Participant Household Payment Data_Updated 07082021.xlsx

Version: 2021.07.15

Template Name: Participant Household Payment Data

Instructions to Reporter: - Do not change the cell formatting - Do not reformat the template - All data should be as text - Do not publish the "Field ID" row (Treasury Internal Use Only)

Label

Address Line 1

Address Line 2

Address Line 3

City Name

State Code

Zip5

Zip4

Payee Type

Amount of Payment

Date of Payment

Type of Assistance Covered by the payment

Start Date Covered by the Payment

End Date Covered by the Payment

Required or Optional

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Optional

Optional

Required

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Help Text

Record the first line of the Payee's physical address.

Second line of Payee's physical address.

Third line of the Payee's physical address.

Name of the city in which the Payee address is located.

Report the United States Postal Service (USPS) two-letter abbreviation for the state or territory in which the Payee address is located. Valid Responses: (AL, AK, AS, AZ, AR, CA, CO, CT, DE, DC, FM, FL, GA, GU, HI, ID, IL, IN, IA, KS, KY, LA, ME, MH, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND, MP, OH, OK, OR, PW, PA, PR, RI, SC, SD, TN, TX, UT, VT, VI, VA, WA, WV, WI, WY)

Report the United States ZIP code (five digits) concatenated with the additional +4 digits associated with the Payee's physical address. Format XXXXX, 5 numeric characters.

Zip Plus4 (four digits) identifying where the physical address of the payee. Format XXXX, 4 numeric characters.

Select the drop down correlating to the type of Payee. Select one of the following: '|- Tenant |- Landlord or Owner |- Utility / Home Energy Service Provider |- Other Housing Services and Eligible Expenses Provider

Report the total amount dispersed to the Payee. DO NOT INCLUDE $ sign when entering amount.

Report the date which payment was processed to Payee. Formatt MMDDYYYY

Select the drop down correlating to the type of assistance. Select one of the following: '- Financial Assistance: Rent; - Financial Assistance: Rental Arrears; - Financial Assistance: Utility/Home Energy Costs; - Financial Assistance: Utility/Home Energy Costs Arrears; - Financial Assistance: Other Housing Costs Incurred due to Covid-19;

Report the start date indicating the time period covered by the assistance. Format MMDDYYYY

Report the end date indicating the time period covered by the assistance. Format MMDDYYYY