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					          FEMA FMAGP APPLICANT FORMS




                   EXCEL 97 FORMAT


              ALL SHEETS ARE PRINTABLE



  Note: Only the blocks in Yellow need to be filled out.
White boxes are automatically filled from previous sheets.
                                         U. S. DEPARTMENT OF HOMELAND SECURITY
                                        FEDERAL EMERGENCY MANAGEMENT AGENCY                                                                                 O.M.B. NO. 1660-0058
                         REQUEST FOR FIRE MANAGEMENT ASSISTANCE DECLARATION                                                                                 Expires July 31, 2008
                                                                    PAPERWORK BURDEN DISCLOSURE NOTICE
DISCLOSURE OF BURDEN-Public reporting burden for the collection of information entitled "Request for Fire Management Assistance Declaration" using FEMA Form 90-58 is
estimated to average 1 hour per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the needed data, and financial
resources expended by persons, and completing and submitting the form. You are not required to complete this collection of information unless a valid OMB control numbers
appears in the upper right corner on this form. Send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden,
to: Information Collections Management, U.S. Department of Homeland Security, Federal Emergency Management Agency, 500 C Street, SW, Washington D.C. 20472,
Paperwork Reduction Project (3067-0290).
NOTE: Do not send your completed form to the above address.
1. STATE                                                                                            2. DATE OF REQUEST                                            3. TIME OF REQUEST



4. NAME OF GOVERNOR OR AUTHORIZED REPRESENTATIVE                                                    PHONE NO. INCLUDING AREA CODE


                                                                                                    a. Day                                             b. Night
5. AGENCY REPRESENTED                                                        ADDRESS (Street, City, Zip)



NOTE: In making this request, the Government agrees to abide by provisions contained in FEMA-State Agreement for Fire Management Assistance under Section 420, Pl 93-288
as amended. This request must be signed below by the Governor personally or by his authorized representative, whom he has previously authorized to sign this request in
the FEMA-State Agreement.
6. SIGNATURE                                                                 TITLE                                                                                DATE



                                                                               I. EXISTING CONDITIONS
              7.             a. TEMPERATURE         b. RELATIVE HUMIDITY                                 c. DIRECTION AND VELOCITY OF WINDS
      EXISTENCE OF
           HIGH
      FIRE DANGER            d. PREVAILING WEATHER CONDITIONS AND PREDICTIONS FOR NEXT 24 HOURS
       CONDITIONS


8. NUMBER OF WILD FIRES


a. CONTROLLED                           ACRES BURNED                                   b. UNCONTROLLED                                            ACRES BURNED


c. EXISTENCE OF OTHER FIRES NEARBY WHICH LIMITS THE COMMITMENT OF STATE FIRE FIGHTING RESOURCES                                         #


d. EXISTENCE OF OTHER FIRES NEARBY THAT MAY RESULT IN A CONFLAGRATION                       #


9. INDICES:                                                                  10. STATE & LOCAL
              NATIONAL FIRE DANGER RATING SYSTEM                               BURN BANS:                             YES          NO


              OTHER (KBDI, SPI, HAINES, PALMER, ETC.)                        11. NATIONAL
                                                                               WATCHES:                  YES          NO                    WARNINGS              YES         NO


                                                                              II. FIRE SITUATION REPORT

12. TIME OF REPORT                    13. NAME OF UNCONTROLLED FIRE                                                                                14. DATE STARTED


15. LOCATION OF UNCONTROLLED FIRE: (County)                                  16. ACRES BURNING:
                                                                             a. FEDERAL                      %               b. STATE              %          c. PRIVATE            %

17. MANPOWER AND RESOURCES COMMITTED (Attach separate sheet if necessary)

STATE:                                                                       LOCAL:




18. TYPE AND AMOUNT OF FEDERAL OR OTHER ASSETS & RESOURCES NEEDED: (FEMA does not order resources)




FEMA Form 90-58, MAR 05 [M/S Excel]                       REPLACES ALL PREVIOUS EDITIONS
                                                                       III. CURRENT THREAT
19. THREAT TO LIFE                                    a. PREPARATIONS MADE FOR EVACUATION?                                         b. PERSONS EVACUATED:
  #                                                          YES                               NO                                     #
20. NAME AND LOCATION OF COMMUNITY THREATENED                         ADDITIONAL INFORMATION


CITY                               TOWN



SUBDIVISION


21. CASUALTIES:                                                       22. THREAT TO PRIVATE PROPERTY: (Dwellings)
 1. CIVILIAN LOSS OF LIFE                                                 1. NUMBER OF HOMES
 2. CIVILIANS INJURED
 3. FIRE FIGHTERS LOSS OF LIFE                                            a. % OF PRIMARY                                      b. % OF SECONDARY
 4. FIRE FIGHTERS INJURED


23. THREAT TO FACILITIES (Include number when applicable)
                                       AMOUNT                 TYPE                                                       AMOUNT               TYPE
       BUILDINGS                                                                  RECREATION

       ROADS & BRIDGES                                                            EQUIPMENT

       INFRASTRUCTURE                                                             BUSINESS

       UTILITIES                                                                  OTHER

ADDITIONAL INFORMATION




24. THREAT TO RESOURCES


       WATERSHED                                             WILDLIFE (Type threatened, fur-bearing animals, big game, etc.)

       IRRIGATION                                            ENVIRONMENTAL RESOURCES (bio-diverse areas, etc.)

       FLOOD CONTROL                                         CULTURAL RESOURCES

       FISHING STREAMS & SPAWNING SITES                      ECONOMIC INJURY

ADDITIONAL INFORMATION




                                                                      IV. STATE ASSESSMENT
25. EMERGENCY MANAGEMENT ASSESSMENT OF THE SITUATION




SIGNATURE                                                                                                                                            DATE


26. FORESTRY ASSESSMENT OF THE SITUATION




SIGNATURE                                                                                                                                            DATE


                                                                     FEMA REGIONAL USE ONLY
27. NAME OF PERSON WHO RECEIVED OFFICIAL REQUEST                                         TITLE                                                       DATE
Request for Fire Management Assistance Declaration Instructions

1. Enter name of State
2. Enter date of request
3. Enter time of request
4. Enter name of Governor or Authorized Representative,
 including day and night time phone numbers and area codes
5. Enter Agency Representative,
 including address (street, city, zip
6. Enter signature, including title and date
7. Existence of high fire danger conditions
7a. Enter temperature
7b. Enter relative humidity
7c. Enter direction and velocity of winds
7d. Enter prevailiing weather conditions and predictions for next 24 hours
8. Number of wild fires
8a. Enter number of controlled wild fires and number of acres burned
8b. Enter number of uncontrolled wild fires and number of acres burned
8c. Enter number of the existence of other fires nearby which limit the
commitment of State fire fighting resources
8d. Enter the number of the existence of other fires nearby that may result
in a conflagaration
9. Indices: select either the box indicating the use of the National Fire Danger
Rating System or the box indicating the use of Other indices (KBDI, SPI,
Haines, Palmer, Etc.
10. State & Local Burn Bans: select either the box indicating yes or no
11. National
Watches: select either the box indicating yes or no
Warnings select either the box indicating yes or no
12. Enter time of report
13. Enter name of controlled fire
14. Enter date started
15 Enter locatio of uncontrolled fire (county)
16. Acres Burned
16a. Enter percentage of Federal acres burned
16b. Enter percentage of State acres burned
16c. Enter percentage of private acres burned
17. Enter State and Local manpower and resources committed (attach
separate sheet if necessary)
18. Enter type and amount of Federal or other assets and resources
needed (FEMA does not order resources)
19. Enter threat to life in numbers
19a. Answer the question: Preparations made for evacaution? By selecting
either the box indicating yes or no
19b. Enter the number of persons evacuated
20. Enter the name and locations of community threatened, including city,
town, subdivision, and additional information
21. Enter the number of casualties: (in the following areas)
   1. Civilian loss of life
   2. Civilians injured
   3. Fire fighters loss of life
   4. Fire fighters injured
22. Enter the threat to private property: (in the following areas)
   1. Number of homes
   a. Percentage of primary homes
   b. Percentage of secondary homes
23. Enter the threat to facilities (include number when applicaple in the
following areas)
   Buildings: amount and type
   Roads and Bridges: amount and type
   Infrastructure: amount and type
   Utilities: amount and type
   Recreation: amount and type
   Equipment: amount and type
   Business: amount and type
   Other: amount and type
   Additional information
24. Enter the threat to resources (select the boxes that apply)
   Watershed
   Irrigation
   Flood control
   Fishing streams and spawning sites
   Wildlife (type threatened, fur-bearing animals, big game, etc.)
   Environmental resources (bio-diverse areas, etc.)
   Cultural resources
   Economic injury
   Additional information
25. Enter Emergency Management assessment of the situation, include
signature and date
26. Enter Forestry assessment of the situation, include signature and date
27. Enter name of person who received the official request (For FEMA
Regional use only), include title and date
APPLICATION FOR                                                                                                                                                     OMB Approval No. 0348-0043
FEDERAL ASSISTANCE                                                                        2. DATE SUBMITTED                                           Applicant Identifier




1. TYPE OF SUBMISSION:                                                                    3. DATE RECEIVED BY STATE                                   State Application Identifier


    Application                         Preapplication
           Construction                     Construction                                  4. DATE RECEIVED BY FEDERAL AGENCY                          Federal Identifier
           Non-Construction                 Non-Construction


5. APPLICANT INFORMATION
Legal Name:                                                                                                         Organizational Unit:
Address (give city, county, state, and zip code):                                                                   Name and telephone number of person to be contacted on matters involving
                                                                                                                    this application (give area code)




6. EMPLOYER IDENTIFICATION NUMBER (EIN):                                                                            7. TYPE OF APPLICANT: (enter appropriate letter in box)
                -
                                                                                                                        A. State                          H. Independent School Dist.
8. TYPE OF APPLICATION:                                                                                                 B. County                         I. State Controlled Institution of Higher Learning
                             New                Continuation                              Revision                      C. Municipal                      J. Private University
                                                                                                                        D. Township                       K. Indian Tribe
If Revision, enter appropriate letter(s) in box(es)                                                                     E. Interstate                     L. Individual
                                                                                                                        F. Intermunicipal                 M. Profit Organization
    A. Increase Award                   B. Decrease Award                         C. Increase Duration                  G. Special District               N. Other (Specify)
    D. Decrease Duration                Other (specify):
                                                                                                                    9. NAME OF FEDERAL AGENCY:




