ERA Redirected Funds Form

OMB Approved No. 1505-0266

Expiration Date: 07/31/2021

Emergency Rental Assistance Program

Redirected Funds Form

The Emergency Rental Assistance (ERA) Program (established by section 501 of Division N of the consolidated Appropriations Act, 2021, Pub. L. No. 116-260 (Dec. 27, 2020)) has disbursed award funds to all eligible grantees. After further review of the ERA program, some local governments have decided to cancel their ERA awards and request that their award funds be redirected to their respective states. For purposes of tracking, documenting the de-obligation of the funds obligated to the local government, recording a modification to the state’s obligation, and auditability of the funds that were redirected from the local governments to their respective states, the information below must be completed and returned to Treasury via the email address, [email protected].

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 1 hour 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.

Redirected Information:

On ___________(date), _______________________ (Name of local government transferring award funds) transferred all of its award funds allocated under the ERA program in the amount of $__________________ (dollar amount) to ____________________ (Name of State), which received the transferred award funds on _______________(date). ___________________(Name of local government) understands that transfer of all funds issued under this award to _________________ (Name of State), completing and submitting this Redirected Funds form to Treasury, and attaching a copy of the ACH or wire transfer as evidence of the transfer effectively cancels ERA award listed as Award number, __________________ and FAIN number, _______________ and there is no further legal obligation to Treasury under the ERA award. _________________ (Name of State) understands that receipt of the award funds from ___________________(Name of local government) on _________________ (date) effectively modified its ERA award amount listed as Award number, __________________ and FAIN number, _______________ and ____________________ (Name of State) is now legally obligated to Treasury for the additional ERA award funds of $__________________ (dollar amount), and the completion of all legally mandated reporting.

I certify under penalty of perjury to the U.S. Department of the Treasury (“Treasury”) that the information provided above are true and correct.

___________________________________ _________________________________
Signature of Chief Executive Officer of the local government Print Name: _________________________	Signature of Authorized Official of the State Print Name:___________________________
Title: _______________________________	Title: _________________________________

Date: _______________________________ Date: ________________________________