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Expanded Pandemic Unemployment Assistance eligibility

Summary ETA added three COVID-19 reasons under which a claimant could self certify for Pandemic Unemployment Assistance: certain unsafe work situations, certain work in education, and reduced hours or layoffs. The change explained retroactive application and limits on backdating claims filed after December 27, 2020. It includes sample certification language and detailed eligibility guidance for this historical program.
Document
Federal guidance
Agency
U.S. Department of Labor, Employment and Training Administration (ETA)
Document number
UIPL No. 16-20, Change 5
Date issued
February 25, 2021
Status
Active
ETA’s listing marks this change Active, and the PDF prints “Rescissions: None” and “Expiration Date: Continuing.” PUA and the application dates discussed are historical.
Status last verified October 24, 2026

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This page explains the general guidance. Ask about your specific situation and see what current federal labor law says, with citations.

About this page: The full text below is the official document from U.S. Department of Labor, Employment and Training Administration (ETA). Ezel adds the plain-English summary and tracks the document's status. The official source linked on this page is authoritative for any reliance.
CLASSIFICATION
      EMPLOYMENT AND TRAINING ADMINISTRATION              Unemployment Insurance
                   ADVISORY SYSTEM                        CORRESPONDENCE SYMBOL
             U.S. DEPARTMENT OF LABOR
                  Washington, D.C. 20210
                                                          OUI/DUIO
                                                          DATE
                                                          February 25, 2021

ADVISORY:       UNEMPLOYMENT INSURANCE PROGRAM LETTER NO. 16-20,
                Change 5

TO:             STATE WORKFORCE AGENCIES

FROM:           SUZAN G. LEVINE
                Principal Deputy Assistant Secretary

SUBJECT:        Expanded Eligibility Provisions for the Pandemic Unemployment Assistance
                (PUA) Program

1. Purpose. To provide states with updated guidance for the PUA program, specifically
   regarding expanded eligibility provisions authorized under Section 2102(a)(3)(A)(ii)(I)(kk)
   of the Coronavirus Aid, Relief, and Economic Security (CARES) Act.

2. Action Requested. The Department of Labor’s (Department) Employment and Training
   Administration (ETA) requests State Workforce Administrators provide the information
   contained in this Unemployment Insurance Program Letter (UIPL) and the attachments to
   appropriate program and other staff in state workforce systems to implement these changes to
   the PUA program.

3. Summary and Background.

   a. Summary –The Department expands PUA eligibility to include three COVID-19 related
      reasons under which an individual may self-certify. This expansion is made under the
      authority provided by Section 2102(a)(3)(A)(ii)(I)(kk) of the CARES Act. These three
      reasons are added to the existing COVID-19 related reasons specified in items (aa)-(jj) of
      Section 2102(a)(3)(A)(ii)(I) of the CARES Act and the reason previously approved by
      the Secretary of Labor (Secretary) under Section 2102(a)(3)(A)(ii)(I)(kk) of the CARES
      Act for individuals who are self-employed and experience a significant reduction of
      services because of COVID-19.

       These additional reasons address circumstances when an individual is directly affected by
       the COVID-19 public health emergency. They are: (1) individuals who refuse to return
       to work that is unsafe or to accept an offer of new work that is unsafe; (2) certain
       individuals providing services to educational institutions or educational service agencies;
       and (3) individuals experiencing a reduction of hours or a temporary or permanent lay-
       off.



   RESCISSIONS                                             EXPIRATION DATE
   None                                                    Continuing

   These additional eligibility provisions apply retroactively to the beginning of the PUA
   program, though individuals who did not file an initial PUA claim on or before December
   27, 2020 are limited to weeks of unemployment beginning on or after December 6, 2020.
   This limitation on backdating of a PUA claim is discussed in more detail in Section 4.b.
   of this UIPL. States must determine PUA effective dates consistent with instructions
   provided in Section C.15. of Attachment I to UIPL No. 16-20, Change 4.

   States may seek additional funding of up to $100,000 to cover startup costs for
   implementing the expanded eligibility provisions, including an update to the self-
   certification declaration as part of their initial PUA application and continued claim
   forms. States must submit the required request for funding (SF-424) electronically to
   [email protected], with a copy to the appropriate ETA Regional Office by March 15,
   2021. Acknowledging that states need time to modify their initial PUA claim application
   and PUA continued claim forms to include these additional COVID-19 related reasons as
   part of the self-certification declaration, the Department expects many states will need
   until the end of March or later to have the new COVID-19 related reasons in place.

   Attachment I provides a sample self-certification declaration that includes the original
   and new COVID-19 related reasons. ETA recommends that states use this with their
   initial PUA claim application and PUA continued claim forms. Attachment III provides
   instructions for completing the SF-424.

b. Background – On March 27, 2020, the CARES Act was enacted (Public Law (Pub. L.)
   116-136), which includes the Relief for Workers Affected by Coronavirus Act set out in
   Title II, Subtitle A. Section 2102 of the CARES Act created a new, temporary federal
   program called PUA and provided states with administrative funding to operate the
   program through an agreement with the Department.

   PUA is a benefit of last resort and, in general, provides unemployment benefits to
   individuals who are: (1) not eligible for regular unemployment compensation (UC),
   Pandemic Emergency Unemployment Compensation (PEUC), or Extended Benefits
   (EB), including those who have exhausted all rights to such benefits, and those who are
   self-employed, seeking part-time employment, do not have sufficient wage history, or
   otherwise would not qualify for regular UC, PEUC, or EB; and (2) unemployed, partially
   unemployed, or unable or unavailable to work due to a specific COVID-19 related reason
   identified in Section 2102(a)(3)(A)(ii)(I)(aa)-(kk) of the CARES Act and Department
   guidance. Any weeks of benefits previously received under the regular UC or EB
   programs starting with week ending February 8, 2020 (February 9, 2020 for states with a
   Sunday week ending date) through week ending April 10, 2021 (April 11, 2021 for states
   with a Sunday week ending date) are deducted from the individual’s PUA entitlement
   (see Section C.17. of Attachment I of UIPL No. 16-20, Change 4). States are reminded
   that PUA is 100 percent federally funded and states may not charge employers for these
   benefits.