10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER:                                                                  11. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT:
                                                                                           -
    TITLE:
12. AREAS AFFECTED BY PROJECT (Cities, Counties, States, etc.):




13. PROPOSED PROJECT:                           14. CONGRESSIONAL DISTRICTS OF:
Start Date                Ending Date           a. Applicant                                                                             b. Project



15. ESTIMATED FUNDING:                                                                                                  16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE
a. Federal                       $                                                                                         ORDER 12372 PROCESS?


b. Applicant                     $                                                                                           a. YES.     THIS PREAPPLICATION/APPLICATION WAS MADE AVAILABLE
                                                                                                                                         TO THE STATE EXECUTIVE ORDER 12372 PROCESS FOR
c. State                         $                                                                                                       REVIEW ON:


d. Local                         $                                                                            0                          DATE:


e. Other                         $                                                                            0              b. NO.          PROGRAM IS NOT COVERED BY E.O. 12372
                                                                                                                                             OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR
f. Program Income                $                                                                            0                              REVIEW
                                                                                                                        17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT?
g. TOTAL                         $                                                                            .00                  Yes            If "Yes," attach an explanation                  No


18. TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATION/PREAPPLICATION ARE TRUE AND CORRECT, THE DOCUMENT HAS BEEN
DULY AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WITH THE ATTACHED ASSURANCES IF THE ASSISTANCE
IS AWARDED.
a. Type Name of Authorized Representative                                                                b. Title                                                          c. Telephone Number



d. Signature of Authorized Representative                                                                                                                                  e. Date Signed



Previous Edition Usable                                                                                                                                                    Standard Form 424 (REV. 4-92)
Authorized for Local Reproduction                                                                                                                                          Prescribed by OMB Circular A-102
                           FEDERAL EMERGENCY MANAGEMENT AGENCY                                                                O.M.B. NO. 3067-0290
              REQUEST FOR FIRE MANAGEMENT ASSISTANCE SUBGRANT                                                                 Expires July 31, 2008
                                                  PAPERWORK BURDEN DISCLOSURE NOTICE

DISCLOSURE OF BURDEN-Public reporting burden for the collection of information entitled “Request for Fire Management Assistance Declaration”
using FEMA Form 90-133 is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data
sources, gathering and maintaining the needed data and financial resources expended by persons, and completing and submitting the form. You are not
required to complete this collection of information unless a valid OMB control number appears in the upper right hand corner on this form. Send
comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden, to: Information Collections
Management, Federal Emergency Management Agency, 500 C Street, SW, Washington, D.C. 20472, Paperwork Reduction Project (3067-0290). NOTE:
Do not send your completed form to the above address.

1. APPLICANT (Political subdivision or eligible applicant)                                                          2. DATE SUBMITTED
Example - Washington

3. COUNTY (location of firefighting activities. If located in multiple counties, please indicate)
Example - Elma

                                                         APPLICANT PHYSICAL LOCATION
FEMA


2. CITY                                          3. COUNTY                         4. STATE                         5. ZIP CODE


                                      MAILING ADDRESS (IF DIFFERENT FROM PHYSICAL LOCATION)
1. STREET ADDRESS


2. POST OFFICE BOX                               3. CITY                           4. STATE                         5. ZIP CODE


            Primary Contact/Applicant’s Authorized Agent                                                     Alternate Contact
1. NAME                                                                            1. NAME


2. TITLE                                                                           2. TITLE


3. BUSINESS PHONE                                                                  3. BUSINESS PHONE


4. FAX NUMBER                                                                      4. FAX NUMBER


5. HOME PHONE                                                                      5. HOME PHONE


6. CELL PHONE                                                                      6. CELL PHONE


7. E-MAIL ADDRESS                                                                  7. E-MAIL ADDRESS


8. PAGER & PIN NUMBER                                                              8. PAGER & PIN NUMBER


Title 44 CFR Part 204.41 defines Fire Management Assistance eligibility criteria as: (a) The following entities are eligible to apply through a State grantee
for a subgrant under an approved fire management assistance grant: 1) State agencies; 2) Local governments; and 3) Indian Tribal Governments. (b)
Entities that are not eligible to apply for a subgrant as identified in (a), such as privately owned entities and volunteer firefighting organizations, may be
reimbursed through a contract or compact with an eligible applicant for eligible cost associated with the fire or fire complex. (c) Eligibility is contingent
upon the finding that the applicant’s resources were requested by the Incident Commander or comparable State official. (d) The activities performed must
be the legal responsibility of the applying entity, required as a result of the fire or fire complex for which a fire management assistance declaration was
approved, and located within the declared area.

 FEMA Form 90-133, NOV 02
                           FEDERAL EMERGENCY MANAGEMENT AGENCY                                                             O.M.B. No. 3067-0151
                                    PROJECT WORKSHEET                                                                      Expires July 31, 2008
                                               PAPERWORK BURDEN DISCLOSURE NOTICE

Public reporting burden for this form is estimated to average 90 minutes per response. The burden estimate includes the time for reviewing instructions,
searching existing data sources, gathering and maintaining the needed data, and completing, reviewing, and submitting the form. You are not required to
respond to this collection of information unless a valid OMB control number appears in the upper right hand corner of this form. Send comments regarding
the accuracy of the burden estimate and any suggestions for reducing the burden to: Information Collections Management, Federal Emergency
Management Agency, 500 C Street SW, Washington, DC 20472, Paperwork Reduction Project (3067-0151). Submission of the form is required to obtain
benefits under the Public Assistance Program. NOTE: Do not send your completed form to the above address.
DISASTER                          PROJECT NO.                         PA ID NO.                         DATE                           CATEGORY
FEMA -XXXX -DR - XX                                                         000-00000-00                                                    H
 DAMAGED FACILITY                                                                                       WORK COMPLETE AS OF
                                                                                                         ________ : ________ %
 APPLICANT                                                                             COUNTY
Example - Washington                                                                  Example - Elma
 LOCATION                                                                                                         LATITUDE             LONGITUDE
Example - 12 miles Northeast of Elma
 DAMAGE DESCRIPTION AND DIMENSIONS




 SCOPE OF WORK




 Does the Scope of Work change the pre-disaster conditions at the site?                       Yes        No
 Special Considerations included?             Yes        No                           Hazard Mitigation proposal included?              Yes        No
 Is there insurance coverage on this facility?             Yes        No
                                                                   PROJECT COST
     ITEM           CODE                            NARRATIVE                          QUANTITY         UNIT        UNIT PRICE                COST
                                                                                                                                              $0.00
                                                                                                                                              $0.00
                                                                                                                                              $0.00
                                                                                                                                              $0.00
                                                                                                                                              $0.00
                                                                                                                                              $0.00
                                                                                                                                              $0.00
                                                                                                                                              $0.00
                                                                                                                                              $0.00

                                                                                                                 TOTAL COST                   $0.00
 PREPARED BY                                                                            TITLE                     SIGNATURE

 APPLICANT REP.                                                                         TITLE                     SIGNATURE

FEMA Form 90-91, OCT 02                                  REPLACES ALL PREVIOUS EDITIONS.
                                                             PROJECT WORKSHEET
                                                                INSTRUCTIONS

The Project Worksheet must be completed for each identified damaged project. A project may include damages more than one site.

After completing all Project Worksheets, submit the worksheets to your Public Assistance Coordinator.

                                                               Identifying Information

Disaster: Indicate the disaster declaration number as established by FEMA (i.e. "FEMA 1136-DR-TN", etc.).
Project No: Indicate the project designation number you established to track the project in your system (i.e. 1,2,3, etc.).
PA ID No.: Indicate your Public Assistance identification number on this space. This is optional.
Date: Indicate the date the worksheet was prepared in MM/DD/YY format.
Category: Indicate the category of the project according to FEMA specified work categories (i.e.,A,B,C,D,E,F,G). This is optional.
Applicant: Name of the government or other legal entity to which the funds will be awarded.
County: Name of the county where the damaged facility is located. If located in multiple counties, indicate "Multi-County."
Damage Facility: Identify the facility and describe its basic function and pre-disaster condition.

Work Complete as of: Indicate the date the work was assessed in the format of MM/DD/YY and the percentage of work completed to that date.
Location: This item can range anywhere from an "address," intersection of…," "1 mile south of …on…" to "county wide." If damages are in
different locations or different counties please list each location. Include latitude and longitude of the project if known.
Damage Description and Dimensions: Describe the disaster-related damage to the facility, including the cause of the damage and the area or
components affected.
Scope of Work: List work that has been completed, and work to be completed, which, is necessary to repair disaster-related damage.
Does the Scope of Work change the pre-disaster conditions of the site: If the work described under the Scope of Work changes the site
conditions (i.e. increases/decreases the size or function of the facility or does not replace damage components in kind with like materials), check (x)
yes. If the Scope of Work returns the site to its pre-disaster configuration, capacity and dimensions check (x) no.

Special Considerations: If the project includes insurable work, and/or is affected by environmental (NEPA) or historic concerns, check (x) either
the Yes or No box so that appropriate action can be initiated to avoid delays in funding. Refer to Applicant Handbook for further information.
Hazard Mitigation: If the pre-disaster conditions at the site can be changed to prevent or reduce the disaster-related damage, check (x) Yes. If no
opportunities for hazard mitigation exist check (x) no. Appropriate action will be initiated and avoid delays in funding. Refer to Applicant
Handbook for further information.
Is there insurance coverage on this facility: Federal law requires that FEMA be notified of any entitlement for proceeds to repair disaster-related
damages from insurance or any other source. Check (x) yes if any funding or proceeds can be received for the work within the Scope of Work from
any source besides FEMA.
                                                                     Project Cost

Item: Indicate the item number on the column (i.e. 1, 2, 3, etc.). Use additional forms as necessary to include all items.
Code: If using the FEMA cost codes, place the appropriate number here.
Narrative: Indicate the work, material or service that best describes the work (i.e. "force account labor overtime", "42 in. RCP", "drywall
replacement", etc.).
Quantity/Unit: List the amount of units and the unit of measure (48/cy", "32/lf', "6/ea", etc.).
Unit Price: Indicate the price per unit.
Cost: This item can be developed from cost to date, contracts, bids, applicant's experience in that particular repair work, books which lend
themselves to work estimates, such as RS Means, or by using cost codes supplied by FEMA.
Total Cost: Record total cost of the project.

