OMB No. 0581-0326

Pandemic Response and Safety Grant Program

Assistance Listing Number: 10.181

Tribal Seafood Pandemic Response and Safety Grant 

Program (TSPRS)

Appendix B: Application & Funding Request Form

Instructions: Column A provides the outcomes and activities funded by the Tribal Seafood Processors Pandemic Safety and Response 

Grant Program. The funding request to offset costs associated with the outcomes and activities is entered in column B. 

Eligible Outcomes and Activities Funding Request

Implement workplace safety measures to protect workers against COVID-19

• Provide personal protective equipment, thermometers, cleaning supplies, sanitizer, or hand 

washing stations

• Installation and purchase of air filters or new signage

Implement market pivots to protect workers against COVID–19

• Develop and implement online sales platforms and associated costs (online platform development 

and fees, online marketing, credit card processing fees)

• Utilize online or print materials to communicate market pivots

• Transition from restaurant or food service to retail markets, including costs associated with shifting 

from fresh to frozen products (building cold storage, purchasing new packaging, or implementing 

new distribution methods)

Retrofit facilities for worker and consumer safety to protect against COVID–19

• Installation and purchase of protective barriers made of plexiglass or plastic sheeting, walk up 

windows, heat lamps/heaters, fans, tents, propane, weights, tables, chairs and lighting

• Installing new production or processing equipment required to increase social distancing

Provide additional transportation options to maintain social distancing and worker and consumer safety

to protect against COVID-19

• Secure additional transportation services for workers 

• Offer new delivery routes or distribution services 

Provide worker housing that protects workers against COVID-19

• Secure additional housing resources/services to maintain social distancing, allow for mandatory 

quarantining of newly-arrived seasonal employees, or isolation of exposed employees

Provide health services to protect workers against COVID-19

• Offer or enable vaccinations, testing, or healthcare treatment of infected employees, including any 

paid leave due to COVID-19 infection. 

Total Funding Request (This amount must be between $100,000 and $500,000)
By submitting this application, I attest that: 

• Between January 27, 2020 and December 31, 2021, my entity has implemented and/or plans to implement the 

activity or activities selected, and the funding amount requested in my application reflects the fair market value 

of the goods and services associated with the selected activity or activities and the corresponding outcome(s). 

• No other Federal funds were used to cover the cost of the activity or activities selected.

• I certify that the statements herein are true, complete, and accurate to the best of my knowledge. I also agree to 

comply with any resulting terms if I accept an award. 

• I am aware that any false, fictitious or fraudulent statements or claims may subject me to criminal, civil or 

administrative penalties (U.S. Code, Title 2018, Section 1001)