   The CARES Act authorized the Secretary to establish COVID-19 related reasons for
   which an individual may be eligible for PUA in addition to those specific COVID-19

related reasons specified in items (aa)-(jj) of Section 2102(a)(3)(A)(ii)(I) of the CARES
Act. To date, the Department has added one additional COVID-19 related reason under
this authority found in Section 2102(a)(3)(A)(ii)(I)(kk). The Department most recently
discussed this COVID-19 related reason in Section C.1.kk. of Attachment I to UIPL No.
16-20, Change 4, which provides that “[s]elf-employed individuals (including
independent contractors and gig workers) who experienced a significant diminution of
their customary or usual services because of the COVID-19 public health emergency,
even absent a suspension of services, may self-certify under item (kk).” This COVID-19
related reason remains in effect.

On December 27, 2020, the Consolidated Appropriations Act, 2021 (Pub. L. 116-260),
was enacted, which includes the Continued Assistance for Unemployed Workers Act of
2020 (Continued Assistance Act) set out in Division N, Title II, Subtitle A. The
Continued Assistance Act extends the PUA program and enacts several program integrity
measures, including a requirement that all individuals receiving a PUA payment after
December 27, 2020, submit documentation substantiating employment, self-employment,
or the planned commencement of employment or self-employment.

Where the CARES Act, as amended, and the operating instructions are silent, states
should refer to the Disaster Unemployment Assistance (DUA) regulations at 20 C.F.R.
Part 625.

The Department has published several UIPLs providing guidance to states regarding the
PUA program.

   UIPL No. 16-20, published on April 5, 2020, provides implementation and operating
    instructions, instructions for obtaining administrative funding, and reporting
    instructions for the ETA 902-P report.

   UIPL No. 16-20, Change 1, published on April 27, 2020, includes several Questions
    and Answers, along with instructions for calculating an individual’s weekly benefit
    amount (WBA) and completing the ETA 9178-P Quarterly Narrative Progress
    Report.

   UIPL No. 16-20, Change 2, published on July 21, 2020, includes additional Questions
    and Answers.

   UIPL No. 16-20, Change 3, published on August 27, 2020, explains specific
    scenarios under which an individual who is a caregiver and affected by the reopening
    of school systems may be eligible for PUA.

   UIPL No. 16-20, Change 4, which the Department published on January 8, 2021,
    provides updated implementation and operating instructions, updates reporting
    instructions for the ETA 902-P report, and includes a summary table in Attachment
    III about how to process PUA claims based on the claim filing date.

      Importance of Program Integrity. Addressing improper payments and fraud is a top
      priority for the Department and the entire UI system. States play a fundamental role in
      ensuring the integrity of the UI system. Especially during this time of extraordinary
      workloads, states should maintain a steadfast focus on UI functions and activities that
      ensure program integrity and the prevention and detection of improper payments and
      fraud across all programs operated within the UI system. It is critical that states
      implement processes that ensure payments are being made to eligible individuals and that
      states have aggressive strategies and tools in place to prevent, detect, and recover
      fraudulent payments, with a particular emphasis on imposter fraud by claimants using
      false or stolen identities.

      Additionally, under the Continued Assistance Act, for states to have an adequate system
      for administering the PUA program, states must include procedures for identity
      verification or validation and for timely payment, to the extent reasonable and
      practicable, for all new PUA claims filed on or after January 26, 2021 (see Section C.3.
      of Attachment I to UIPL No. 16-20, Change 4).

      UIPL No. 28-20, published on August 31, 2020, and UIPL No. 28-20, Change 1,
      published January 15, 2021, provides states with funding to assist with efforts to prevent
      and detect fraud and identity theft and recover fraud overpayments in the PUA and PEUC
      programs.

4. Guidance.

   a. Expanded list of COVID-19 related reasons approved by the Department. To be
      eligible for PUA, the state must verify that the individual is not eligible for regular UC
      (or PEUC or EB). The Department reminds states of other requirements for PUA:

         In general, an individual who has the ability to telework with pay, or who is receiving
          paid sick leave or other paid leave benefits is not eligible for PUA. See Section C.1.
          of Attachment I to UIPL No. 16-20, Change 4.

         An individual must report any earnings from covered employment or income from
          self-employment each week. The individual’s WBA must be reduced on account of
          such earnings and income as prescribed under state law. See the DUA regulations at
          20 C.F.R. 625.6(f) for additional details regarding the effect earnings and income
          have on an individual’s WBA. Question 15 of Attachment I to UIPL No. 16-20,
          Change 2, provides additional details regarding self-employment income.

         An individual who continues to receive their full pay (e.g., is not experiencing any
          reduction in pay) during the period they are not working is not considered to be
          “unemployed.” See Section 4.a. of UIPL No. 10-20.

      Individuals must also self-certify that they are unemployed, partially unemployed, or
      unable or unavailable to work for a COVID-19 related reason. Refer to Section 4.c. of

this UIPL for benefit payment control processes to address program integrity in the PUA
program.

In addition to the current COVID-19 related reasons identified in items (aa)-(jj) of
Section 2102(a)(3)(A)(ii)(I) of the CARES Act and the one reason previously approved
under the Secretary’s authority provided in Section 2102(a)(3)(A)(ii)(I)(kk) of the
CARES Act (see Section 4.b. of UIPL No. 16-20, Change 2, and Section C.1.kk. of
Attachment I to UIPL No. 16-20, Change 4), the Department hereby establishes
additional COVID-19 related reasons under which an individual may self-certify to
establish eligibility for PUA. These additional COVID-19 related reasons are described
below.

  i.   Individuals who refuse to return to work that is unsafe or accept an offer of new
       work that is unsafe. The Department approves the following COVID-19 related
       reason for an individual to self-certify for PUA eligibility: “The individual has
       been denied continued unemployment benefits because the individual refused to
       return to work or accept an offer of work at a worksite that, in either instance, is
       not in compliance with local, state, or national health and safety standards
       directly related to COVID-19. This includes, but is not limited to, those related to
       facial mask wearing, physical distancing measures, or the provision of personal
       protective equipment consistent with public health guidelines.”

       For purposes of this COVID-19 related reason, unemployment benefits include
       regular UC, Unemployment Compensation for Federal Employees (UCFE),
       Unemployment Compensation for Ex-Servicemembers (UCX), PUA, PEUC, EB,
       Short-Time Compensation (STC), Trade Readjustment Allowances (TRA),
       Disaster Unemployment Assistance (DUA), and payments under the Self-
       Employment Assistance (SEA) program.

       An individual is generally denied unemployment benefits if the state determines
       that the work is suitable and the individual did not have good cause for refusing
       such work. This new COVID-19 related reason applies only to individuals who
       had already been receiving unemployment benefits but were determined to be
       ineligible or disqualified under state law because they refused an offer of work at
       a worksite that was not in compliance with local, state, or national health and
       safety standards directly related to COVID-19. This is a separate COVID-19
       related reason from item (ii) of Section 2102(a)(3)(A)(ii)(I) of the CARES Act,
       which provides eligibility to an individual who quits their job as a direct result of
       COVID-19.

