Acceptance of Award Terms Form with certification

Coronavirus State and Local Fiscal Recovery Funds Program

SLFRP Acceptance of Award Terms Form with certification for States-Territories-DC (Final 5-7-2021)

Acceptance of Award Terms

OMB: 1505-0271

Document [docx]
Download: docx | pdf


OMB Approved No.:1505-0271

Expiration Date: 11/30/2021


U.S. Department of the Treasury
coronavirus state Fiscal recovery fund


Recipient name and address:
[
Recipient to provide]

DUNS Number: [Recipient to provide]

Taxpayer Identification Number: [Recipient to provide]

Assistance Listing Number: 21.019


Section 602(b) of the Social Security Act (the Act), as added by section 9901 of the American Rescue Plan Act (ARPA), Pub. L. No. 117-2 (March 11, 2021), authorizes the Department of the Treasury (Treasury) to make payments to certain recipients from the Coronavirus State Fiscal Recovery Fund.

As a condition to receiving such payment from Treasury, the authorized representative below hereby (i) certifies that the recipient named above requires the payment to be made pursuant to section 602(b) of the Act in order to carry out the activities listed in section 602(c) of the Act and (ii) agrees to the terms attached hereto.


The following applies only to States:

Section 603(b)(2) of the Act as added by section 9901 of ARPA authorizes Treasury to make payments to States for the State to distribute to nonentitlement units of local government within the State in accordance with section 603(b)(2).  The authorized representative below hereby agrees to use such payment from Treasury to make payments to such nonentitlement units of local government in accordance with Section 603(b) and Treasury’s implementing regulations and guidance.


Section 603(b)(3)(B)(ii) of the Act authorizes Treasury to make payments to States, in the case of an amount to be paid to a county that is not a unit of general local government, for the State to distribute to units of general local government within such county in accordance with Section 603(b)(3)(B)(ii) of the Act.  To the extent applicable, the authorized representative below hereby agrees to use any such payment from Treasury to make payments to such units of general local government in accordance with Section 603(b) of the Act and Treasury’s implementing regulations and guidance.


Recipient: U.S. Department of the Treasury:


________________________________________ _________________________________________

Authorized Representative: Authorized Representative:


Title: Title:


Date signed: 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.

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File Modified0000-00-00
File Created2022-01-05

© 2024 OMB.report | Privacy Policy