Interim Reporting

User Instructions
Thank you for you participation in the U.S. Department of the Treasury (Treasury) Homeowner Assistance Fund.
Please complete the Interim Report covering activity of your HAF awards for the period between January 21, 2020 through January 31, 2022 (reporting period) . The
submission deadline is Monday, February 28, 2022.
(Note: The Homeowner Assistance Fund ("HAF") Is authorized by Title III, Subtitle B, Section 3206 of the American Rescue Plan Act, 2021, Pub. L. No. 117-2 (March 11,
2021).)
As a reminder, the assistance listing number for HAF is 21.026 Homeowner Assistance Fund. Data on prime awards for Participants may be found on the HAF page of
Treasury.gov and USASpending.gov at the following link: https://www.usaspending.gov/search/?hash=64f2ac3c28fa423ce60366dbfa481cd9
The required Interim Report includes the data elements as described in the Coronavirus HAF Guidance on Required Interim Report provided on Treasury's HAF website
(insert URL)
Please note, HAF participants will be asked to disaggregate the number of Homeowners assisted, obligations, and amount of assistance provided during the reporting
period at the Program Design Element level. If a HAF participant program covers multiple Program Design Elements, HAF participants are expected to know how the
program has impacted each of the Program Design Elements it covers including the number of Homeowners assisted, Obligations, and Expenditures. For example, if a
HAF participant previously submitted a HAF plan with a general program under the "Other measures to prevent homeowner displacement" Program Design Element and
the program covers one of the other Program Design Elements (i.e., mortgage payment assistance, internet, utilities, etc.), the HAF participant is expected to report on all
Program Design Elements covered.
HAF participants are required to comply with the reporting requirements established by Treasury pursuant to the "Reporting " section of the HAF Financial Assistance
Agreement, which provides in pertinent part, "Recipient agrees to comply with any reporting obligations established by Treasury related to this award. Recipient
acknowledges that any such information required to be reported pursuant to this section may be publicly disclosed." Treasury has decided to implement this Interim
Report as a substitute to the first Quarterly Report to reduce burden on HAF participants.

Treasury will use the reported information from the HAF participants to determine whether participants are complying with HAF requirements. HAF participants should
maintain all documents and financial records sufficient to support the data requests and establish compliance with program requirements.

We appreciate your attention on these issues and please email HAF@Treasury.gov with any questions or concerns.
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PARTICIPANT GENERAL INFORMATION
Instructions

Please verify that you are an authorized representative of the HAF participant and confirm the accuracy of the HAF participant's profile.

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Participant DUNS:
Participant DUNS (+4):
Participant TIN:
Participant Legal Entity Name:
Participant Type:
CFDA No./Assistance Listing
FAIN

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Participant Address:
Participant Address 2:
Participant Address 3:
Participant City:
Participant State/Territory:
Participant Zip5:
Participant Zip+4:

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Please report discrepancies (if any) on the above information
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Authorized Representative for
Reporting (ARR) Name:
ARR Title:
ARR Email Address:
ARR Phone:

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Secondary ARR Name:
Secondary ARR Title:
Secondary ARR Email Address:
Secondary ARR Phone:

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Tertiary ARR Name:
Tertiary ARR Title:
Tertiary ARR Email Address:
Tertiary ARR Phone:

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PROGRAM DESIGN ELEMENT INTERIM EXPENDITURE INFORMATION
Reporting Period: January 21, 2020 - January 31, 2022
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Instructions
Please fill out the following information below. If the HAF participant has not begun accepting HAF applications from Homeowners or disbursing HAF assistance to Homeowners whose HAF application was accepted,
please select the radio button for Questions #1-6 and place zeros in the table for Question #7.
1. Please enter the number of unique Homeowners that received HAF assistance of any kind during the
reporting period.

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PD1

The HAF participant has Expended
zero dollars of HAF assistance.

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PD2

Data Not Yet Available

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PD3

Data Not Yet Available

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PD4

Data Not Yet Available

5. Please enter the number of Delinquencies that were resolved with monetary HAF assistance
Expended during the reporting period.

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PD5

Data Not Yet Available

6. Please enter the number of unique Homeowners receiving HAF assistance that are not Delinquent.

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PD6

Data Not Yet Available

2. Please enter the number of unique Homeowners at or below 100% Area Median Income (or US
Median Income, whichever is greater) who received HAF assistance of any kind during the reporting
period.
3. Please enter the number of unique Homeowners classified as "Socially Disadvantaged Individuals"
who received HAF assistance of any kind during the reporting period.
4. Please enter the number of Delinquencies that were resolved through non-monetary HAF assistance
(i.e., housing counseling helped resolved a Delinquency through an existing servicer's program)
during the reporting period.