       For example, an individual may self-certify under this new COVID-19 related
       reason who has previously been denied because the state law does not consider
       health and safety standards when assessing suitability or good cause, or who has
       previously been denied because the health and safety standards considered under
       state law are more restrictive than the local, state, or national COVID-19 health

                 standards. Below are a few non-exhaustive scenarios. See Section 4.b.iv. of this
                 UIPL for additional details regarding PUA effective dates.

                      o An individual was laid off in June 2020 and began receiving regular UC.
                        The individual was recalled to work in October 2020. However, because
                        the worksite was not in compliance with the local mask mandate, the
                        individual refused to return to work. The individual was disqualified from
                        continued receipt of regular UC under state law. The individual is now
                        eligible to apply for PUA under this new COVID-19 related reason.

                      o An individual was laid off in October 2020 and began receiving regular
                        UC. The individual received a new job offer in January 2021, however,
                        the new worksite was unsafe due to non-compliance with physical
                        distancing measures under state law. The individual was disqualified from
                        continued receipt of regular UC under state law. The individual is now
                        eligible to apply for PUA under this new COVID-19 related reason.

                 An individual is not eligible for PUA if they are otherwise eligible for regular UC
                 (or PEUC or EB). Many states have provisions in their state UC law that consider
                 work that unreasonably exposes an individual to health and safety risks to be
                 unsuitable work. The state may determine, if it is consistent with the state’s law,
                 that the work is not suitable. Or, the state may find the work is suitable but
                 determine that the individual had good cause for refusing such work.1 In these
                 circumstances, the individual must continue to receive unemployment benefits,
                 provided they are otherwise eligible. The individual is not eligible for PUA using
                 this new COVID-19 related reason if the individual was determined eligible for
                 continued unemployment benefits for refusal of work under state law. Moreover,
                 an individual who is allowed continued unemployment benefits and subsequently
                 exhausts such benefits is not eligible for PUA using this new COVID-19 related
                 reason.

          ii.    Certain individuals providing services to educational institutions or educational
                 service agencies. The Department approves the following COVID-19 related
                 reason for an individual to self-certify for PUA eligibility: “An individual
                 provides services to an educational institution or educational service agency and
                 the individual is unemployed or partially unemployed because of volatility in the
                 work schedule that is directly caused by the COVID-19 public health emergency.
                 This includes, but is not limited to, changes in schedules and partial closures.”

                 This new COVID-19 related reason addresses situations where an individual
                 provides services to educational institutions or educational service agencies and is
                 subject to significant volatility in the school schedule directly related to COVID-

1
  The Department reminds states that Section 4102(b) of the Emergency Unemployment Insurance Stabilization and
Access Act of 2020 (EUISAA), set out at Division D of the Families First Coronavirus Response Act (Pub. L. 116-
127), provides states with the authority to temporarily modify their good cause provisions as needed in response to
the spread of COVID-19 (see Section 5.C. of UIPL No. 13-20).

                 19. Whether the individual is “between or within terms” and has a “contract” or
                 “reasonable assurance” to return in the subsequent year or term will affect the
                 individual’s ability to self-certify under this COVID-19 related reason, as
                 described below.2 Attachment II provides a graphical representation of the
                 process for determining PUA eligibility.

                     A. Individual does not have a contract or reasonable assurance. An
                        individual who: (1) has provided services to an educational institution or
                        educational service agency; (2) lacks a contract or reasonable assurance
                        and, as a result, is not subject to the “between and within terms” denial
                        provisions; and (3) is not otherwise eligible for regular UC (or PEUC or
                        EB) may self-certify eligibility for PUA under this new COVID-19 related
                        reason if they are subject to significant volatility in the school schedule.

                         If the individual does not have a contract or reasonable assurance to return
                         and self-certifies eligibility under this new COVID-19 related reason (or
                         another COVID-19 related reason that is applicable to their situation), the
                         individual may use wages from the educational institution to potentially
                         qualify for a WBA that is higher than the state’s minimum PUA WBA.

                     B. Individual has a contract or reasonable assurance. An individual is
                        generally not eligible for PUA if they: (1) have provided services to an
                        educational institution or educational service agency; and (2) are filing for
                        a week that is between or within terms and they have a contract or
                        reasonable assurance to return in the subsequent year or term, and, as a
                        result, they are denied regular UC (or PEUC or EB). However, the
                        individual may be eligible for PUA if they have other non-educational
                        employment from which they are able to self-certify that they are
                        unemployed, partially unemployed, or unable or unavailable to work for a
                        different COVID-19 related reason. As described in Section 4.e.i. of
                        UIPL No. 10-20, Change 1, wages from the educational institution may
                        not be used to calculate the individual’s PUA WBA.

                         If school schedules or planned school openings are disrupted and an
                         individual is found to no longer have a contract or reasonable assurance to
                         return in the subsequent year or term, then they can establish eligibility
                         going forward as described in subparagraph (A) under this new COVID-
                         19 related reason or another COVID-19 related reason that is applicable to
                         their situation.




2
 UIPL No. 10-20, Change 1, provides additional information about the “between and within terms” denial provision
within the context of COVID-19. UIPL No. 05-17 clarifies the Department’s interpretation of the terms “contract”
and “reasonable assurance” and assists states in applying these terms consistent with federal law requirements.

                         Federal law allows retroactive payments of regular UC (or PEUC or EB)
                         under certain circumstances for individuals in a nonprofessional capacity
                         if they no longer have a contract or reasonable assurance. See Section
                         4.d.(4). of UIPL No. 05-17. When determining if such individuals may
                         receive PUA for weeks previously denied under regular UC (or PEUC or
                         EB) because the individual had a contract or reasonable assurance and the
                         individual was later found not to have reasonable assurance, states must
                         first determine if the individual qualifies for regular UC (or PEUC or EB)
                         under the state’s backdating provisions. If the individual does not qualify
                         for backdating for regular UC, then they may retroactively self-certify for
                         PUA under this new COVID-19 related reason. States must determine
                         PUA effective dates consistent with instructions provided in Section
                         4.b.iv. of this UIPL and Section C.15. of Attachment I to UIPL No. 16-20,
                         Change 4.

