The State Department announced on Tuesday it was withholding $65m out of a $125m aid package earmarked for the United Nations Relief and Works Agency for Palestinian Refugees (UNRWA).
In a letter, the department said that additional US donations will be contingent on major changes by UNRWA.
Those funds are "frozen for future consideration", Heather Nauert, State Department spokeswoman, told reporters.
For nearly 70 years, UNRWA has been the lifeline to the more than five million registered Palestinian refugees in the occupied territories and in Lebanon, Jordan and Syria.
It offers support in food supply, access to education, healthcare, social services and employment.
"This is going to be a big blow," Al Jazeera's James Bays, reporting from the UN headquarters in New York, said of the move by the US, which is UNRWA's largest donor supplying almost 30 percent of its budget.
"UNRWA is the agency that deals with the needs of so many desperate people," he added.
'Political dimension'
The announcement came after US President Donald Trump had threatened on January 3 to cut aid to Palestinians.
In a series of tweets, Trump had said: "... We pay the Palestinians HUNDRED OF MILLIONS OF DOLLARS a year and get no appreciation or respect.
"... With the Palestinians no longer willing to talk peace, why should we make any of these massive future payments to them?"
The posts came less than a month after his controversial decision to recognise Jerusalem as Israel's capital, a move that prompted widespread international condemnation and led Palestinian leaders to say that they would "no longer" accept any peace plan put forward by the US.
Following the US threats about cutting aid, Israeli Prime Minister Benjamin Netanyahu called for UNRWA to be scrapped and accused the agency of helping "fictitious refugees".
Antonio Guterres, the UN secretary-general, said on Tuesday he had not been informed of Washington's decision.
"First of all, UNRWA is not a Palestinian institution, UNRWA is a UN institution," Guterres said, expressing his deep "concern" about the move.
If the agency is not in a position to provide "vital services" and emergency support it will create a "very very serious problem," he told reporters.
"In my opinion, and an opinion that is shared by most international observers, including some Israeli ones, it [UNRWA] is an important factor of stability."
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