COVID-19 Technical Assistance Program Application Form

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Please use this form to submit your CTAP application materials to Berkeley Lab. Berkeley Lab will then coordinate with you and others in submitting application materials to DOE / OTT.

More information is available here:
- Summary of CTAP: https://ipo.lbl.gov/berkeley-lab-accepting-proposals-for-covid-19-technical-assistance-program/

Email *

Principal Investigator at External Entity *

Name and Address of External Entity requesting CTAP project *

Berkeley Lab Principal Investigator, if known

Proposed CTAP Project Title *

Proposed Brief CTAP Project Description - must include explanation of potential impact to work related to a COVID-19 response *

Proposed Funding Request (itemizing anticipated number of hours and cost of materials) *

Proposed CTAP Project Duration (provide anticipated start to end dates of project) *

You must certify to the following CTAP requirements:

1. Proposed work is directly related to COVID-19 support work
2. Proposed Statement of work is here attached.
3. Proposed work does not involve clinical testing of patients.
4. Proposed work does not involve project personnel or organizations that have any affiliations that could present the appearance of conflict of interest.
5. Proposed work will use an existing DOE pre-approved agreement that preserves and allocates rights to subject inventions.
6. Proposed work does not utilize Human or Animal Subjects.
7. Proposed work is for a U.S. entity not subject to foreign majority control.
8. Proposed work:
a. is consistent with or complementary to DOE mission;
b. does not adversely impact execution of assigned programs at the facility;
c. does not involve any construction or modifications to Department facilities; and
d. does not create a detrimental future burden on DOE resources.
9. Proposed work does not involve:
a. use or generation of classified information;
b. Export Controlled Information (ECI),
c. Unclassified Controlled Nuclear Information (UCNI),
d. intelligence-related work;
e. unescorted access to security areas;
f. nuclear nonproliferation detection technology; or
g. space nuclear or noncommercial power reactor work.
10. Proposed work does not involve Foreign travel.
11. If the proposed work involved contributed funds from the external entity, Federal Administration Charge applies in accordance with DOE O 522.1.

I certify to the above CTAP requirements *

I certify

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