                 The individual must report any earnings each week that they file for PUA. The
                 individual’s WBA must be reduced on account of such earnings and income as
                 prescribed under state law. Individuals who receive a full salary during periods of
                 disruption are not considered to be “unemployed” and would not be eligible for
                 PUA. See Section 4.a. of UIPL No. 10-20.

         iii.    Individuals experiencing a reduction of hours or a temporary or permanent lay-
                 off. The Department approves the following COVID-19 related reason for an
                 individual to self-certify for PUA eligibility: “An individual is an employee and
                 their hours have been reduced or the individual was laid off as a direct result of
                 the COVID-19 public health emergency.”

                 This new COVID-19 related reason expands eligibility beyond the current
                 provision of item (jj) of Section 2102(a)(3)(A)(ii)(I) of the CARES Act, which is
                 limited to situations where the individual’s place of employment is closed. Under
                 this new COVID-19 related reason, if an individual is laid off because the place of
                 employment is partially closed (either permanently or temporarily) or the
                 individual has experienced a reduction in hours, the individual may now self-
                 certify eligibility.

                 Generally, individuals in covered employment who are laid off, are experiencing
                 a reduction in hours, or are working part-time as a result of partial business
                 closure would qualify for regular UC (or PEUC or EB) and therefore would not
                 be eligible for PUA. However, such individuals may not be eligible for regular
                 UC (or PEUC or EB) because, for example, they lack sufficient wages to qualify,
                 have a previous disqualification, or have exhausted regular UC, PEUC, and EB.
                 This expanded COVID-19 related reason establishes a circumstance under which
                 they may self-certify eligibility for PUA.3


3
 For examples of individuals who may qualify for PUA with previous disqualifications, refer to Questions 30, 31,
and 33 of Attachment I to UIPL No. 16-20, Change 1, or Question 12 of Attachment I to UIPL No. 16-20, Change 2.

            The individual must report any earnings from the reduced hours when filing
            continued claims and such amounts must be deducted from the PUA weekly
            benefit amount in accordance with the state law. See Section C.16.c. of
            Attachment I to UIPL No. 16-20, Change 4.

b. Processing claims using the expanded list of COVID-19 related reasons. This section
   describes the steps that each state must take to: (1) update the self-certification
   declarations to include the new COVID-19 related reasons; (2) notify individuals of the
   expanded list of COVID-19 related reasons; (3) establish eligibility, as appropriate, using
   the expanded list of COVID-19 related reasons; and (4) adhere to the backdating
   limitations for retroactive PUA claims as described below.

       i.   States must update the self-certification declarations to include the new COVID-
            19 related reasons. States must modify their initial PUA claim application and
            PUA continued claim forms to include these additional COVID-19 related reasons
            as part of the self-certification declaration. Such changes are retroactive to the
            beginning of the PUA program. States must determine PUA effective dates
            consistent with instructions provided in Section C.15. of Attachment I to UIPL
            No. 16-20, Change 4.

            Acknowledging that states need time to modify their initial PUA claim
            application and PUA continued claim forms to include these additional COVID-
            19 related reasons as part of the self-certification declaration, the Department
            expects many states will need until the end of March or later to have the new
            COVID-19 related reasons in place.

            Attachment I provides a sample self-certification declaration, which includes the
            original and new COVID-19 related reasons that ETA recommends states use
            with their initial PUA claim application and PUA continued claim forms.
            Additionally, states must comply with the following instructions when updating
            the self-certification declarations.

            A. Paraphrasing of the COVID-19 related reasons is not permissible.
               Acknowledging that eligibility under the PUA program is limited to specific
               COVID-19 related reasons, states must include the specific text for each item
               as provided in the CARES Act statute and Department guidance, including
               this UIPL. States may shorten the original COVID-19 related reason
               approved by the Secretary to read, “The individual is self-employed and
               experienced a significant reduction of services because of COVID-19.”
               However, states may not paraphrase the other COVID-19 related reasons
               except to personalize the responses (e.g., instead of saying “The individual has
               been…” the state may write “I have been…”).

                While states must include the specific text for each item, to help individuals
                understand the COVID-19 related reasons and to comply with the
                requirements outlined in UIPL No. 02-16, Change 1, states may translate the

   text into the appropriate languages for their population and provide examples
   consistent with Section C.1. of Attachment I to UIPL No. 16-20, Change 4,
   and Section 4.a. of this UIPL as an additional resource.

B. Individuals must be permitted to select more than one COVID-19 related
   reason. Acknowledging that an individual may have more than one COVID-
   19 related reason affecting their unemployment or inability to work in a given
   week, states must provide individuals with the ability to choose more than one
   COVID-19 related reason on each self-certification declaration for the initial
   application and continued claim forms.

   For example, an individual may have quit their job because their child, for
   which they are the primary caregiver, is unable to attend school because the
   school is closed to in-person instruction as a direct result of the COVID-19
   public health emergency. The individual continues to be unable to work
   because the child continues to be unable to attend school in-person. Under
   these circumstances, the individual may self-certify that they are unemployed
   under item (dd) and unavailable under item (ii) of Section 2102(a)(3)(A)(ii)(I)
   of the CARES Act.

   As another example, an individual may be unable to work because they are the
   primary caregiver of a child who is unable to attend school because the school
   is closed to in-person instruction as a direct result of the COVID-19 public
   health emergency. That same individual may also be immunocompromised
   and unable to reach their place of employment because they have been
   advised by a health care provider to self-quarantine. Under these
   circumstances, the individual may self-certify that they are unable or
   unavailable to work under both items (dd) and (ff) of Section
   2102(a)(3)(A)(ii)(I) of the CARES Act.

C. Individuals must be permitted to select different COVID-19 related reasons
   each week. Acknowledging that an individual’s circumstances may change
   over time, states must provide individuals with the ability to select different
   COVID-19 related reasons each week on the continued claim form, rather
   than automatically carrying over an individual’s response from the initial
   claim application or prior week’s certification.

   To continue the examples in paragraph B., the school may reopen in a
   subsequent week to provide in-person instruction. With this change in
   circumstances, the first and second individuals may no longer self-certify
   under item (dd) of Section 2102(a)(3)(A)(ii)(I) of the CARES Act because the
   school is no longer closed. However, both individuals may continue to self-
   certify under the other COVID-19 related reasons that are applicable to their
   respective situations.