Prepared By: Record the name, title, and signature of the person completing the Project Worksheet.
Applicant Rep.: Record the name, title, and signature of Applicant's representative.

                                                                Records Requirements

Please review the Applicant Handbook, FEMA 323 for detailed instructions and examples.
For all completed work, the applicant must keep the following records:
        *Force account labor documentation sheets identifying the employee, hours worked, date and location;
        *Force account equipment documentation sheets identifying specific equipment, operator, usage by hour/mile and cost used;
        *Material documentation sheets identifying the type of material, quantity used and costs;
        *Copies of all contracts for work and any lease/rental equipment costs.
For all estimated work, keep calculations, quantity estimates, pricing information, etc. as part of the records to document the "cost/estimate" for
which funding is being requested.
                               FEDERAL EMERGENCY MANAGEMENT AGENCY                 O.M.B. No. 3067-0151
                                                                                   Expires July 31, 2008
                              PROJECT WORKSHEET - Maps and Sketches Sheet
DISASTER                               PROJECT NO.            PA ID NO.     DATE     CATEGORY
FEMA ___    - DR -   ______                                                                      H
APPLICANT                               COUNTY
Example - Washington




FEMA Form 90-91C, OCT 02
                          FEDERAL EMERGENCY MANAGEMENT AGENCY                                                                       O.M.B. No. 3067-0151
                              SPECIAL CONSIDERATION QUESTION                                                                       Expires October 31, 2008

APPLICANT'S NAME                                                                                                           DATE


PROJECT NAME                                                               LOCATION


                                                       Form must be filled out - for each project.
1.   Does the damaged facility or item of work have insurance and/or is it an insurable risk? (e.g., buildings, equipment, vehicles, etc.)

          Yes           No             Unsure             Comments




2.   Is the damaged facility located within a floodplain or coastal high hazard area/or does it have an impact on a floodplain or wetland?

          Yes           No             Unsure             Comments




3.   Is the damaged facility or item of work located within or adjacent to a Coastal Barrier Resource System Unit or an Otherwise Protected Area?

          Yes           No             Unsure             Comments




4.   Will the proposed facility repairs/reconstruction change the pre-disaster condition? (e.g., footprint, material, location, capacity, use or function)


          Yes           No             Unsure             Comments




5.   Does the applicant have a hazard mitigation proposal or would the applicant like technical assistance for a hazard mitigation proposal?

          Yes           No             Unsure             Comments




6.    Is the damaged facility on the National Register of Historic Places or the state historic listing? Is it older than 50 years? Are there
       other, similar buildings near the site?

          Yes           No             Unsure             Comments




7.   Are there any pristine or undisturbed areas on, or near, the project site? Are there large tracts of forestland?

          Yes           No             Unsure             Comments




8.   Are there any hazardous materials at or adjacent to the damaged facility and/or item of work?

          Yes           No             Unsure             Comments




9.   Are there any other environmentally or controversial issues associated with the damaged facility and/or item of work?

          Yes           No             Unsure             Comments




FEMA Form 90-120, FEB 06
                              FEDERAL EMERGENCY MANAGEMENT AGENCY                                                            O.M.B. No 3067-0151
                                                                                              PAGE ____ OF ____
                            FORCE ACCOUNT LABOR SUMMARY RECORD                                                           Expires October 31, 2008
APPLICANT                                  PA ID NO.                            PROJECT NO.                        DISASTER
Example - Washington                                   000-00000-00
LOCATION/SITE                                                                   CATEGORY                           PERIOD COVERING
Example - 12 miles Northeast of Elma                                                          H                                TO
DESCRIPTION OF WORK PERFORMED



                                                 Dates and Hours Worked Each Week                                     Costs
                                                                                                                                TOTAL
                                                                                                  TOTAL   HOURLY   BENEFIT                     TOTAL
                               DATE                                                                                            HOURLY
                                                                                                  HOURS    RATE    RATE/HR                     COSTS
                                                                                                                                 RATE
NAME
                                                                                                   0.00                          $0.00             $0.00
                               REG.
JOB TITLE
                                                                                                   0.00                          $0.00             $0.00
                                O.T.
NAME
                                                                                                   0.00                          $0.00             $0.00
                               REG.
JOB TITLE
                                                                                                   0.00                          $0.00             $0.00
                                O.T.
NAME
                                                                                                   0.00                          $0.00             $0.00
                               REG.
JOB TITLE
                                                                                                   0.00                          $0.00             $0.00
                                O.T.
NAME
                                                                                                   0.00                          $0.00             $0.00
                               REG.
JOB TITLE
                                                                                                   0.00                          $0.00             $0.00
                                O.T.
NAME
                                                                                                   0.00                          $0.00             $0.00
                               REG.
JOB TITLE
                                                                                                   0.00                          $0.00             $0.00
                                O.T.
NAME
                                                                                                   0.00                          $0.00             $0.00
                               REG.
JOB TITLE
                                                                                                   0.00                          $0.00             $0.00
                                O.T.
                                        TOTAL COST FOR FORCE ACCOUNT LABOR REGULAR TIME                                                            $0.00
                                          TOTAL COST FOR FORCE ACCOUNT LABOR OVERTIME                                                              $0.00
     CERTIFY THAT THE ABOVE INFORMATION WAS OBTAINED FROM PAYROLL RECORDS, INVOICES, OR OTHER DOCUMENTS THAT ARE AVAILABLE FOR AUDIT.
CERTIFIED                                              TITLE                                              DATE

FEMA Form 90-123, OCT
                                                            PAPERWORK BURDEN DISCLOSURE NOTICE
Public reporting burden for this form is estimated to 30 minutes per response. The burden includes the time for reviewing instruction, searching existing data sources,
gathering and maintaining the needed data, and completing, reviewing, and submitting the form. You are not required to respond to this collection of information unless a
valid OMB control number appears in the upper right corner of this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing
this burden to: Information Collections Management, Federal Emergency Management Agency, 500 C Street, SW, Washington, DC 20472, Paperwork Reduction Project
(3067-0151). Submission of the form is required to obtain or retain benefits under the Public Assistance Program. Please do not send your completed form to the
above address.
                                            FORCE ACCOUNT LABOR SUMMARY RECORD
                                                       INSTRUCTIONS

Force account is the term used to define labor performed and equipment owned by the applicant.

 •►   Record regular and overtime hours separately.

 •►   Record the benefits separately for regular and overtime hours. Most overtime hours include fewer benefits than regular
      hours.

 •►   Attach a Fringe Benefit Rate Sheet giving a breakdown of what is included in your benefits, by percentages, e.g.,
      social security----15.2%, worker's compensation----4.3%, insurance----18.5%, etc. You can use an average
      rate if you have different benefit rates for different employees.

Complete the Record as Follows:

 *    Applicant: Enter organization's name.
 *    PA ID No.: Enter the computer tracking number that FEMA assigns to applicant organization. Your Public Assistance Coordinator can
      provide you with this number.
 *    Project No.: Enter the number assigned to this project.
 *    Disaster: Enter the declaration number for this disaster. The Public Assistance Coordinator can also provide you with this information.
 *    Location/Site: This item can range anywhere from an "address," intersection of…/" "1 mile south of …on…" to "county wide." If
      damages are in different locations or different counties please list each location. Include latitude and longitude of the project if known.
 *    Category: Indicate the category of the project according to FEMA specified work categories (i.e., B, H, Z). This is optional.
 *    Period Covering: This is auto filled from the "Dates & Hours Worked Each Week / Date."
 *    Description of Work Performed: Describe the type of work performed.
 *    Dates & Hours Used Each Week / Date: Enter the days of the week.
 *    Name: Enter the names of each employee who worked on the project.

 *    Job Title: Enter the title or occupation of each employee who worked on the project.

 *    REG: Enter the regular hours that each employee worked on the project.
 *    O.T.: Enter overtime hours that each employee worked on the project. REMINDER: Only overtime is eligible
      for reimbursement for emergency work. Record both regular and overtime hours, so that personnel
      hours can be compared with equipment use hours, if necessary.
 *    Costs / Total Hours: Calculates the total hours for the week and auto fills "Total Hours" block.

 *    Costs / Hourly Rate: Enter each employee's hourly rate.

 *    Costs / Benefit Rate/Hr: Enter each employee's hourly benefit rate. Their should be different percentages for benefits
      pertaining to regular and overtime wages.
 *    Costs / Total Hourly Rate: Excel will add the employee's hourly rate in the "Hourly Rate" block and the hourly benefits rate in the
      "Benefit Rate/HR" block and auto fills "Total Hourly Rate" block.

 *    Costs / Total Cost: Multiply the entries in the "Total Hrs" and "Total Hourly Rate" blocks and auto fills "Total Costs" block.
 *    Total Cost for Force Account Labor Regular Time: Add the entries in the "Total Costs", "REG" block for each employee and the
      results in the "Total Cost for Force Account Labor Regular Time" block.

 *    Total Cost for Force Account Labor Overtime: Add the entries in the "Total Costs", "O.T." block for each employee and the results in
      the "Total Cost for Force Account Labor Overtime" block.
 *    Certified: Record the name, title, and date of the person certifying the Force Account Labor Summary Record.




      updated 5/6/05                                                                               036be722-34b0-45fe-9888-ef434660ddc5.xls, 8
                       FEDERAL EMERGENCY MANAGEMENT AGENCY                                                               O.M.B. No. 3067-0151
                                                                                          Page ____ OF ______
                              MATERIAL SUMMARY SHEET                                                                    Expires October 31, 2008

APPLICANT                       PA ID NO.                                   PROJECT NO.                          DISASTER

Example - Washington
LOCATION/SITE                                                               CATEGORY                             PERIOD COVERING
Example - 12 miles Northeast of Elma                                                                                              TO
DESCRIPTION OF WORK PERFORMED




                                                                                                                                INFO FROM
                                                                                          TOTAL        DATE       DATE
            VENDOR                          DESCRIPTION             QUAN.   UNIT PRICE                                            (CHECK ONE)
                                                                                          PRICE      PURCHASED    USED
                                                                                                                               INVOICE   STOCK

                                                                                           $0.00

                                                                                           $0.00

                                                                                           $0.00

                                                                                           $0.00

                                                                                           $0.00

                                                                                           $0.00

                                                                                           $0.00

                                                                                           $0.00

                                                                                           $0.00

                                                                                           $0.00
                                                                                           $0.00
                                                     GRAND TOTAL                           $0.00

    I CERTIFY THAT THE ABOVE INFORMATION WAS OBTAINED FROM PAYROLL RECORDS, INVOICES, OR OTHER DOCUMENTS THAT ARE AVAILABLE FOR AUDIT.

