Request for Second Extension

OMB Approved No. 1505-0271 Expiration Date: 4/30/2025

Coronavirus State and Local Fiscal Recovery Funds

Request for Extension Form (Subsequent 30-Day Extension for Distribution of Funds to Nonentitlement Units of Local Government)

Updated June 2022

The Coronavirus State and Local Fiscal Recovery Funds (SLFRF) Program, established by sections 602 and 603 of the Social Security Act, as added by section 9901 of the American Rescue Plan Act of 2021 (ARPA), authorizes the U.S. Department of the Treasury (Treasury) to make payments to states for distribution to their nonentitlement units of local government (NEUs). Section 603(b)(2)(C)(i) of the Act states that “[n]ot later than 30 days after a State

receives a payment,” the state “shall distribute” funds to each NEU in the state. Section 603(b)(2)(C)(ii)(I) directs Treasury to grant a 30-day extension if a state certifies an “excessive administrative burden” in writing before the end of the 30-day distribution period, and section 603(b)(2)(C)(ii)(II) provides for further extensions at the discretion of the Secretary of the Treasury, provided that the Secretary may only grant a further extension if the Secretary determines that the state’s plan is reasonably designed to distribute all the funds to NEUs by the end of the distribution period (as so extended).

To request a subsequent 30-day extension, states must complete the information requested below and return to Treasury by emailing [email protected] with the subject line “NEU Distribution - Extension Form” at least 5 business days before the end of their current distribution period. Treasury expects to provide a determination shortly after the form has been received. States should submit this completed form to request all extensions after the first extension.

Please note that this form is only for states that have already been granted their first 30-day extension. States that would like to request their first 30-day extension can find that form here.

Request for Extension

(Name of State) hereby requests, pursuant to section 603(b)(2)(C)(ii)(II), an extension for an additional 30 days to distribute SLFRF funding to its NEUs. As part of the request, the state is providing an update on its distributions below (Parts 1 and 2), in addition to a written plan that explains when the state expects to make the remaining distributions and the actions the state has taken and will take in order to make these distributions before the end of the distribution period (Part 3). As previously stated in its Frequently Asked Questions on Distribution of Funds to Non-entitlement Units of Local Government, Treasury will accept plans from states that detail reasonable efforts to contact non-responsive NEUs and propose issuing a subsequent distribution of unclaimed funds if the NEUs remain non-responsive for at least 60 days after the state begins accepting and processing requests for funding from NEUs.

For purposes of determining the beginning of the 30-day distribution period outlined in section 603(b)(2)(C)(i), the state acknowledges that Treasury will assume that the state receives its NEU payment under section 603(b)(2)(B) three business days after the “invoice date,” which is the date on which Treasury initiates the payment to the state. This date, along with the status of extensions, can be found on Treasury’s website for the SLFRF program. If granted, this extension will add 30 additional days to the current distribution period for states to distribute funding to their NEUs.

Part 1: Overall Update on Distributions

The state must complete the following using the most recent available information as of the date of this request. Please check all that apply and fill in blanks where applicable.

• Determined the eligibility of and allocated funds to NEUs. Note: States determined the eligibility and allocations of NEUs during the first tranche distribution process. Please note that only NEUs that were responsive during the first tranche distribution process are eligible for a second tranche payment.

• Begun accepting and processing requests for payment from NEUs

• Distributed payments to out of NEUs

($ out of a total of $ of NEU funds paid to the state)

Part 2: Reporting Update on Distributions

Treasury requests information on whether the state is complying with Treasury’s reporting guidance on NEU distributions as detailed in the NEU and non-UGLG Distribution Template user guide.

According to the user guide, states should send updated templates detailing its distributions to eligible NEUs to Treasury every month until distributions have been made. Each report should cover all distributions for the second tranche payment. Please check the box below to indicate whether the state has been substantially compliant with the monthly reporting requirement.

• Yes, the state is in substantial compliance

• No, the state is not in substantial compliance

Part 3: State Plan on Remaining Distributions

The state must provide a detailed explanation below of when the state expects to make the remaining distributions and the actions the state has taken and will take to make these distributions before the end of the distribution period, as extended by the granting of this request for extension.

Please make sure to address each of the following: current status of distributions, specific steps that need to be taken to make the remaining distributions (see NEU Guidance for an outline of steps that states are expected to complete), and expected timing for the remaining distributions. Please describe key challenges that remain, particularly on outreach to unresponsive NEUs, and plans to overcome these challenges. Please specify whether you intend to issue a subsequent distribution. Please provide your explanation below, and feel free to attach additional pages if necessary.

I certify to the U.S. Department of the Treasury that the information provided above is true and correct.

Signature of Authorized Representative of the State

Print Name of Authorized Representative: Title of Authorized Representative:

Date:

PAPERWORK REDUCTION ACT NOTICE

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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.