       D. Individuals must be permitted to file and select no COVID-19 related reasons.
          Acknowledging that, along with an individual’s changing circumstances, an
          individual might continue to file after they are no longer unemployed,
          partially unemployed, or unable or unavailable to work because of a COVID-
          19 related reason, the initial claim application and continued claim forms must
          provide an option for the individual to self-certify that none of the COVID-19
          related reasons apply. For example, the state could provide an option for the
          individual to select “None of the above.” However, if the individual self-
          certifies that none of the COVID-19 related reasons apply, the individual will
          be denied for the week in question because they no longer meet the eligibility
          requirements for PUA and the state must issue a written, appealable
          determination (see Section C.20. of Attachment I to UIPL No. 16-20, Change
          4).

ii.    Notification of the expanded list of COVID-19 related reasons.

       A. Notification to individuals. States must notify every individual who had
          previously filed a PUA claim at any time while the PUA program was in
          effect, and was denied for any week because they were not unemployed,
          partially unemployed, or unable or unavailable to work for one of the COVID-
          19 related reasons available at the time. This notification must advise the
          individual of the opportunity to self-certify to the complete list of COVID-19
          related reasons, including the new criteria provided in Section 4.a. of this
          UIPL. Such notification must occur individually as described in Section C.28.
          of Attachment I to UIPL No. 16-20, Change 4.

          The Department reminds states that if the state determines that a PUA claim
          was filed by an individual that did not own the identity, the state may not send
          any notification of potential entitlement to the individual.

          Because states should have notified all individuals of the opportunity to file
          for PUA at the time a regular UC, PEUC, or EB claim was denied of the
          opportunity to file for PUA, states need not individually notify such
          individuals who did not apply for PUA about the expanded eligibility
          provisions.

       B. Notification to media. To assure public knowledge of the status of the PUA
          program, consistent with Section C.28.c. of Attachment I to UIPL No. 16-20,
          Change 4, states must notify all appropriate news media having coverage
          throughout the state of the new eligibility provisions of the PUA program.
          States may also post general information about the expanded eligibility
          provisions on their websites and other social media.

iii.   Establishing eligibility using the expanded list of COVID-19 related reasons. To
       establish eligibility for PUA based on one of the new COVID-19 related reasons,
       the individual must complete an initial PUA application (if they have not already

      filed a PUA claim) and the state must verify that the individual is not eligible for
      regular UC (or PEUC or EB). Additionally, the state must provide the individual
      with a self-certification declaration including the expanded list of COVID-19
      related reasons to assess initial eligibility for the PUA claim.

      If the state determines that the individual is not eligible for PUA, the state must
      issue an appealable determination. See Section C.20. of Attachment I to UIPL
      No. 16-20, Change 4.

      An individual who establishes retroactive initial eligibility for PUA must then be
      required to complete continued claim forms for each week (including the self-
      certification declaration that includes the original and expanded list of COVID-19
      related reasons) to receive payment. States must process this additional
      information and make retroactive payment as appropriate. This includes paying
      FPUC at the appropriate amount for any weeks paid during the relevant time
      period (i.e., FPUC payments at the $600 amount for eligible weeks of
      unemployment between the weeks ending April 4, 2020 and July 25, 2020 (or
      between the weeks ending April 5, 2020 and July 26, 2020 for states with a
      Sunday week ending date) and FPUC at the $300 dollar amount for weeks of
      unemployment between the weeks ending January 2, 2021 and March 13, 2021
      (or between the weeks ending January 3, 2021 and March 14, 2021 for states with
      a Sunday week ending date). See UIPL Nos. 15-20 and 15-20, Change 3, for
      additional information regarding FPUC payments.

      Individuals filing new PUA initial claims that have not been through the state’s
      identity verification process must have their identities verified to be eligible (see
      Section C.3. of Attachment I to UIPL No. 16-20, Change 4). The Department also
      strongly encourages states to validate the identity for reopened claims that have not
      previously been verified.

iv.   Effective dates.

      A. Existing PUA claims. For individuals with a PUA claim filed on or before
         December 27, 2020, the expanded COVID-19 related reasons provided in
         Section 4.a. of this UIPL are to be applied retroactively based on the effective
         date of an individual’s existing PUA claim.

         However, if the new COVID-19 related reason applied before the effective
         date of the individual’s existing PUA claim, the claim must be backdated to
         the date that the new COVID-19 related reason applied. For example, an
         individual may have filed a new PUA claim before December 27, 2020 with
         an effective date in April 2020 based on the previous COVID-19 related
         reasons available. With the addition of the new COVID-19 related reason, the
         individual actually may have first been eligible in February 2020. Because
         this existing PUA claim was filed on or before December 27, 2020, the state
         must backdate the PUA claim from April 2020 to February 2020 – when the
         individual first met the applicable COVID-19 related reason.

                  B. New PUA claims. For individuals filing an initial PUA claim after December
                     27, 2020, states must determine PUA effective dates for new PUA claims
                     consistent with instructions provided in Section C.15. of Attachment I to
                     UIPL No. 16-20, Change 4. For example, if an individual files a new PUA
                     claim after the publication of this UIPL because of circumstances occurring in
                     July 2020, absent a PUA claim already being on file and consistent with the
                     Continued Assistance Act, the claim effective date may not be any earlier than
                     December 1, 2020 (weeks of unemployment beginning on or after December
                     6, 2020), and retroactive benefits may not be awarded prior to that date.

    c. Benefit payment control processes. Section 2102 of the CARES Act relies on self-
       certification to verify that an individual is unemployed, partially unemployed, or unable or
       unavailable to work because of a listed COVID-19 related reason. However, states have
       multiple tools to identify and address suspicion of fraud in the PUA program.

        As described in Question 23 of Attachment I to UIPL No. 16-20, Change 2, states have
        authority to request supporting documentation when investigating the potential for fraud
        and improper payments. For example, the DUA regulation at 20 C.F.R. 625.14(h) refers
        to the Secretary’s “Standard for Fraud and Overpayment Detection” found in Sections
        7510 et seq. of the Employment Security Manual (20 C.F.R. Part 625 Appendix C).
        Requests for supporting documentation and a state’s investigative and adjudicative
        practices must be done in alignment with the processes described in UIPL No. 01-16 to
        ensure individuals are afforded appropriate procedural protections.

