OMB Approved No. 1505-0266
Expiration Date: 07/31/21
Eligible grantees—states (including the District of Columbia), U.S. Territories (Puerto Rico, the United States Virgin Islands, Guam, the Commonwealth of the Northern Mariana Islands, and American Samoa), local governments with more than 200,000 residents, the Department of Hawaiian Homelands, and Indian tribes (defined to include Alaska native corporations) or the tribally designated housing entity of an Indian tribe, as applicable—must provide payment information and an executed copy of the award terms not later than 11:59 p.m. EDT on January 12, 2021.
An exception is provided in the statute for Indian tribes that opted out of receiving a grant allocation under the Native American Housing Block Grants program formula in fiscal year 2020. Those Indian tribes must provide payment information and an executed copy of the award terms not later than 11:59 p.m. on January 26, 2021.
An authorized representative of the eligible grantee with legal authority to bind the eligible grantee must sign the first page of the award terms form. In the case of a local government, the chief executive officer of the local government must sign the award terms form.
Eligible grantees MUST also complete and execute the award terms form to receive payment from Treasury. Please click on the download link below to generate a filled pdf of the award terms form.
An authorized representative of the eligible grantee with legal authority to bind the eligible grantee must sign the first page of the award terms form. In the case of a local government, the chief executive officer of the local government must sign the award terms form. Attach a copy of the signed and scanned document below.
Download award terms
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