Last day to submit an application is 12/14/2020 at 11:59pm.

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* Have you previously applied to the Pasco PPE Reimbursement Program?

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* Contact Information

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* Business Information

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* Employer Identification Number (EIN) / Federal Employer Identification Number (FEIN)

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* Total Number of Employees

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* Number of Those Employees Residing in Pasco County

PPEs Purchased

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* Face Masks / Respirators?

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* If Yes, please complete the Description and Cost for Face Masks / Respirators below.

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* Gloves?

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* If Yes, please complete the Description and Cost for Gloves below.

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* Face Shields?

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* If Yes, please complete the Description and Cost for Face Shields below.

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* Eye Protection?

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* If Yes, please complete the Description and Cost for Eye Protection below.

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* Gowns?

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* If Yes, please complete the Description and Cost for Gowns below.

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* Hand Sanitizer with an alcohol content of 60% or higher?

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* If Yes, please complete the Description and Cost for Hand Sanitizer below.

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* Disinfecting products identified on the US Environmental Protection Agency’s website of disinfectants for use against SARS-CoV-2 (https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2)?

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* If Yes, please complete the Description and Cost for Disinfecting products below.

Pasco County representatives will contact the applicant with instructions on how to upload required documentation to support this application

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