As a reminder of Provider Relief Funds Attestation, you must sign an attestation confirming receipt of the funds and agree to the terms and conditions within 30 days of payment. Should you choose to reject the funds, you must also complete the attestation to indicate this. This Payment Portal will guide you through the attestation process to accept or reject the funds.

Link to Attestation: The CARES Act Provider Relief Fund Payment Attestation Portal

Below are the steps once you log into the attestation.

Link to: Terms & Conditions

NOTE: you will need the last 6 digits of the deposit account number and the Relief Fund Payment amount.

Payment Terms Attestation

Please attest to and accept the Terms & Conditions below for each TIN you have entered. The current TIN is shown in the box to the right. Once you complete the first TIN you will be asked to attest to each TIN in the list.

I acknowledge receipt of $_______________ from the Public Health and Social Services Emergency Fund (“Relief Fund”), and accept the Terms & Conditions. If you received a payment from funds appropriated in the Relief Fund under Division B of Public Law 116-127 and retain that payment for at least 30 days without contacting HHS regarding the remittance of those funds, you are deemed to have accepted the following Terms & Conditions. This is not an exhaustive list and you must comply with any other relevant statutes and regulations, as applicable. Your commitment to full compliance with all Terms and Conditions is material to the Secretary’s decision to disburse these funds to you. Non-compliance with any Term or Condition is grounds for the Secretary to recoup some or all of the payment made from the Relief Fund. These Terms and Conditions apply directly to the recipient of payment from the Relief Fund. In general, the requirements that apply to the recipient, also apply to sub-recipients and contractors under grants, unless an exception is specified.

By receiving and accepting Relief Fund payment, you attest that in accordance with the “Coronavirus Aid, Relief, and Economic Security Act” or the “CARES Act”, you are eligible for this payment. You acknowledge that you may be asked to submit to the review process established by the U.S Department of Health and Human Services, including its contractor (collectively, “HHS”), to determine your eligibility for this payment. Additionally, upon request by HHS, you will provide any and all information related to the disposition or use of the funds received under the Relief Fund for auditing and/or reporting purposes. I attest that I have the legal authority to act on behalf of the provider group that has received payment under the Relief Fund. For Electronic Funds Transfer / ACH Payments, HHS or its contractor may make adjustments to the payment whenever a correction or change is required. For example, if there is an error, you agree that HHS may correct the error immediately and without notice. Such errors may include but are not limited to, reversing an improper credit, and correcting calculation and input errors. The right to make adjustments are not subject to any limitations or time constraints, except as required by law.

By providing your email and phone number, you agree that HHS or its contractor may send you communications or call you regarding Relief Fund payment. You understand that you need to give us the most up to date contact information.

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