CERTIFIED                                                          TITLE                                         DATE


FEMA Form 90-124, OCT 02
                                                           PAPERWORK BURDEN DISCLOSURE NOTICE

Public reporting burden for this form is estimated to 15 minutes per response. The burden includes the time for reviewing instruction, searching existing data sources,
gathering and maintaining the needed data, and completing, reviewing, and submitting the form. You are not required to respond to this collection of information
unless a valid OMB control number appears in the upper right corner of this form. Send comments regarding the accuracy of the burden estimate and any
suggestions for reducing this burden to: Information Collections Management, Federal Emergency Management Agency, 500 C Street, SW, Washington, DC 20472,
Paperwork Reduction Project (3067-0151). Submission of the form is required to obtain or retain benefits under the Public Assistance Program. Please do not send
your completed form to the above address.
                                       THE MATERIAL RECORD SUMMARY
                                               INSTRUCTIONS


This form is used to record the costs of supplies and materials purchased in response to the disaster or used to repair
damages caused by the disaster.


Complete the Record as Follows:

  *      Applicant: Enter organization's name.

  *      PA ID No.: Enter the computer tracking number that FEMA assigns to applicant organization. Your Public
         Assistance Coordinator can provide you with this number.

  *      Project No.: Enter the number assigned to this project.

  *      Disaster: Enter the declaration number for this disaster. The Public Assistance Coordinator can also provide
         you with this information.

  *      Location/Site: This item can range from an "address," "intersection of…," "1 mile south of…on…" to "county
         wide." If damages are in different locations or different counties please list each location. Include latitude and
         longitude of the project if known.

  *      Category: Indicate the category of the project according to FEMA specified work categories (i.e., B, H, Z). This
         is optional.

  *      Period Covering: Enter the dates that this period covers.

  *      Description of Work Performed: Describe the type of work that was performed.

  *      Vendor: Enter the name of the supplier if the material was bought specifically as a result of the disaster.

  *      Description: Enter a brief description of the supplies or materials used or purchased.

  *      Quan.: Enter the number purchased.

  *      Unit Price: Enter the price per unit.

  *      Total Price: Calculates the "Quan." times the "Unit Price" and auto fills "Total Price" block.

  *      Date Purchased: Enter the date item was purchased.

  *      Date Used: Enter the date item was used.

  *      Info. from (Check One) Invoice or Stock: Place a check (√) in either the "Invoice" or "Stock" block.

  *      Grand Total: Adds the costs from "Total Price" blocks and auto fills "Grant Total" block.

  *      Certified: Record the name, title, and date of the person certifying the Material Summary Record.




      Updated 5/6/05                                                             036be722-34b0-45fe-9888-ef434660ddc5.xls, 10
                                       FEDERAL EMERGENCY MANAGEMENT AGENCY                                                            O.M.B. No. 3067-0151
                                                                                                       PAGE ____ OF _____
                                       RENTED EQUIPMENT SUMMARY RECORD                                                             Expires October 31, 2008
APPLICANT                                                 PA ID NO.               PROJECT NO.                       DISASTER
Example - Washington                                           000-00000-00
LOCATION/SITE                                                                     CATEGORY                          PERIOD COVERING
Example - 12 miles Northeast of Elma                                                             H                                    TO
DESCRIPTION OF WORK PERFORMED


       TYPE OF EQUIPMENT                 DATES     RATE PER HOUR
                                          AND                          TOTAL                                         INVOICE     DATE AND
Indicate size, Capacity, Horsepower,                        W/OUT                             VENDOR                                                CHECK NO.
                                         HOURS    W/OPR                 COST                                           NO.      AMOUNT PAID
  Make and Models as Appropriate          USED               OPR


                                                                        $0.00


                                                                        $0.00


                                                                        $0.00


                                                                        $0.00


                                                                        $0.00


                                                                        $0.00


                                                                        $0.00


                                                                        $0.00


                                                                        $0.00


                                                                                          GRAND TOTAL                                       $0.00
             I CERTIFY THAT THE ABOVE INFORMATION WAS OBTAINED FROM PAYROLL RECORDS, INVOICES, OR OTHER DOCUMENTS THAT ARE AVAILABLE FOR AUDIT.

CERTIFIED                                                                         TITLE                                        DATE


FEMA Form 90-125, OCT 02
                                                           PAPERWORK BURDEN DISCLOSURE NOTICE

Public reporting burden for this form is estimated to 15 minutes per response. The burden includes the time for reviewing instruction, searching existing data sources,
gathering and maintaining the needed data, and completing, reviewing, and submitting the form. You are not required to respond to this collection of information unless
a valid OMB control number appears in the upper right corner of this form. Send comments regarding the accuracy of the burden estimate and any suggestions for
reducing this burden to: Information Collections Management, Federal Emergency Management Agency, 500 C Street, SW, Washington, DC 20472, Paperwork
Reduction Project (3067-0151). Submission of the form is required to obtain or retain benefits under the Public Assistance Program. Please do not send your
completed form to the above address.
                                   RENTED EQUIPMENT SUMMARY RECORD
                                             INSTRUCTIONS


This form is used to record the costs of equipment that rented or leased to respond to the disaster or be used in making
repairs to damages caused by the disaster.

Complete the Record as Follows:

   *    Applicant: Enter your organization's name.

   *    PA ID No.: Enter the computer tracking number that FEMA assigns to applicant organization. Your Public
        Assistance Coordinator can provide you with this number.

   *    Project No.: Enter the number assigned to this project.

   *    Disaster: Enter the declaration number for this disaster here. The Public Assistance
        Coordinator can also provide you with this information.

   *    Location/Site: This item can range from an "address," "intersection of…," "1 mile south of…on…" to
        "county wide." If damages are in different locations or different counties please list each location. Include
        latitude and longitude of the project if known.
        Category: Indicate the category of the project according to FEMA specified work categories (i.e., B, H, Z).
   *    This is optional.

   *    Period Covering: Enter the dates that this period covers.

   *    Type of Equipment: Enter a brief description of the equipment that was leased or rented. Indicate if the
        equipment was rented on a daily, weekly, or monthly rate, instead of an hourly rate.

   *    Date and Hours Used: Enter the dates for each day the project was worked in the top box and the hours the
        equipment was used in the bottom box.

   *    Rate Per Hour With or Without Operator: Enter the hourly rental or lease cost of the equipment with or
        without operator. NOTE: Determine that the rental rate is fair and reasonable and has not been raised
        to an unacceptable rate because of the disaster.

   *    Total Cost: Multiplies the entries in the second box under "Dates & Hours Used" and times it by the "Rate
        Per Hour - W/OPR or W/OUT OPR" and auto fills "Total Cost" block.

   *    Vendor: Enter the name of the vendor.

   *    Invoice No.: Enter the invoice number.

   *    Date & Amount Paid: Enter the date of invoice in the top box and the usage cost based on the renter's
        agreement in the bottom box.

   *    Check No.: Enter the check number.

   *    Grand Total: Calculates the "Total Cost" blocks and auto fills the "Grand Total" block.

   *    Certified: Record the name, title, and date of the person certifying the Rent Equipment Summary Record.




   Updated 5/6/05                                                              036be722-34b0-45fe-9888-ef434660ddc5.xls, 12
                           FEDERAL EMERGENCY MANAGEMENT AGENCY                                                          O.M.B. No. 3067-0151
                                                                                        PAGE ____ OF _____
                           CONTRACT WORK SUMMARY RECORD                                                              Expires October 31, 2008
APPLICANT                                       PA ID NO.        PROJECT NO.                          DISASTER
Example - Washington
LOCATION/SITE                                                    CATEGORY                             PERIOD COVERING
Example - 12 miles Northeast of Elma                                                H                               TO
DESCRIPTION OF WORK PERFORMED




                                                                  BILLING/INVOICE
   DATES WORKED                         CONTRACTOR                                      AMOUNT                   COMMENTS - SCOPE
                                                                      NUMBER




                                                 GRAND TOTAL                             $0.00

    I CERTIFY THAT THE ABOVE INFORMATION WAS OBTAINED FROM PAYROLL RECORDS, INVOICES, OR OTHER DOCUMENTS THAT ARE AVAILABLE FOR AUDIT.

CERTIFIED                                                        TITLE                                           DATE



FEMA Form 90-126, OCT 02
                                                           PAPERWORK BURDEN DISCLOSURE NOTICE

Public reporting burden for this form is estimated to 15 minutes per response. The burden includes the time for reviewing instruction, searching existing data sources,
gathering and maintaining the needed data, and completing, reviewing, and submitting the form. You are not required to respond to this collection of information unless
a valid OMB control number appears in the upper right corner of this form. Send comments regarding the accuracy of the burden estimate and any suggestions for
reducing this burden to: Information Collections Management, Federal Emergency Management Agency, 500 C Street, SW, Washington, DC 20472, Paperwork
Reduction Project (3067-0151). Submission of the form is required to obtain or retain benefits under the Public Assistance Program. Please do not send your
completed form to the above address.
                                    CONTRACT WORK SUMMARY RECORD
                                             INSTRUCTIONS

This form is used to record the costs of contracts awarded to respond to the disaster.


Complete the Record as Follows:

  *      Applicant: Enter organization's name.

  *      PA ID No.: Enter the computer tracking number that FEMA assigns to applicant organization.
         Your Public Assistance Coordinator can provide you with this number.

  *      Project No.: Enter the number assigned to this project.

  *      Disaster: Enter the declaration number for this disaster here. The Public Assistance
         Coordinator can also provide you with this information.

  *      Location/Site: This item can range from an "address," "intersection of…," "1 mile south of…on…" to "county
         wide." If damages are in different locations or different counties please list each location. Include latitude and
         longitude of the project if known.

  *      Category: Indicate the category of the project according to FEMA specified work categories (i.e., B, H,
         Z). This is optional.

  *      Period Covering: Enter the dates that this period covers.

  *      Description of Work Performed: Enter a brief description of the work performed.

  *      Date Worked: Enter the date on the invoice.

