Carbon County

COVID-19 County Relief Block Grant Application Instructions

SMALL BUSINESS GRANTS

The COVID-19 County Relief Block Grant Program allows the county to provide funding for a small businessgrant program. The County has developed an application for small businesses to apply for funding throughthis program. The effects of the pandemic for which the entity is requesting funding must relate to theperiod that began on March 1, 2020 and ends on December 30, 2020.

Like many things related to the COVID-19 pandemic, guidance relating to the Coronavirus Relief Fund andPennsylvania’s related COVID-19 – County Relief Block Grant Program is subject to change. Some of thelimited guidance issued by the federal government has already been revised several times. TheCommonwealth has not yet issued extensive guidance relating to the COVID-19 – County Relief BlockGrant Program but may do so in the future.

It should be noted that funding is limited and not all requests may be fully funded.

According to federal and state guidelines, a business must employ less than 100 employees to be eligiblefor funding through this program. In addition, state regulations require that preference be given tobusinesses that have not received funding through the Paycheck Protection Program (‘PPP”) or EconomicInjury Disaster Loan Program (“EIDL”) established under the CARES Act.

The applications are to be submitted to the County by July 31 and the applications must include allrequired documentation. The applications will not be processed without all required documentation.

1. Complete the Application that is provided on the County’s website.2. Details to Provide in Narrative Section

a. A description of how the pandemic affected your business, includingi. Complete Closureii. Partial Closure

iii. Steps taken responding to the pandemic to allow your business to continuecurrent or future operations

iv. Details on lost business (analysis of income lost)b. Incurred Expenses

i. Provide a narrative of the expenses you incurred responding to the pandemicfor your business

ii. Attach copies of all invoices for which you are requesting funding to reimbursec. Revenue Decline

i. Provide details on the effect the pandemic has had on your businesses revenuegeneration. This may include comparisons to prior years or months, or revenueexpectations for businesses recently started

3. Items to attacha. Most recent filed IRS Form 941, if your business has employeesb. Most recent filed business tax returnc. Copies of Invoices for expense incurred for which funding is requestedd. Support for revenue decline included in narrative. This may include copies of income or

sales tax filings.

Block Grant Administration Group – Phone: 570-325-3611 Email: CovidGrantCor@carboncounty.net

Application: COVID-19 County Relief Block Grant

Organization/Business Name: _______________________________________________

Organization/Business County Relief Block Grant Category: ____________________________

If Other, explain: ______________________________________________

Organization/Business Information:

Street Address: __________________________

Municipality/Town: _____________________________

Zip Code: ___________________________________

Phone Number: ____________________________

Email: ______________________________________________

Website: ________________________________________

Facebook Page: _____________________________________________

EIN: ___________________________________

Type of Business: ____________________________________________

Did you participate in the Federal Paycheck Protection Program (PPP) or Economic Injury Disaster Loan (EIDL) Program established under the CARES ACT or any other COVID-19 grant/loan program?

Yes: ____ No: ____ If yes, which program: ____________________

If Other, indicate: ___________________________________________________________

Amount of award received: _____________________

Amount of COVID-19 Relief County Block Grant requested: _______________

Did your expenses occur between March 1, 2020 through December 31, 2020: Yes: ____ No: ____

Justification for grant funds (clear, concise & complete):

Block Grant Administration Group – Phone: 570-325-3611 Email: CovidGrantCor@carboncounty.net

Justification continued:

Primary Point of Contact:

Last Name: ______________________ First Name: _____________________________

Role in organization/business: __________________

Phone Number: _______________________

Email: __________________________

Alternate Point of Contact

Last Name: ______________________ First Name: _____________________________

Role in organization/business: __________________

Phone Number: _______________________

Email: __________________________

I certify under penalty of law that this document and the information submitted are, to the best of my knowledge and belief, true, accurate and complete. I understand that false statements made herein or in the information submitted are subject to the penalties for unsworn falsification to authorities set forth in the 18 Pa.C.S.A. § 4904.

Signature: ________________________________________________________________

Date: ______________________________________________

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