Certification of Recall Notice Requirement - No Involunt

OMB Control No. 1505-0263

CERTIFICATION OF YOUR RECALL NOTICE REQUIREMENT

The Payroll Support Program Extension (PSP2) under Division N, Title IV, Subtitle A of the Consolidated Appropriations Act, 2021 (PSP Extension Law) and Section 16 of your PSP2 Agreement requires (Recipient or you) to provide Treasury with information and certifications to validate your compliance with the terms and conditions of the PSP2 Agreement, including the RECALL and REHIRE provisions. All capitalized terms herein have the meaning set forth in the PSP2 Agreement.

In your application for PSP2 funding, you indicated that your company did not involuntarily terminate or furlough any of its Employees between October 1, 2020 and the date that the Recipient) submitted its PSP2 application.

Before Treasury will process your second PSP2 payment, you must certify, by the CERTIFICATION AND SUBMISSION form included below, that Recipient did not furlough or involuntarily terminate any Employees between October 1, 2020 and ____________________ [date of PSP2 Agreement]. Section 2 of your PSP2 Agreement provides that the timing of your PSP2 payments will be determined by Treasury in its sole discretion.

PSP2 Application Number:

PSP1 Application Number:

Under Section 404 of the PSP Extension Law and Section 4.1 of your PSP2 Agreement, any passenger carrier that (1) received financial assistance under the Payroll Support Program (PSP1) under the Coronavirus, Aid, Relief, and Economic Security Act (CARES Act) and (2) conducted an Involuntary Termination or Furlough between October 1, 2020 and the date on which the passenger carrier or contractor entered into its PSP2 Agreement with Treasury (i.e., the date Treasury executed the agreement), must:

1. Recall, not later than 72 hours after the PSP2 Agreement has been executed, each Employee who was subject to an Involuntary Termination or Furlough between October 1, 2020, and the date that the passenger carrier or contractor entered into its PSP2 Agreement, and enable each Returning Employee to return to employment within 30 days after making the election to do so;
   
   

2. Compensate, not later than 30 days after a Returning Employee returns to employment, such Returning Employee for lost Salary, Wages, and Benefits (offset by any amounts received by the Returning Employee from the Recipient or an Affiliate as a result of such Returning Employee’s Involuntary Termination or Furlough, including any Severance Pay or Other Benefits or furlough pay) between, with respect to passenger carriers, December 1, 2020 and the date that the passenger carrier entered into its PSP2 Agreement, or, with respect to contractors, between December 27, 2020, and the date that the contractor entered into its PSP2 Agreement; and

3. Restore the rights and protections for each Returning Employee as if such Returning Employee had not been subject to an involuntary termination or furlough.

Did you involuntarily furlough or terminated any Employees between October 1, 2020 and the date of your PSP2 Agreement?

□ Yes □ No

[Certification Page to Follow]

CERTIFICATION

On behalf of the Recipient (including all Affiliates participating in the PSP2) and its undersigned authorized representatives, I certify that the responses and information the Recipient provided above are true and correct. I make this certification after reasonable inquiry of people, systems, and other information available to the Recipient. I acknowledge that a materially false, fictitious, or fraudulent statement (or concealment or omission of material fact) in this submission may be the subject of criminal prosecution and also may subject the Recipient to civil penalties and/or administrative remedies for false claims or otherwise.

The undersigned are authorized representatives of the Recipient with authority to make the above certifications and representations on behalf of the Recipient.

                                                                                         

Recipient

Signature of First Authorized Representative           Date

                                                                                         

Print Name of First Authorized Representative        Title

                                                                                ­­         

Recipient

Signature of Second Authorized Representative       Date

                                                                                ­­         

Print Name of Second Authorized Representative    Title

WARNING: Anyone who knowingly submits a false claim or makes a false statement is subject to criminal and/or civil penalties, including confinement for up to 5 years, fines, and civil penalties. (18 U.S.C. §§ 287, 1001; 31 U.S.C. §§ 3729, 3802).

PAPERWORK REDUCTION ACT NOTICE: The information collected will be used for the U.S. Government to process requests for support. An agency many 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. The estimated burden associated with this collection of information is 30 minutes per response. Comments concerning the accuracy of this burden estimates 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, DC 20220. DO NOT send the form to this address.