number of applications submitted

January 2022
Number of unique households that will be assisted
Amount of assistance to eligible households expended	$
Number of applications submitted

February 2022
Number of unique households that will be assisted
Amount of assistance to eligible households expended	$
Number of applications submitted

OMB Approved No.: 1505-0266

Exp.: 11/30/2021