COVID-19 Video Doorbell Program

THE PROGRAM

On November 9, 2020, Tribal Council approved the use of the Coronavirus Relief Fund, ("CRF") for the COVID-19 Video Doorbell Program, ("Program") provides reimbursement for video doorbells  ("Assistance") to Pokagon Band of Potawatomi Indian ("Band") citizens whose households include at least one person who is potentially at increased risk of severe illness from COVID-19 according to the Centers for Disease Control ("CDC").

Purchase & Reimbursement:

  • The COVID-19 Video Doorbell Program (“Program”) provides reimbursement for video doorbells (“Assistance”) to Pokagon Band of Potawatomi Indian (“Band”) citizens whose households include at least one person who is potentially at increased risk of severe illness from COVID-19 according to the Centers for Disease Control (“CDC”).
  • The Assistance under this Program is provided with the intent that members of households with persons at potentially increased risk of severe illness from COVID-19 can reduce their potential to contract COVID-19.
  • Assistance shall not duplicate any other assistance, including that provided by the Band under other COVID-19 relief programs or under any federal program.
  • Assistance is limited and subject to available funding.  The maximum dollar amount of Assistance per household shall not exceed $300.
  • The Applicant is responsible for being able to document the underlying medical condition that places a member of the household at potential increased risk for severe illness as a result of COVID-19.  The Applicant must maintain and produce such documentation upon request.
  • Applicant is responsible for notifying the Band if a change in the Applicant's household renders the household no longer eligible for Assistance under the Program.
  • Completed applications must be mailed to the Band's IT Department located at:  P.O. Box 180, Dowagiac, Michigan 49047, or by Email cares.laptop@PokagonBand-nsn.gov.
  • Application for reimbursement must be received by 5:00 pm on December 4, 2020 ("Deadline"). No applications will be accepted after the Deadline.
  • Any decision by the Band regarding the Program, including without limitation the Application or the Assistance, shall be final and shall not be subject to review or appeal.
  • Nothing in this Program shall: (1) be construed to vest in any person any right or interest in any Band revenue or assets; (2) create any obligation that is legally enforceable against the Band; or (3) waive the sovereign immunity of the Band or any of its officials or employees
  • The Tribal Council reserves the right to amend and/or repeal this Program, subject to applicable law.

Application for Video Doorbell

I am applying for reimbursement for a video doorbell because a member of my household has one or more of the following conditions identified by the CDC as potentially increasing risk of severe illness due to COVID-19:

__Age over 55 years

__Cancer

__Chronic kidney disease

__COPD (chronic obstructive pulmonary disease)   

__Heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies

__Immunocompromised state from solid organ transplant

__Obesity or severe obesity (body mass index of 30/kg/m or higher)

__Sickle cell disease

__Smoking

__Type 2 diabetes mellitus

__Asthma (moderate-to-severe)

__Cerebrovascular disease

__Cystic fibrosis

__Hypertension or high blood pressure

__Immunocompromised state from blood or bone marrow transplant, immune deficiencies, HIV, use of corticosteroids, or use of other immune weakening medicines

__Neurological conditions, such as dementia

__Liver disease

__Overweight (body mass index between 25 kg/m and 30 kg/m)

__Pregnancy

__Pulmonary fibrosis

__Thalassemia

__Type 1 diabetes mellitus

__Other (please explain, such as having child with underlying medical condition): 

 

Applicant Information

 

CERTIFICATION AND AUTHORIZATIONS

By submitting this program application below, the undersigned Applicant makes the following representations, authorizations, and certifications:

  • I have read this Application, and I am eligible to receive Assistance under this Program.
  • I attest and certify that to the best of my information, knowledge, and belief all information provided in this Application is true, accurate, and complete.
  • I certify that I have and am able to produce supporting documentation for this Application and that I will do so upon request.
  • I acknowledge and understand that although the Band has structured the program with the intent that the Assistance be non-taxable for Band citizens, if the IRS deems the Assistance or any part of the Assistance, to be taxable, then I (and not the Band) shall be solely responsible for any taxes, interest and penalties owed from my receipt of any Assistance.
  • I certify that the Assistance provided through this Program will not duplicate any other assistance, including that provided by the Band under other COVID-19 relief programs.
  • I acknowledge and understand that I have a duty to notify the Band if my household circumstances change such that my household no longer qualifies for Assistance under this Program.
  • I will ensure that the video doorbell is installed and operational by December 30, 2020.
  • I acknowledge and understand that providing any false information may subject me to legal action, including, without limitation, criminal prosecution.

Because of these timeline restrictions, applicants are encouraged to request reimbursement as soon as possible.

There are many brands, models, and options when purchasing a video doorbell the link below is an example of  a video doorbell that includes installation:

Ring Video Doorbell 2 (includes installation)

WHERE TO FIND THE APPLICATION/WHO TO CONTACT

The online request and reimbursement form can be accessed via the following link: COVID-19 Video Doorbell Program Application & Reimbursement Form

A pdf form can be accessed here, please email the completed form to Cares.Laptop@pokagonband-nsn.gov

If you have questions about the COVID-19 Video Doorbell Program, please reach out the Pokagon IT Department at (269) 462-4269 or email Cares.Laptop@pokagonband-nsn.gov

Tribal Council Resolution No. 20-11-09-03  USE OF CORONAVIRUS RELIEF FUND FOR VIDEO DOORBELLS FOR TRIBAL CITIZENS AT INCREASED RISK OF SEVERE ILLNESS FROM COVID-19