        States must use the required cross matches and tools, and should use the other cross
        matches and tools described in Section 4.b. of UIPL No. 23-20 to monitor for suspicious
        activity on PUA claims, as they do for regular UC. States must share PUA claim
        information with the Department’s Office of Inspector General (OIG) for the purposes of
        investigating fraud. Moreover, the Department strongly recommends that states
        collaborate with the UI Integrity Center (Center). The Center, funded by the Department
        and operated by the National Association of State Workforce Agencies, provides states
        with the Integrity Data Hub (IDH), which includes identity verification (IDV), the
        Suspicious Actor Repository (SAR), suspicious e-mail domains, Multi-State Cross Match
        (MSCM), foreign internet protocol (IP) address detection, and the Fraud Alert system.4
        The Center has provided states with new tools to support data mining to detect fraud. The
        Center also identifies, organizes, shares, and supports promising and innovative integrity
        practices and provides state-specific consulting, mentoring, and technical assistance.
        There is also a range of other tools on the market that states should consider when
        combating fraud and ensuring program integrity.

        Additionally, the Department strongly recommends as a best practice that states
        implement two new cross matches as part of the benefit payment control process for PUA
        to ensure integrity in applying the expanded COVID-19 related reasons provided in this

4
 Note that the Integrity Data Hub is currently only available to the 50 states, plus the District of Columbia, the
Commonwealth of Puerto Rico, and the Virgin Islands.

UIPL. These may be conducted only after the individual has established initial eligibility
for PUA based on self-certification. States may choose to perform these cross matches
before the first PUA payment is issued or later. Additionally, states may develop other
cross matches not already discussed in this UIPL to strengthen program integrity in the
PUA program.

   i.   Cross match of state unemployment claim records with respect to individuals who
        self-certify that they refused work that is unsafe because of the COVID-19 public
        health emergency.

        If the state identifies any discrepancies through this cross match (e.g., the
        individual does not have a previous unemployment claim or the individual was
        disqualified for a reason other than refusing work because of health and safety
        standards at the worksite), the state must review information already on file and
        take any action necessary to address the discrepancies.

        If the information on file with the state contradicts the individual’s PUA self-
        certification (e.g., previous adjudication of the issue determined that the worksite
        was in compliance with health and safety standards or previous adjudication of
        the issue determined that the individual refused work due to a reason that was not
        because of unsafe working conditions), then the state has reasonable suspicion of
        fraud and must open an investigation to conduct fact finding to determine if the
        individual’s PUA eligibility is valid.

        Because the PUA self-certification may be different from the state’s provisions
        for suitable work and good cause (e.g., the new COVID-19 related reason
        accounts for local, state, and national health and safety standards directly related
        to COVID-19), it is possible for an individual to be denied unemployment
        benefits under state law for health and safety standards and be eligible for PUA.

        If the state does not identify any discrepancies through this cross match (e.g., the
        individual has a previous unemployment claim, the individual refused work
        because the worksite was not in compliance with health and safety standards, the
        individual was denied continued benefits, and the state record does not contain
        information which contradicts this self-certification), the state does not have
        reasonable suspicion of fraud to open an investigation.

  ii.   Cross match of state unemployment claim records and individuals who self-
        certify that they were providing services to educational institutions or educational
        service agencies and are unemployed or partially unemployed because of
        volatility in the work schedule caused by the COVID-19 public health emergency.

        If the state identifies any discrepancies through this cross match (e.g., the
        individual does not have a record of providing services to an educational
        institution or educational service agency), the state may have reasonable suspicion
        of fraud.

            The state’s follow-up investigation regarding these results may include whether
            the individual provided services to an educational institution or educational
            service agency prior to filing for PUA and, if so, whether the individual is subject
            to the “between and within terms” denial provision during the time that such
            individual was receiving PUA.

            If the investigation finds that the individual (at the time of certifying under this
            COVID-19 related reason) is subject to the “between and within terms” denial
            provision because they have a contract or reasonable assurance to return at the
            subsequent year or term, then the PUA payment is improper – unless the
            individual meets the condition of having other non-educational employment and
            also self-certifies for a different COVID-19 related reason, as described in Section
            4.a.iii.B. of this UIPL. An overpayment must be established and state law will
            determine whether or not such an overpayment is considered fraudulent.

d. Additional administrative costs for implementation. Section 4.d. of UIPL No. 09-21
   provides $250,000 to cover startup costs for states implementing the PUA program.
   Additional funding of up to $100,000 is available to states under this UIPL to cover costs
   for implementing these expanded eligibility provisions, including an update to the self-
   certification declaration as part of their initial PUA application and continued claim forms
   as described in this UIPL. States must submit a signed SF-424 form to request this
   funding.

    Permissible implementation costs include:

       Computer programming and other technology costs;
       Implementation of necessary business processes required for program
        implementation;
       Training and travel;
       Notices to beneficiaries; and
       Overhead related only to the above.

    States will receive funding to administer claims under these provisions as part of their
    usual submissions of workload counts to the Department. Such ongoing administrative
    costs must not be included in the request for implementation funding. See Attachment II
    of UIPL No. 16-20, Change 4, for updated instructions on the ETA 902P report.

    States that need funding in addition to the $100,000 offered under this UIPL to cover
    implementation costs must submit a Supplemental Budget Request (SBR) detailing such
    costs along with the required SF-424 form. The basis for these estimated costs must be
    included in the SBR application. Calculations for costs for state staff and contractors
    should be shown in accordance with the SBR instructions in ET Handbook No. 336, 18th
    Edition, Change 4, Unemployment Insurance State Quality Service Plan Planning and
    Reporting Guidelines.

       States must submit the required request for funding electronically to [email protected],
       with a copy to the appropriate ETA Regional Office by March 15, 2021. For SBR
       application instructions, refer to UIPL No. 16-20, Attachment IV, Supplemental Budget
       Request (SBR) Application Template. For information on completing the SF-424, refer
       to Attachment III of this UIPL, Instructions for Completing the SF-424.

       Additionally, please note that grantees that receive supplemental grant awards for
       implementing these program changes must submit a quarterly progress report using the
       form ETA 9178-P to the appropriate ETA Regional Office. The form ETA 9178-P
       requires the grantee to provide ETA with narrative updates on supplemental grant
       activities. Attachments III and IV to UIPL No. 16-20, Change 1 contain form ETA 9178-
       P and instructions for completing the form ETA 9178-P and timeline for the submission
       of these status reports.