  *      Contractor: Enter the name of the contractor receiving the contract.

  *      Billing/Invoice Number: Enter the invoice number.

  *      Amount: Enter the total dollar figure listed for each invoice.

  *      Comments - Scope: Enter a brief description of the type of work that was performed on each invoice.

  *      Grand Total: Calculates the "Amount" blocks and auto fills the "Grand Total" block.

  *      Certified: Record the name, title, and date of the person certifying the Contract Work Summary Record.




      Updated 5/6/05                                                             036be722-34b0-45fe-9888-ef434660ddc5.xls, 14
                            FEDERAL EMERGENCY MANAGEMENT AGENCY                                                               O.M.B. No. 3067-0151
                           FORCE ACCOUNT EQUIPMENT SUMMARY RECORD                        PAGE       ___ OF   ______       Expires October 31, 2008
APPLICANT                                               PA ID NO.                 PROJECT NO.                         DISASTER

Example - Washington
LOCATION/SITE                                                                     CATEGORY                            PERIOD COVERING

Example - 12 miles Northeast of Elma                                                            H                                    TO
DESCRIPTION OF WORK PERFORMED




                Type of Equipment                                   Dates and Hours Used Each Day                                    Costs
 INDICATE SIZE, CAPACITY,      EQUIPMENT   OPERATOR'S
                                                                                                                      TOTAL     EQUIPMENT      TOTAL
 HORSEPOWER, MAKE AND            CODE         NAME      DATE
                                                                                                                      HOURS       RATE          COST
  MODEL AS APPROPRIATE          NUMBER

                                                        Hours
                                                                                                                        0.0                     $0.00

                                                        Hours
                                                                                                                        0.0                     $0.00

                                                        Hours
                                                                                                                        0.0                     $0.00

                                                        Hours
                                                                                                                        0.0                     $0.00

                                                        Hours
                                                                                                                        0.0                     $0.00

                                                        Hours
                                                                                                                        0.0                     $0.00

                                                        Hours
                                                                                                                        0.0                     $0.00
                                                                          GRAND TOTALS                                  0.0                     $0.00

     I CERTIFY THAT THE ABOVE INFORMATION WAS OBTAINED FROM PAYROLL RECORDS, INVOICES, OR OTHER DOCUMENTS THAT ARE AVAILABLE FOR AUDIT.
CERTIFIED                                               TITLE                                                         DATE


FEMA Form 90-127, OCT 02
                                                                 PAPERWORK BURDEN DISCLOSURE NOTICE

Public reporting burden for this form is estimated to 15 minutes per response. The burden includes the time for reviewing instruction, searching existing data sources, gathering and
maintaining the needed data, and completing, reviewing, and submitting the form. You are not required to respond to this collection of information unless a valid OMB control number
appears in the upper right corner of this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing this burden to: Information Collections
Management, Federal Emergency Management Agency, 500 C Street, SW, Washington, DC 20472, Paperwork Reduction Project (3067-0151). Submission of the form is required to
obtain or retain benefits under the Public Assistance Program. Please do not send your completed form to the above address.
                            FORCE ACCOUNT EQUIPMENT SUMMARY RECORD
                                         INSTRUCTIONS

Force account is the term used to define labor performed and equipment owned by the applicant.

Complete the Record as Follows:

* Applicant: Enter organization's name.

* PA ID No.: Enter the computer tracking number that FEMA assigns applicant organization. Your Public Assistance
  Coordinator can provide you with this number.
* Project No.: Enter the number assigned to this project.
* Disaster: Enter the declaration number for this disaster here. The Public Assistance Coordinator can also provide you
  with this information.
* Location/Site: This item can range anywhere from an "address," intersection of…/" "1 mile south of …on…" to "county
  wide." If damages are in different locations or different counties please list each location. Include latitude and longitude
  of the project if known.
* Category: Indicate the category of the project according to FEMA specified work categories (i.e., B, H, Z). This is
  optional.
* Period Covering: It's auto filled from "Dates & Hours Used Each Day / Date" blocks.
* Description of Work Performed: Describe the type of work performed.
* Type of Equipment / Indicate size, capacity, horsepower, make and model as appropriate: Enter a brief description
  of the equipment, including the rated horsepower or capacity of the equipment. Be sure to include this information if you
  also use a trade name or common name to describe the equipment, e.g., Ditch Witch.
* Equipment Code Number: Enter the FEMA cost code for the equipment.
* Operator's Name: Enter the equipment operators name.
* Dates & Hours Used Each Day / Date: Enter the days of the week.
* Hours: Enter the hours the equipment worked. Notes: Standby time for equipment is not eligible.

* Costs / Total Hours: Adds the total hours for the week and auto fills the Total Hours block.

* Costs / Equipment Rate: Enter the hourly rate for the equipment.

* Costs / Total Cost: Multiply the number in the Total Hours block by the number in the Equipment Rate block and auto
  fills the amount in the Total Cost block.
* Grand Totals: Add the numbers in the Total Hours blocks and auto fills into the Grand Total block; Add the numbers in
  the Total Cost blocks and auto fills into the Grand Total block.

* Certified: Record the name, title, and date of the person certifying the Force Account Equipment Summary Record.




      Updated 5/6/05                                                            036be722-34b0-45fe-9888-ef434660ddc5.xls, 16
                  FEDERAL EMERGENCY MANAGEMENT AGENCY                                            O.M.B. No. 3067-0151
                   APPLICANT'S BENEFITS CALCULATION                         PAGE ____ OF ____                         Expires
                                                                                                        October 31, 2008
                              WORKSHEET
 APPLICANT                                                                                       PA ID NO.
Example - Washington
 DISASTER                                                                  PROJECT NO.




   FRINGE BENEFITS (by %)                    REGULAR TIME                                    OVERTIME


HOLIDAYS
                                                 3.8%
VACATION LEAVE
                                                 5.8%
SICK LEAVE
                                                 4.6%
SOCIAL SECURITY
                                                 7.7%                                           7.7%
MEDICARE


UNEMPLOYMENT
                                                 1.5%                                           1.5%
WORKER'S COMP.
                                                 2.0%                                           2.0%
RETIREMENT
                                                 5.5%                                           5.5%
HEALTH BENEFITS
                                                23.3%
LIFE INS. BENEFITS
                                                 1.2%
OTHER

  TOTAL in % of annual salary                   55.3%                                         16.6%
COMMENTS




    I CERTIFY THAT THE INFORMATION ABOVE WAS TRANSCRIBED FROM PAYROLL RECORDS OR OTHER DOCUMENTS WHICH ARE AVAILABLE

CERTIFIED BY                                      TITLE                                          DATE



FEMA Form 90-128, OCT 02
                                        PAPERWORK BURDEN DISCLOSURE NOTICE

Public reporting burden for this form is estimated to 30 minutes per response. The burden includes the time for reviewing
instruction, searching existing data sources, gathering and maintaining the needed data, and completing, reviewing, and submitting
the form. You are not required to respond to this collection of information unless a valid OMB control number appears in the upper
right corner of this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing this
burden to: Information Collections Management, Federal Emergency Management Agency, 500 C Street, SW, Washington, DC
20472, Paperwork Reduction Project (3067-0151). Submission of the form is required to obtain or retain benefits under the Public
Assistance Program. Please do not send your completed form to the above address.
                                        Fringe Benefit Calculations
                  There are other ways to calculate Fringe Benefits, this is only one.
                                   This is normally done for each employee or each pay grade.
              Employee Name:

                       Applicant:

                       PA ID No:

            Disaster Number:

                     Department:

        All calculations are based on the amount that only the employer pays .
                Most figures can be obtained from accounting department.
   Blocks that you fill in =

Work hrs per year (2080 hrs is normal work year )                   #       2,080
Pay / Hour                                                          $       20.00
Basic Pay Annualized                                                $     41,600.00
                                                                                                     See note 1
                                                                        Regular Time        %        Overtime         %
Vacation - days/year                #       15    days                     120.00           5.8          *
Holidays - days/year                #       10    days                      80.00           3.8          *
Sick - days/year                    #       12    days                      96.00           4.6          *
Retirement (% of annual salary)     )      5.45                              5.45           5.5        5.45          5.5
Social Security - fixed rate        %      7.65                              7.65           7.7        7.65          7.7
Unemployment                        %      1.50                              1.50           1.5        1.50          1.5
Workman’s Comp                      %      2.00                              2.00           2.0        2.00          2.0
Health Insurance                    $    800.00   / mo / employee           23.08          23.1          *
Life Insurance                      $     40.00   / mo / employee            1.15           1.2          *
Dental                              $      5.00   / mo / employee            0.14           0.1          *
Vision                              $      3.00   / mo / employee            0.09           0.1          *
                                                                                                         *
                                    %                                                                    *

                                                        Total Percent =                      55.3                      16.6
                                           Transfer to Data Sheet for Employee
                                                   Starting at row F35

                                                         Typical ranges                 20-60 %                   3-20 %

I certify that the information above was transcribed from payroll records or other
documents which are available for audit.
Certified by: ________________________________________
Title: ______________________________________________

Note 1: Vacation, Holidays and Insurance are not figured into overtime benefits.
401K plans or similar type plans sometimes are not included in Overtime.
Retirement, Unemployment and Workman's Comp are sometimes included in overtime benefits.




 updated 5/6/05                                                     036be722-34b0-45fe-9888-ef434660ddc5.xls, Fringe Benefits
                                FRINGE BENEFIT RATE SHEET INSTRUCTIONS

     Fringe Benefit Calculations

     Fringe benefits for force account labor is eligible. Except in extremely unusual cases, fringe benefits for
     overtime will be significantly less than regular time.
     The following steps will assist in calculating the percentage of fringe benefits paid on an employee's salary.
     Note: items and percentages will vary from one entity to another.

1) The normal year consists of 2080 hours (52 weeks x 5 workdays/week x 8 hours/day). This does not include holidays
     and vacations.
2) Determine the employee's basic hourly pay rate (annual salary/2080 hours).
3) Fringe benefit percentage for vacation time: Divide the number of hours of annual vacation time provided to the
     employee by 2080 (80 hours (2 weeks)/2080 = 3.85%).
4)   Fringe benefit percentage for paid holidays: Divide the number of paid holiday hours by 2080 (64 hours (8
     holidays)/2080 = 3.07%).
5)   Retirement pay: Because this measure varies widely, use only the percentage of salary matched by the employer.
6)   Social Security and Unemployment Insurance: Both are standard percentages of salary.
7)   Insurance: This benefit varies by employee. Divide the amount paid by the city or county by the basic pay rate
     determined in Step 2.
8)   Workman's Compensation: This benefit also varies by employee. Divide the amount paid by the city or county by
     the basic pay rate determined in Step 2. Use the rate per $100 to determine the correct percentage.

