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CDC Eviction Declaration Form

This Eviction Declaration Form was made by the Centers for Disease Control and Prevention (CDC) as part of their order to bar the eviction of tenants who are unable to pay their rent. To prevent an eviction from occurring, a tenant must meet criteria set by the CDC and give their landlord this document. The federal halt on evictions runs from September 4, 2020 to June 30, 2021. At the end of the temporary eviction moratorium, tenants will be responsible for any missed rent payments. 

Use a Declaration to Temporarily Halt Evictions if you meet the following criteria: 

• You rent your home (This order does not apply to foreclosures on home mortgages.) 

• You have an income of less than $99,000 if single or $198,000 for couples filing jointly

• You have used best efforts to gain government assistance for rent or housing

• You are unable to pay rent due to loss of income, compensable hours of work or wages, lay-offs, or extraordinary out-of-pocket medical expenses 

• You have made best efforts to make timely partial rent payments as circumstances permit

• Eviction would force you to move into a homeless shelter or into a shared living setting 

A Declaration to Temporarily Halt Evictions should be given to your landlord as soon as you are aware that you cannot make your rent payment. If you have questions about the eviction process or eviction moratoriums, it is recommended that you speak with an attorney.