5. Inquiries. Please direct inquiries to [email protected] with a copy to the appropriate ETA
   Regional Office.

6. References.

          Consolidated Appropriations Act, 2021, including Division N, Title II, Subtitle A,
           the Continued Assistance for Unemployed Workers Act of 2020 (Pub. L. 116-260)
           (Continued Assistance Act);
          Coronavirus Aid, Relief, and Economic Security (CARES) Act (Pub. L. 116-136),
           including Title II, Subtitle A, Relief for Workers Affected by Coronavirus Act;
          Families First Coronavirus Response Act (Pub. L. 116-127), including Division D
           Emergency Unemployment Insurance Stabilization and Access Act of 2020
           (EUISAA);
          20 C.F.R. Part 625, Disaster Unemployment Assistance;
          UIPL No. 28-20, Change 1, Additional Funding for Identity Verification or
           Verification of Pandemic Unemployment Assistance (PUA) Claimants and Funding to
           Assist with Efforts to Prevent and Detect Fraud and Identity Theft as well as Recover
           Fraud Overpayments in the PUA and Pandemic Emergency Unemployment
           Compensation (PEUC) Programs, issued January 15, 2021,
           https://wdr.doleta.gov/directives/corr_doc.cfm?docn=9897;
          UIPL No. 28-20, Addressing Fraud in the Unemployment Insurance (UI) System and
           Providing States with Funding to Assist with Efforts to Prevent and Detect Fraud and
           Identity Theft and Recover Fraud Overpayments in the Pandemic Unemployment
           Assistance (PUA) and Pandemic Emergency Unemployment Compensation (PEUC)
           Programs, issued August 31, 2020,
           https://wdr.doleta.gov/directives/corr_doc.cfm?DOCN=8044;
          UIPL No. 23-20, Program Integrity for the Unemployment Insurance (UI) Program
           and the UI Programs Authorized by the Coronavirus Aid, Relief, and Economic
           Security (CARES) Act of 2020 – Federal Pandemic Unemployment Compensation
           (FPUC), Pandemic Unemployment Assistance (PUA), and Pandemic Emergency
           Unemployment Compensation (PEUC) Programs, issued May 11, 2020,
           https://wdr.doleta.gov/directives/corr_doc.cfm?DOCN=4621;

         UIPL No. 16-20, Change 4, Continued Assistance to Unemployed Workers Act of
          2020 – Pandemic Unemployment Assistance (PUA) Program: Updated Operating
          Instructions and Reporting Changes, issued January 8, 2021,
          https://wdr.doleta.gov/directives/corr_doc.cfm?DOCN=6973;
         UIPL No. 16-20, Change 3, Coronavirus Aid, Relief, and Economic Security
          (CARES) Act of 2020 – Eligibility of Individuals who are Caregivers for Pandemic
          Unemployment Assistance (PUA) in the Context of School Systems Reopening, issued
          August 27, 2020, https://wdr.doleta.gov/directives/corr_doc.cfm?DOCN=3849;
         UIPL No. 16-20, Change 2, Coronavirus Aid, Relief, and Economic Security
          (CARES) Act of 2020 – Pandemic Unemployment Assistance (PUA) Additional
          Questions and Answers, issued July 21, 2020,
          https://wdr.doleta.gov/directives/corr_doc.cfm?DOCN=5479;
         UIPL No. 16-20, Change 1, Coronavirus Aid, Relief, and Economic Security
          (CARES) Act of 2020 – Pandemic Unemployment Assistance (PUA) Program
          Reporting Instructions and Questions and Answers, issued April 27, 2020,
          https://wdr.doleta.gov/directives/corr_doc.cfm?DOCN=5899;
         UIPL No. 16-20, Coronavirus Aid, Relief, and Economic Security (CARES) Act of
          2020 – Pandemic Unemployment Assistance (PUA) Program Operating, Financial,
          and Reporting Instructions, issued April 05, 2020,
          https://wdr.doleta.gov/directives/corr_doc.cfm?DOCN=4628;
         UIPL No. 10-20, Change 1, Unemployment Compensation (UC) for Individuals
          Affected by the Coronavirus Disease 2019 (COVID-19) – Interpretation of “Between
          and Within Terms” Denial Provisions in Section 3304(a)(6)(A) of the Federal
          Unemployment Tax Act (FUTA), published May 15, 2020,
          https://wdr.doleta.gov/directives/corr_doc.cfm?DOCN=8879;
         UIPL No. 05-17, Interpretation of “Contract” and “Reasonable Assurance” in
          Section 3304(a)(6)(A) of the Federal Unemployment Tax Act, published December
          22, 2016, https://wdr.doleta.gov/directives/corr_doc.cfm?DOCN=8999;
         UIPL No. 02-16, Change 1, State Responsibilities for Ensuring Access to
          Unemployment Insurance Benefits, Services, and Information, published May 11,
          2020, https://wdr.doleta.gov/directives/corr_doc.cfm?DOCN=5491; and
         ET Handbook No. 336, 18th Edition, Change 4, Unemployment Insurance State
          Quality Service Plan Planning and Reporting Guidelines.

7. Attachment(s).

         Attachment I: Sample Self-Certification Declaration for Individuals Claiming PUA.
         Attachment II: PUA Eligibility for Certain Individuals Providing Services to
          Educational Institutions or Educational Service Agencies.
         Attachment III: Instructions for Completing the SF-424.

                                                      Attachment I to UIPL No. 16-20, Change 5

            Sample Self-Certification Declaration for Individuals Claiming PUA

To be eligible for PUA, the state must determine that the individual is not eligible for regular
UC, PEUC, or EB (see Section C.12.b. of Attachment I to UIPL No. 16-20, Change 4). This
includes an individual who is self-employed, seeking part-time employment, does not have
sufficient work history, or would otherwise not qualify for regular UC (or PEUC or EB). The
individual must also self-certify that they are otherwise able to work and available for work
within the meaning of applicable state law, except that they are unemployed, partially
unemployed, or unable or unavailable to work for a listed COVID-19 related reason(s). ETA
recommends that states use this sample self-certification declaration as part of the initial claim
application and continued claim form to meet the requirement to obtain self-certification that an
individual meets the COVID-19 related reason(s) in Section 2102(a)(3)(A)(ii)(I) of the CARES
Act.

                             A. SELF-CERTIFICATION DECLARATION

 To qualify for PUA, you must be unemployed, partially unemployed, or unable or
 unavailable to work because of one or more of the COVID-19 reasons listed below. Please
 check all of the following categories that apply to you for the week you are claiming.