     Note: Typically, you should not be charging the same rate for regular time and overtime. Generally, only FICA
     (Social Security) is eligible for overtime; however, some entities may charge retirement tax on all income.

     Sample Rates

     Although some rates may differ greatly between organizations due to their particular experiences, the table below
     provides some general guidelines that can be used as a reasonableness test to review submitted claims. These rates are
     based on experience in developing fringe rates for several state departments, the default rate is that used for the state of
     Florida, following Hurricane Andrew (August 1992), and the review of several FEMA claims. The rates presented are
     determined using the gross wage method applicable to the personnel hourly rate (PHR) method. The net available
     hours method would result in higher rates.

             Paid Fringe Benefits
             HCA Matching                                       7.65%          (or slightly less)
             Retirement--Regular                               17.00%          (or less)
             Retirement--Special Risk                          25.00%          (or slightly more)
             Health Insurance                                  12.00%          (or less)
             Life & Disability Insurance                        1.00%          (or less)
             Worker's Compensation                              3.00%          (or less)
             Unemployment Insurance                             0.25%          (or less)
             Leave Fringe Benefits
             Accrued Annual Leave                               7.00%          (or less)
             Sick Leave                                         4.00%          (or less)
             Administrative Leave                               0.50%          (or less)
             Holiday Leave                                      4.00%          (or less)
             Compensatory Leave                                 2.00%          (or less)
           Rates outside of these ranges are possible, but should be justified during the validation process.


     updated 5/6/05                                                               036be722-34b0-45fe-9888-ef434660ddc5.xls, 19
                          FEDERAL EMERGENCY MANAGEMENT AGENCY                                                See Reverse for Instructions and                                                   OMB NO. 3067-0206
                              FINANCIAL STATUS REPORT                                                      Paperwork Burden Disclosure Notice              Page ___ of ___ pages               Expires February 28, 2007

1. FEDERAL AGENCY AND ORGANIZATIONAL                         2. FEDERAL GRANT OR OTHER IDENTIFYING NUMBER                  3. RECIPIENT ORGANIZATION (Name and complete address, including zip code)
  ELEMENT TO WHICH REPORT IS SUBMITTED                             ASSIGNED


4. EMPLOYER I.D. NO.                                         5. RECIPIENT ACCT. NO. OR I.D. 6. FINAL REPORT                7. BASE                      8. Funding/Grant Period          9. Period Covered This Report
                                                                                                    YES                          CASH                   From:                            From:
                                                                                                    NO                           ACCRUAL                To:                              To:

                                                                                               STATUS OF REPORT
10.                                                          (a)                             (b)                           (c)                          (d)                              (e)
                   PROGRAM ACRONYM                                                                                                                                                                     TOTAL
                      CFDA NUMBER

  a. Net Outlays

  b. Recipient share of outlays

  c. Federal share of outlays

  d. Total unliquidated obligations

  e. Recipient share of unliquidated obligations

  f. Federal share of unliquidated obligations

  g. Total Federal share (Sum of line c and line f)
  h. Total Federal funds authorized for this funding
      period
   i. Unobligated balance of Federal funds (Line h
      minus line g)

                                                         COMPUTATION OF TOTAL INDIRECT COST EXPENSE AS REPORTED ON LINES 10a TO 10g

11a. Type of indirect cost rate (Place x in the appropriate box)                                    Provisional-Final            Predetermined                Fixed with carry forward

  b. Indirect cost rate

  c. Base

  d. Total Amount of Indirect cost

  e. Federal share of indirect cost
12. REMARKS: Attach any explanations deemed necessary or information required by Federal sponsoring agency in compliance with governing legislation.




13. CERTIFICATION: I certify to the best of my knowledge and belief that this report is correct and complete and that all outlays and unliquidated obligations are for the purposes set forth in the
    award document.

TYPE OR PRINT NAME AND TITLE                                 SIGNATURE OF AUTHORIZED REPRESENTATIVE                        TELEPHONE NO. (Include area code, and extension)              DATE


FEMA Form 20-10, MAR 01
                           FEDERAL EMERGENCY MANAGEMENT AGENCY                                           O.M.B. No. 3067-02006
               SUMMARY SHEET FOR ASSURANCES AND CERTIFICATIONS                                         Expires September 30, 1998

DATE:                 APPLICANT LEGAL NAME:



This summary sheet includes Assurances and Certifications that must be read, signed, and submitted as a part of the
Application for Federal Assistance.

An applicant must check each item that they are certifying to:

  Part I              FEMA Form 20-16A, Assurances-Nonconstruction Programs

  Part II             FEMA Form 20-16B, Assurances-Construction Programs

  Part III            FEMA Form 20-16C, Certifications Regarding Lobbying;
                      Debarment, Suspension, and Other Responsibility
                      Matters; and Drug-Free Workplace Requirements

  Part IV             SF LLL, Disclosure of Lobbying Activities (If applicable)


As the duly authorized representative of the applicant, I hereby certify that the applicant will comply with the identified
attached assurances and certifications.




            Typed Name of Authorized Representative                                                 Title




             Signature of Authorized Representative                                             Date Signed


NOTE: By signing the certification regarding debarment, suspension, and other responsibility matters for primary covered
transaction, the applicant agrees that, should the proposed covered transaction be entered into, it shall not knowingly enter
into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded
from participation in this covered transaction, unless authorized by FEMA entering into this transaction.

        The applicant further agrees by submitting this application that it will include the clause titled "Certification
Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion-Lower Tier Covered Transaction," provided by
the FEMA Regional Office entering into this covered transaction, without modification, in all lower tier covered transactions
and in all solicitations for lower tier covered transactions. (Refer to 44 CFR Part 17.)

                                               Paperwork Burden Disclosure Notice
"Public reporting burden for this form is estimated to average 1.7 hours per response. The burden estimate includes the
time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing,
reviewing, and maintaining the data needed, and completing and submitting the form. Send comments regarding the
accuracy of the burden estimate and any suggestions for reducing the burden to: Information Collections Management,
Federal Emergency Management Agency, 500 C Street, SW, Washington, DC 20472."

FEMA Form 20-16, JUL 95
                                              FEDERAL EMERGENCY MANAGEMENT AGENCY
                                        ASSURANCES-NON-CONSTRUCTION PROGRAMS

  Note: Certain of these assurances may not be applicable to your project or program. If you have any questions, please
  contact the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to
  additional assurances. If such is the case, you will be notified.

  As the duly authorized representative of the applicant, I certify that the applicant:

  1. Has the legal authority to apply for Federal assistance,          alcohol abuse or alcoholism; (g) Sections 523 and 527 of
  and the institutional, managerial and financial capability           the Public Health Service Act of 1912 (42 U.S.C. 290-dd-3
  (including funds sufficient to pay the non-Federal share of          and 290-ee-3), as amended, relating to confidentiality of
  project costs) to ensure proper planning, management and             alcohol and drug abuse patient records; (h) Title VIII of the
  completion of the project described in this application.             Civil Rights Acts of 1968 (42 U.S.C. Section 3601 et seq.),
                                                                       as amended, relating to nondiscrimination in the sale,
  2. Will give the awarding agency, the Comptroller                    rental or financing of housing; (i) any other
  General of the United States, and if appropriate, the State,         nondiscrimination provisions in the specific statute(s)
  through any authorized representative, access to and the             under which application for Federal assistance is being
  right to examine all records, books, papers, or documents            made; and (j) the requirements of any other
  related to the award; and will establish a proper accounting         nondiscrimination statute(s) which may apply to the
  system in accordance with generally accepted accounting              application.
  standards or agency directives.
                                                                       7. Will comply, or has already complied, with the
  3. Will establish safeguards to prohibit employees from              requirements of Title II and III of the Uniform
  using their positions for a purpose that constitutes or              Relocation Assistance and Real Property Acquisition
  presents the appearance of personal gain.                            Policies Act of 1970 (P.L. 91-646) which provide for fair
                                                                       and equitable treatment of persons displaced or whose
  4. Will initiate and complete the work within the                    property is acquired as a result of Federal or Federally
  applicable time frame after receipt of approval of the               assisted programs. These requirements apply to all
  awarding agency.                                                     interest in real property acquired for project purposes
                                                                       regardless of Federal participation in purchases.
  5. Will comply with the Intergovernmental Personnel
  Act of 1970 (42 U.S.C. Section 4728-4763) relating to                8. Will comply with provisions of the Hatch Act (5
  prescribed standards for merit systems for programs                  U.S.C. Sections 1501-1508 and 7324-7328) which limit
  funded under one of the nineteen statutes or regulations             the political activities of employees whose principal
  specified in Appendix A of OPM's Standards for a Merit               employment activities are funded in whole or in part
  System of Personnel Administration) 5 C.F.R. 900,                    with Federal funds.
  Subpart F).
                                                                       9. Will comply, as applicable, with the provisions of
  6. Will comply with all Federal statutes relating to                 the Davis-Bacon Act (40 U.S.C. Sections 276a to 276a-
  nondiscrimination. These include but are not limited to:             7), the Copeland Act (40 U.S.C. Section 276c and 18
  (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352)           U.S.C. Sections 874), and the Contract Work Hours
  which prohibits discrimination on the basis of race, color           and Safety Standards Act (40 U.S.C. Sections 327-333),
  or national origin; (b) Title IX of the Education Amendments         regarding labor standards for federally assisted
  of 1972, as amended (20 U.S.C. Sections 1681-1683, and               construction subagreements.
  1685-1686), which prohibits discrimination on the basis of
  sex; (c) Section 504 of the Rehabilitation Act of 1973, as           10. Will comply, if applicable, with flood insurance
  amended (29 U.S.C. Section 794), which prohibits                     purchase requirements of Section 102(a) of the Flood
  discrimination on the basis of handicaps; (d) the Age                Disaster Protection Act of 1973 (P.L. 93-234) which
  Discrimination Act of 1975, as amended (42 U.S.C.                    requires recipients in a special flood hazard area to
  Sections 6101-6107), which prohibits discrimination on the           participate in the program and to purchase flood
  basis of age; (e) the Drug Abuse Office and Treatment Act            insurance if the total cost of insurable construction and
  of 1972 (P.L. 92-255), as amended, relating to                       acquisition is $10,000 or more.
  nondiscrimination on the basis of drug abuse; (f) the
  Comprehensive Alcohol Abuse and Alcoholism Prevention,
  Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as
  amended, relating to nondiscrimination on the basis of

