Response Form for RFP on FREE-B Workshops

Please complete all sections of this form. The information that you provide will be used to select sites that will be funded. Incomplete applications will not be considered for funding. Please email the completed form along with any attachments to by March 15th, 2013 by 4:00 pm Eastern. The POC identified in question number 1, below, will be notified by March 31stas to the status of your application.

  1. Contact information

Name:

Title:

Affiliation:

Mailing Address:

Email Address:

Phone Number:

Please indicate your FDA region: (Please click here if you do not know your FDA region.)

Northeast

Central

Southeast

Southwest

Pacific

  1. For what FREE-B scenario is your organization requesting funding?

How Sweet It Is(n’t)

Stealthy Situation

Wilted Woes

Feed-related(NEW scenario)

Water-related (NEW scenario)

Recovery-related (NEW scenario)

  1. Please describe key lessons learned from recent (past 3 years) food protection related tabletop exercises and/or workshops (if any) in which your organization has participated. If your organization has not conducted and/or participated in any, please indicate this. (250 words or less)
  1. If selected, please describe how your organization will incorporate other agencies, municipalities, industry, academic community and or/consumer organizations into this process (250 words or less).
  1. Please provide a timeframe that the tabletop exercise might be held?
  1. Where will this tabletop exercise be held?
  1. What is your anticipated number of attendees for this tabletop exercise?
  1. Please indicate below what the funds provided through this opportunity will be used for. Please note that funds may not be used to support travel (beyond per diem / mileage) or food and beverage. Favorable reviews will be provided for those entities that illustrate in-kind support that other organizations may be providing. You may also submit a budget spreadsheet to support your response to this question, but it is not required.

Meeting space

Handout preparation

Mileage for attendees

Materials related to day of event

Supplies for attendees

Per diem(according to Federal guidelines)

Other (please describe):

  1. What other deliverables might your jurisdiction meet with this exercise? (Where possible, please indicate the complete title of the deliverable, and, while not required, illustrate the nature of the relationship of the FREE-B exercise to the grant program or strategy identified below (or to the one you’ve provided):

Public Health Emergency Preparedness (PHEP) – Centers for Disease Control and Prevention (CDC)

Hospital Preparedness Program (HPP) - Assistant Secretary for Preparedness and Response (ASPR)

National Health Security Strategy

Healthy People 2020

Presidential Policy Directive-8

State / Regional Deliverable

Others (please describe)

  1. If there is anything else that you’d like to describe or reference, that is not captured within these questions, please do so. This section is limited to 500 words: