CDC Eviction Moratorium Declaration Form

This is a step by step interview to complete the required declaration form to stop an eviction under the CDC’s Eviction Moratorium. The CDC has extended this order through June 30, 2021. But, because of certain recent actions in federal court, the CDC moratorium might not protect you in your local eviction court. 

 Rental assistance is available in all 88 counties through your local community action agency. If you cannot pay your rent or are behind on rent, contact your local community action agency as soon as possible to apply for rental assistance. 

You will need to: 

  • Register for a My OLH account. Registering will allow you to save and complete this form on your own schedule.  
  • Enter your information completely and correctly. 
  • All the information you fill out will be saved. You can click "Save & Exit" and return to complete your form.   
  • Download or email your completed form. 
  • Follow the instructions on the completed form to file with the court.

This page was last updated on 4.1.21. 

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Time to Complete: 10 minutes
This is an estimate for the total time it will take you to complete this form. Once you get started, you will be able to save the form in progress.
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Fill out

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Review

Time to Complete: 10 minutes
This is an estimate for the total time it will take you to complete this form. Once you get started, you will be able to save the form in progress.
Send this page to:

After You Finish

Learn what to do when you have finished filling out this form.

Due to recent actions in federal court, the CDC moratorium might not protect you in your local eviction court. But, it can still be a powerful tool if you are behind in rent because of COVID-19 and need to start a conversation with your landlord. Use this form to inform your landlord that you are behind on rent due to losing income during the pandemic. Make sure to tell your landlord that you are seeking rental assistance. If you have good communication with your landlord, you may be able to negotiate a payment plan or another compromise to help you stay in your home until you can find a new place to live. 

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