FEMA Form 20-16A, JUN 94
  11. Will comply with environmental standards which may          14. Will comply with P.L. 93-348 regarding the
  be prescribed pursuant to the following: (a) institution        protection of human subjects involved in research,
  of environmental quality control measures under the             development, and related activities supported by this
  National Environmental Policy Act of 1969 (P.L. 91-190)         award of assistance.
  and Executive Order (EO) 11514; (b) notification of violating
  facilities pursuant to EO 11738; (c) protection of wetlands     15. Will comply with the Laboratory Animal Welfare Act
  pursuant to EO 11990; (d) evaluation of flood hazards in        of 1966 (P.L. 89-544, as amended, 7 U.S.C. 2131 et seq.)
  floodplains in accordance with EO 11988; (e) assurance of       pertaining to the care, handling, and treatment of warm
  project consistency with the approved State management          blooded animals held for research, teaching, or other
  program developed under the Coastal Zone Management             activities supported by this award of assistance.
  Act of 1972 (16 U.S.C. Section 1451 et seq.); (f) conformity
  of Federal actions to State (Clean Air) Implementation          16. Will comply with the Lead-Based Paint Poisoning
  Plans under Section 176(c) of the Clean Air Act of 1955,        Prevention Act (42 U.S.C. Section 4801 et seq.) which
  as amended (42 U.S.C. Section 7401 et seq.); (g) protection     prohibits the use of lead based paint in construction or
  of underground sources of drinking water under the Safe         rehabilitation of residence structures.
  Drinking Water Act of 1974, as amended, (P.L. 93-523);
  and (h) protection of endangered species under the              17. Will cause to be performed the required financial
  Endangered Species Act of 1973, as amended,                     and compliance audits in accordance with the Single
  (P.L. 93-205).                                                  Audit Act of 1984.

  12. Will comply with the Wild and Scenic Rivers Act of          18. Will comply with all applicable requirements of all
  1968 (16 U.S.C. Section 1271 et seq.) related to                other Federal laws, executive orders, regulations and
  protecting components or potential components of                policies governing this program.
  the national wild and scenic rivers system.
                                                                  19. It will comply with the minimum wage and maximum
  13. Will assist the awarding agency in assuring                 hours provisions of the Federal Fair Labor Standards
  compliance with Section 106 of the National Historic            Act (29 U.S.C. 201), as they apply to employees of
  Preservation Act of 1966, as amended (16 U.S.C. 470),           institutions of higher education, hospitals, and other
  EO 11593 (identification and protection of historic             non-profit organizations.
  properties), and the Archaeological and Historic
  Preservation Act of 1974 (16 U.S.C. 469a-1 et seq.).




FEMA Form 20-16A (BACK)
                                                FEDERAL EMERGENCY MANAGEMENT AGENCY
                                             ASSURANCES-CONSTRUCTION PROGRAMS

  NOTE: Certain of these assurances may not be applicable to your project or program. If you have any questions, please
  contact the awarding agency. Further, certain Federal assistance awarding agencies may require applicants to
  certify to additional assurances. If such is the case, you will be notified.

  As the duly authorized representative of the applicant, I certify that the applicant:

  1. Has the legal authority to apply for Federal assistance,           9. Will comply with the Lead-Based Paint Poisoning
  and the institutional, managerial and financial capability            Prevention Act (42 U.S.C. Sections 4801 et seq.) which
  (including funds sufficient to pay the non-Federal share of           prohibits the use of lead based paint in construction or
  project costs) to ensure proper planning, management and              rehabilitation of residence structures.
  completion of the project described in this application.
                                                                        10. Will comply with all Federal statutes relating to
  2. Will give the awarding agency, the Comptroller                     non-discrimination. These include but are not limited to:
  General of the United States, and if appropriate, the State,          (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352)
  through any authorized representative, access to and the              which prohibits discrimination on the basis of race, color
  right to examine all records, books, papers, or documents             or national origin; (b) Title IX of the Education Amendments
  related to the assistance; and will establish a proper                of 1972, as amended (20 U.S.C. Sections 1681-1683, and
  accounting system in accordance with generally accepted               1685-1686), which prohibits discrimination on the basis of
  accounting standards or agency directives.                            sex; (c) Section 504 of the Rehabilitation Act of 1973, as
                                                                        amended (29 U.S.C. Section 794), which prohibits
  3. Will not dispose of, modify the use of, or change the              discrimination on the basis of handicaps; (d) the Age
  terms of the real property title, or other interest in the site       Discrimination Act of 1975, as amended (42 U.S.C.
  and facilities without permission and instructions from               Sections 6101-6107), which prohibits discrimination on the
  the awarding agency. Will record the Federal interest in              basis of age; (e) the Drug Abuse Office and Treatment Act
  the title of real property in accordance with awarding                of 1972 (P.L. 92-255), as amended, relating to
  agency directives and will include a covenant in the                  non-discrimination on the basis of drug abuse; (f) the
  title of real property acquired in whole or in part with              Comprehensive Alcohol Abuse and Alcoholism Prevention,
  Federal assistance funds to assure nondiscrimination                  Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as
  during the useful life of the project.                                amended, relating to non-discrimination on the basis of
                                                                        alcohol abuse or alcoholism; (g) Sections 523 and 527 of
  4. Will comply with the requirements of the assistance                the Public Health Service Act of 1912 (42 U.S.C. 290 dd-3
  awarding agency with regard to the drafting, review and               and 290 ee-3), as amended, relating to confidentiality of
  approval of construction plans and specifications.                    alcohol and drug abuse patient records; (h) Title VIII of the
                                                                        Civil Rights Acts of 1968 (42 U.S.C. Section 3601 et seq.),
  5. Will provide and maintain competent and adequate                   as amended, relating to non-discrimination in the sale, rental
  engineering supervision at the construction site to ensure            or financing of housing; (i) any other non-discrimination
  that the complete work conforms with the approved plans               provision in the specific statute(s) under which application
  and specifications and will furnish progress reports and              for Federal assistance is being made; and (j) the
  such other information as may be required by the                      requirements of any other non-discrimination statute(s)
  assistance awarding agency or state.                                  which may apply to the application.

  6. Will initiate and complete the work within the applicable          11. Will comply, or has already complied, with the
  time frame after receipt of approval of the awarding agency.          requirements of Title II and III of the Uniform
                                                                        Relocation Assistance and Real Property Acquisition
  7. Will establish safeguards to prohibit employees from               Policies Act of 1970 (P.L. 91-646) which provide for fair
  using their positions for a purpose that constitutes or               and equitable treatment of persons displaced or whose
  presents the appearance of personal or organizational                 property is acquired as a result of Federal or Federally
  conflict of interest, or personal gain.                               assisted programs. These requirements apply to all
                                                                        interest in real property acquired for project purposes
  8. Will comply with the Intergovernmental Personnel Act               regardless of Federal participation in purchase.
  of 1970 (42 U.S.C. Sections 4728-4763) relating to prescribed
  standards for merit systems for programs funded under one             12. Will comply with provisions of the Hatch Act (5 U.S.C.
  of the nineteen statutes or regulations specified in                  Sections 1501-1508 and 7324-7328) which limit the
  Appendix A of OPM's Standards for a Merit System of                   political activities of employees whose principal employment
  Personnel Administration (5 C.F.R. 900, Subpart F).                   activities are funded in whole or in part with Federal funds.
FEMA Form 20-16B, JUN 94
  13. Will comply, as applicable, with the provisions of the      20. It will comply with the minimum wage and maximum
  Davis-Bacon Act (40 U.S.C. Sections 276a to 276a-7),            hours provisions of the Federal Fair Labor Standards
  the Copeland Act (40 U.S.C. Section 276c and 18 U.S.C.          Act (29 U.S.C. 201), as they apply to employees of
  Section 874), the Contract Work Hours and Safety                institutions of higher education, hospitals, and other
  Standards Act (40 U.S.C. Sections 327-333) regarding            non-profit organizations.
  labor standards for federally assisted construction
  subagreements.                                                  21. It will obtain approval by the appropriate Federal
                                                                  agency of the final working drawings and specifications
  14. Will comply with the flood insurance purchase               before the project is advertised or placed on the market
  requirements of Section 102(a) of the Flood Disaster            for bidding; that it will construct the project, or cause it to
  Protection Act of 1973 (P.L. 93-234) which requires             be constructed, to final completion in accordance with the
  recipients in a special flood hazard area to participate in     application and approved plans and specifications; that it
  the program and to purchase flood insurance if the total        will submit to the appropriate Federal agency for prior
  cost of insurable construction and acquisition is $10,000       approval changes that alter the cost of the project, use of
  or more.                                                        space, or functional layout, that it will not enter into a
                                                                  construction contract(s) for the project or undertake other
  15. Will comply with environmental standards which may          activities until the conditions of the construction grant
  be prescribed pursuant to the following: (a) institution        program(s) have been met.
  of environmental quality control measures under the
  National Environmental Policy Act of 1969 (P.L. 91-190)         22. It will operate and maintain the facility in accordance
  and Executive Order (EO) 11514; (b) notification of violating   with the minimum standards as may be required or
  facilities pursuant to EO 11738; (c) protection of wetlands     prescribed by the applicable Federal, State, and local
  pursuant to EO 11990; (d) evaluation of flood hazards in        agencies for the maintenance and operation of such
  floodplains in accordance with EO 11988; (e) assurance of       facilities.
  project consistency with the approved State management
  program developed under the Coastal Zone Management             23. It will require the facility to be designed to comply
  Act of 1972 (16 U.S.C. Section 1451 et seq.); (f) conformity    with the "American Standard Specifications for Making
  of Federal actions to State (Clean Air) Implementation          Buildings and Facilities Accessible to, and Usable by,
  Plans under Section 176(c) of the Clean Air Act of 1955,        the Physically Handicapped," Number A117. - 1961, as
  as amended (42 U.S.C. Section 7401 et seq.); (g) protection     modified (41 CFR 101-17.703). The applicant will be
  of underground sources of drinking water under the Safe         responsible for conducting inspections to ensure
  Drinking Water Act of 1974, as amended, (P.L. 93-523);          compliance with these specifications by the contractor.
  and (h) protection of endangered species under the
  Endangered Species Act of 1973, as amended, (P.L. 93-205).      24. If any real property or structure thereon is provided
                                                                  or improved with the aid of Federal financial assistance
  16. Will comply with the Wild and Scenic Rivers Act of          extended to the applicant, this assurance shall obligate
  1968 (16 U.S.C. Section 1271 et seq.) related to                the applicant, or in the case of any transfer of such
  protecting components or potential components of the            property, any transfer, for the period during which the
  national wild and scenic rivers system.                         real property or structure is used for a purpose for which
                                                                  the Federal financial assistance is extended or for
  17. Will assist the awarding agency in assuring                 another purpose involving the provision of similar
  compliance with Section 106 of the National Historic            services or benefits.
  Preservation Act of 1966, as amended (16 U.S.C. 470),
  EO 11593 (identification and preservation of historic           25. In making subgrants with nonprofit institutions
  properties), and the Archaeological and Historic                under this Comprehensive Cooperative Agreement, it
  Preservation Act of 1974 (16 U.S.C. 469a-1 et seq.).            agrees that such grants will be subject to OMB Circular
                                                                  A-122, "Cost Principles for Non-profit Organizations"
  18. Will cause to be performed the required financial           included in Vol. 49, Federal Register, pages 18260
  and compliance audits in accordance with the Single Audit       through 18277 (April 27, 1984).
  Act of 1984.

