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 issued a new eviction moratorium order on August 3 for all counties with "high" or "substantial" rates of COVID-19 transmission. This new order is through October 3, 2021.

 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 8.4.21.

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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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Download

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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.

Step 1. Sign the form and make copies.

Carefully review, sign and date the form. Every adult that is on the lease must sign and date the form. Fill out the “Proof of Service” section with the information about when, how and where you will deliver the form to the landlord. Make at least two copies of the signed form.

Step 2. Deliver a copy of the form to your landlord.

Mail or deliver by hand one of the copies of the form. Keep the original version of the form for your records.

 

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