  I have been diagnosed with COVID-19 or am experiencing symptoms of COVID-19 and am
   seeking a medical diagnosis.
  A member of my household has been diagnosed with COVID-19.
  I am providing care for a family member or a member of my household who has been
   diagnosed with COVID-19.
  A child or other person in my household for which I am the primary caregiver is unable to
   attend school or another facility that is closed as a direct result of the COVID-19 public
   health emergency and such school or facility care is required for me to work.
  I am unable to reach my place of employment because of a quarantine imposed as a
   direct result of the COVID-19 public health emergency.
  I am unable to reach my place of employment because I have been advised by a health
   care provider to self-quarantine due to concerns related to COVID-19.
  I was scheduled to commence employment and do not have a job or am unable to reach
   the job as a direct result of the COVID-19 public health emergency.
  I have become the breadwinner or major support for my household because the head of
   the household has died as a direct result of COVID-19.
  I quit my job as a direct result of COVID-19.
  My place of employment is closed as a direct result of the COVID-19 public health
   emergency.
  I am self-employed (including an independent contractor and gig worker) and
   experienced a significant reduction of my customary or usual services because of the
   COVID-19 public health emergency.

 I was denied continued unemployment benefits because I refused to return to work or
  accept an offer of work at a worksite that, in either instance, is not in compliance with
  local, state, or national health and safety standards directly related to COVID-19. This
  includes but is not limited to, those related to facial mask wearing, physical distancing
  measures, or the provision of personal protective equipment consistent with public
  health guidelines.
 I provide services to an educational institution or educational service agency and am
  unemployed or partially unemployed because of volatility in the work schedule that is
  directly caused by the COVID-19 public health emergency. This includes, but is not
  limited to, changes in schedules and partial closures.
 I am an employee and my hours have been reduced or I was laid off as a direct result of
  the COVID-19 public health emergency.
 None of the above apply to me.

                                 B. ACKNOWLEDGEMENT

CERTIFICATION: I certify that the information I have provided above, which will be used to
determine my eligibility for Pandemic Unemployment Assistance, is correct to the best of my
knowledge. I understand that I am subject to administrative penalties, including the
penalties for perjury, or legal action if it is determined that I withheld or provided false
information to obtain assistance payments to which I am not entitled.


SIGNATURE OF APPLICANT:                                                DATE (Month/
                                                                       Day/Year):

                                                                                                           Attachment II to UIPL No. 16-20, Change 5

            PUA Eligibility for Certain Individuals Providing Services to Educational Institutions or Educational Service Agencies

As part of the state’s assessment on whether an individual providing services to an educational institution or educational service agency is eligible for
regular UC (or PEUC or EB), the state will determine if the individual is claiming a week that occurs between or within terms and, if so, whether the
individual has a contract or reasonable assurance to return in the subsequent year or term. See UIPL Nos. 10-20, Change 1, and 05-17 for more
information. If the individual qualifies for regular UC (or PEUC or EB), they may not receive PUA. This includes individuals who are subject to the
“between and within terms” denial provisions but are eligible for regular UC (or PEUC or EB) with the use of non-educational wages only.

This chart describes an individual’s potential eligibility for PUA after the state has already determined that the individual is not eligible for regular
UC (or PEUC or EB) or that the individual has exhausted such benefits.

                                                  Attachment III to UIPL No. 16-20, Change 5

                           Instructions for Completing the SF-424

Application for Federal Assistance (SF-424)

Use the current version of the form for submission. Expired forms will not be accepted. SF-424,
Expiration Date 12/31/2022, Office of Management and Budget (OMB) Control No. 4040-0004
(Grants.gov). http://www.grants.gov/web/grants/forms/sf-424- family.html

Section # 8, APPLICANT INFORMATION:

      Legal Name: The legal name must match the name submitted with the System for Award
       Management (SAM). Please refer to instructions at https://www.sam.gov/SAM/.
      Employer/Tax Identification Number (EIN/TIN): Input your correct 9-digit EIN and
       ensure that it is recorded within SAM.
      Organizational DUNS: All applicants for Federal grant and funding opportunities are
       required to have a 9-digit Data Universal Numbering System (D-U-N-S®) number, and
       must supply their D-U-N-S® number on the SF-424. Please ensure that your state is
       registered with the SAM. Instructions for registering with SAM can be found at
       https://www.sam.gov. Additionally, the state must maintain an active SAM registration
       with current information at all times during which it has an active Federal award or an
       application under consideration. To remain registered in the SAM database after the
       initial registration, there is a requirement to review and update the registration at least
       every 12 months from the date of initial registration or subsequently update the
       information in the SAM database to ensure it is current, accurate, and complete. Failure
       to register with SAM and maintain an active account will result in a rejection of your
       submission.
      Address: Input your complete address including Zipcode+4; Example: 20210-0001. For
       lookup, use link at https://tools.usps.com/go/ZipLookupAction!input.action.
      Organizational Unit: Input appropriate Department Name and Division Name, if
       applicable.
      Name and contact information of person to be contacted on matters involving this
       application: Provide complete and accurate contact information including telephone
       number and email address for the point of contact.

Section # 9, Type of Applicant 1: Select Applicant Type: Input “State Government”

Section # 10, Name of the Federal Agency: Input “Employment and Training Administration”

Section # 11, Catalog of Federal Domestic Assistance Number: Input “17.225”; CFDA Title:
Input “Unemployment Insurance”

Section # 12, Funding Opportunity Number and Title:

       For Pandemic Unemployment Assistance Funding Allotment:
       Input “UIPL No. 16-20, Change 5, Pandemic Unemployment Assistance Implementation
       Grants”

Section # 13, Competition Identification Number: Leave Blank

Section # 14, Areas Affected by Project: Input the place of performance for the project
implementation; Example “NY” for New York

Section # 15, Descriptive Title of Applicant’s Project:

       For Pandemic Unemployment Assistance Funding Allotment:
       Input “UIPL No. 16-20, Change 5, Pandemic Unemployment Assistance Implementation
       Grants”

Section # 16, Congressional Districts of:

   a. Applicant: Input the Congressional District of your home office. For lookup, use link at
      www.house.gov with Zip code + 4
   b. Program/Project: Input the Congressional District where the project work is performed.
      If it’s the same place as your home office, input the congressional district for your home
      office. For lookup, use link at www.house.gov with Zipcode+4

Section # 17, Proposed Project

   a. Start Date: Input a valid start date for the project (earliest start date will be January 1,
      2021)
   b. End Date: Input a valid end date for the project (June 30, 2022)

Section # 18, Estimated Funding ($):

Each state is allotted up to $100,000 in funding to cover implementation costs

Section #s 19 – 20: Complete as per instructions for Form SF-424

Section # 21, Authorized Representative: Please select the “I AGREE” check box and provide
complete information for your authorized signatory including contact information such as
telephone number and email address. If your Authorized Representative has changed from your
previous application submission for this program, please include a letter from a higher level
leadership authorizing the new signatory for the application submission

Remember to get the SF-424 signed and dated by the Authorized representative.

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