7. Please enter disaggregated data for each of the Program Design Elements below.
Note: Because Homeowners may have received assistance in multiple categories, the total number of unique Homeowners assisted (Q1 above) may be less than the sum of the disaggregated figures in Column 2
below.

Program Design Element

Mortgage Payment Assistance Amount
Mortgage Reinstatement
Mortgage Principal Reduction
Facilitating Mortgage Interest Rate Reduc.
Utilities Assistance
Internet Assistance
Insurance Assistance
HOA Assistance
Loans Assistance
Tax Assistance
Measures Preventing Displacement
Counseling or Education
Legal Services

7A - Column 1
Reference information: your HAF Plan
indicated that you would provide HAF
assistance by Program Design Element(s)
checked below. PD7

7B - Column 2
Please enter the number of
Homeowners with HAF
assistance Expended by Program
Design Element during the
reporting period. PD8

Number of Homeowners Assisted
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7C - Column 3
Please enter the dollar amount of
HAF assistance Obligated by
Program Design Element during
the reporting period. PD9

7D - Column 4
Please enter the dollar amount of
HAF assistance Expended by
Program Design Element during the
reporting period. PD10

Obligated ($)

Expended ($)

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GENERAL INTERIM EXPENDITURE INFORMATION
Reporting Period: January 21, 2020 - January 31, 2022
Instructions
Please fill out the following information below
8.

GIE1
Please enter the date that the HAF participant started accepting HAF applications for
HAF assistance. For HAF participants with multiple programs that have varying
application periods, HAF participants should share the earliest date the applications
are/will be available across any of their HAF funded programs.

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9. Please enter the number of unique Homeowners that submitted a HAF application
for HAF assistance during the reporting period.

GIE2
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Data Not Yet Available

10. Please enter the number of unique Homeowners that submitted a HAF application
for HAF assistance and were approved during the reporting period.

GIE3
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Data Not Yet Available

11. Please enter the amount of HAF assistance for administrative expenses during the
reporting period:
GIE4
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11A. Obligated as of January 31, 2022
GIE5
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11B. Expended as of January 31, 2022

The HAF participant has zero dollars of
HAF assistance currently Obligated.
The HAF participant has Expended zero
dollars of HAF assistance.

GIE6
Y/N

12. Did the HAF participant Expend any HAF assistance for reimbursement expenses
during the reporting period?

If Yes, please fill out the relevant reimbursement expense categories below. Please note, reimbursement expenses
should be a subset of the amount of assistance expended as reported on the previous screen. Each reimbursement
expense amount by Program Design Element should be less than the corresponding Program Design Element HAF
assistance Expended in question #7D.

The HAF participant has Expended zero
dollars for reimbursement expenses.

This would only appear if the participant 
said "No" to Q12

GIE7
Reimbursement Expenses
($)

Reimbursement Expense Categories
Mortgage Payment Assistance Amount
Mortgage Reinstatement
Mortgage Principal Reduction
Facilitating Mortgage Interest Rate Reduc.
Utilities Assistance
Internet Assistance
Insurance Assistance
HOA Assistance
Loans Assistance
Tax Assistance
Measures Preventing Displacement
Counseling or Education
Legal Services
Administrative expenses

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This would only appear if the participant 
said "Yes" to Q12

GIE8
13. The amount of HAF assistance Obligated as of January 31, 2022 as calculated from
the previous screen.

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The HAF participant has zero dollars of
HAF assistance currently Obligated.

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The HAF participant has Expended zero
dollars of HAF assistance.

GIE9
14. The amount of HAF assistance Expended as of January 31, 2022 as calculated
from previous questions.

15. Please indicate whether the HAF participant has prioritized identifying if loss
mitigation is available to the homeowner through their servicer in determining how to
distribute HAF assistance to servicers. Please respond "Yes" if you have prioritized GIE10
identifying whether loss mitigation is available to homeowners through their servicer,
otherwise select "No."

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Certification
I (the undersigned) certify that the information provided in the HAF submission is accurate and complete after reasonable inquiry
of people, systems, and other information available to the HAF participant. The HAF participant and I acknowledge that any
materially false, fictitious, or fraudulent statement or representation (or concealment or omission of material fact) in this
submission may be the subject of criminal prosecution under the False Statements Accountability Act of 1996, as amended, 18
U.S.C. § 1001 and also may subject me and HAF participant to civil penalties and/or administrative remedies for false claims or
otherwise, (including 31 U.S.C. §3729 et seq.). I am an authorized representative of HAF participant with authority to make the
above certifications and representations on behalf of the HAF participant.

Authorized Representative [Type name/signature equivalent]:
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