  19. Will comply with all applicable requirements of all
  other Federal laws, Executive Orders, regulations and
  policies governing this program.


FEMA Form 20-16B (BACK)
                                                        FEDERAL EMERGENCY MANAGEMENT AGENCY
                          CERTIFICATIONS REGARDING LOBBYING; DEBARMENT, SUSPENSION AND
                       OTHER RESPONSIBILITY MATTERS; AND DRUG-FREE WORKPLACE REQUIREMENTS

  Applicants should refer to the regulations cited below to determine the certification to which they are required to attest. Applicants
  should also review the instructions for certification included in the regulations before completing this form. Signature on this
  form provides for compliance with certification requirements under 44 CFR Part 18, "New Restrictions on Lobbying; and 28 CFR
  Part 17, "Government-wide Debarment and suspension (Nonprocurement) and Government-wide Requirements for Drug-Free
  Workplace (Grants)." The certifications shall be treated as a material representation of fact upon which reliance will be placed
  when the Federal Emergency Management Agency (FEMA) determines to award the covered transaction, grant, or cooperative
  agreement.

  1. LOBBYING                                                                 (b) Have not within a three-year period preceding this application been
                                                                              convicted of ar had a civilian judgment rendered against them for
  A. As required by section 1352, Title 31 of the U.S. Code, and              commission of fraud or a criminal offense in connection with
  implemented at 44 CFR Part 18, for persons entering into a grant            obtaining, attempting to obtain, or perform a public (Federal, State,
  or cooperative agreement over $100,000, as defined at 44 CFR                or local) transaction or contract under a public transaction; violation
  Part 18, the applicant certifies that:                                      of Federal or State antitrust statutes or commission of embezzlement,
                                                                              theft, forgery, bribery, falsification or destruction of records,
  (a) No Federal appropriated funds have been paid or will be paid,           making false statements, or receiving stolen property;
  by or on behalf of the undersigned, to any person for influencing or
  attempting to influence an officer or employee of any agency, a             (c) Are not presently indicted for or otherwise criminally or civilly
  Member of Congress, an officer or employee of congress, or an               charged by a governmental entity (Federal, State, or local) with
  employee of a Member of Congress in connection with the making              commission of any of the offenses enumerated in paragraph (1)(b)
  of any Federal grant, the entering into of any cooperative agreement,       of this certification; and
  and the extension, continuation, renewal, amendment, or modification
  of any Federal grant or cooperative agreement;                              (d) Have not within a three-year period preceding this application
                                                                              had one or more public t ransactions (Federal, State, or local)
  (b) If any other funds than Federal appropriated funds have been            terminated for cause or default; and
  paid or will be paid to any person for influencing or attempting to
  influence an officer or employee of any agency, a Member of                 B. Where the applicant is unable to certify to any of the statements
  Congress, an officer or an employee of Congress, or employee                in this certification, he or shall shall attached an explanation to this
  of a member of Congress in connection with this Federal grant or            application.
  cooperative agreement, the undersigned shall complete and submit
  Standard Form LLL, "Disclosure of Lobbying Activities," in                  3. DRUG-FREE WORKPLACE
  accordance with its instructions;                                           (GRANTEES OTHER THAN INDIVIDUALS)

  (c) The undersigned shall require that the language of this certification   As required by the Drug-Free Workplace Act of 1988, and
  be included in the award documents for all subawards at all tiers           implemented at 44 CFR Part 17, Subpart F, for grantees, as defined
  (including subgrants, contracts under grants and cooperative                at 44 CFR Part 17, Sections 17.615 and 17.620:
  agreements, and subcontract(s) and that all subrecipients shall
  certify and disclose accordingly.                                           A. The applicant certifies that it will continue to privide a drug-
                                                                              free workplace by:
      Standard Form LLL, "Disclosure of Lobbying Activities" attached.
  (This form must be attached to certification if nonappropriated funds       (a) Publishing a statement notifying employees that the unlawful
  are to be used to influence activities.)                                    manufacture, distribution, dispensing, possession, or use of a
                                                                              controlled substance is prohibited in the grantee's workplace and
  2. DEBARMENT, SUSPENSION, AND OTHER                                         specifying the actions tht will be taken against employees for
  RESPONSIBILITY MATTERS                                                      violation of such prohibition;
  (DIRECT RECIPIENT)
                                                                              (b) Establishing an on-going drug free awareness program to
  As required by Executive Order 12549, Debarment and Suspension,             inform empoyees about:
  and implemented at 44 CFR Part 67, for prospective participants in
  primary covered transactions, as defined at 44 CFR Part 17,                    (1) The dangers of drug abuse in the workplace;
  Section 17.510-A. The applicant certifies that it and its principals:          (2) The grantee's policy of maintaining a drug-free workplace;
                                                                                 (3) Any available drug counseling, rehabilitation, and
  (a) Are not presently debarred, suspended, proposed for debarment,          employee assistance programs; and
  declared ineligible, sentenced to a denial of Federal benefits by a State      (4) the penalties that may be imposed upon employees for
  or Federal court, or voluntarily excluded from covered transactions by      drug abuse violations occurring in the workplace;
  any Federal department or agency;
FEMA Form 20-16C, JUN 94
  (c) Making it a requirement that each employee to be engaged in               (2) Requiring such employee to participate satisfactorily in a
  the performance of the grant to be given a copy of the statement           drug abuse assistance or rehabilitation program approved for
  required by paragraph (a);                                                 such purposes by a Federal, State, or local health, law enforcement,
                                                                             or other appropriate agency.
  (d) Notifying the employee in the statement required by
  paragraph (a) that, as a condition of employment under the grant,          (g) Making a good faith effort to continue to maintain a drug free
  the employee will:                                                         workplace through implementation of paragraphs (a), (b), (c), (d), (e),
                                                                             and (f).
     (1) Abide by the terms of the statement; and
                                                                             8. the grantee may insert in the space provided below the site(s) for
     (2) Notify the employee in writing of his or her conviction for a       the performance of work done in connection with the specific grant:
  violation of a criminal drug statute occurring in the workplace no later
  than five calendar days after such conviction.                             Place of Performance (Street address, City, County, State, Zip code)


  (e) Notifying the agency, in writing, within 10 calendar days after
  receiving notice under subparagraph (d)(2) from an employee or
  otherwise receiving actual notice of such conviction. Employers of
  convicted employees must provide notice, including position title,
  to the applicable FEMA awarding office, i.e., regional office or
  FEMA office.
                                                                             Check        if there are workplaces on file that are not identified here.
  (f) Taking one of the following actions, within 30 calendar days of
  receiving notice under subparagraph (d)(2), with respect to any
  employee who is so convicted:                                              Section 17.630 of the regulations provide that a grantee that is a State
                                                                             may elect to make one certification in each Federal fiscal year. A copy
     (1) Taking appropriate personnel action against such an employee,       of which should be included with each application for FEMA funding.
  up to and including termination, consistent with the requirements          States and State agencies may elect to use a Statewide certification.
  of the Rehabilitation Act of 1973, as amended; or




FEMA Form 20-16C (BACK)
                                   DISCLOSURE OF LOBBYING ACTIVITIES                                                                        Approved by OMB
                         Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352                                      0348-0046
                                            (See reverse for public burden disclosure)
1. Type of Federal Action:                                2. Status of Federal Action:                      3. Report Type:
                     a. contract                                   a. bid/offer/application                        a. initial filing
                     b. grant                                      b. initial award                                b. material change
                     c. cooperative agreement                      c. post-award                                For Material Change Only:
                     d. loan                                                                                       year                     quarter
                     e. loan guarantee                                                                             date of last report
                     f. loan insurance
4. Name and Address of Reporting Entity:                                                      5. If Reporting Entity in No. 4 is Subawardee, Enter Name
                         Prime                            Subawardee                            and Address of Prime:
                                                          Tier                 , if known:



Congressional District, if known:                                                             Congressional District, if known:
6. Federal Department/Agency:                                                                 7. Federal Program Name/Description:



                                                                                              CFDA Number, if applicable:

8. Federal Action Number, if known:                                                           9. Award Amount, if known:
                                                                                               $

10. a. Name and Address of Lobbying Registrant                                                b. Individuals Performing Services (including address if
      (if individual, last name, first name, MI):                                               different from No. 10a)
                                                                                                (last name, first name, MI):




16.              Information requested through this form is authorized by title 31 U.S.C.
                 section 1352. This disclosure of lobbying activities is a material                Signature:
                 representation of fact upon which reliance was placed by the tier
                 above when this transaction was made or entered into. This                        Print Name:
                 disclosure is required pursuant to 31 U.S.C. 1352. This information
                 will be reported to the Congress semi-annually and will be                        Title:
                 available for public inspection. Any person who fails to file the
                 required disclosure shall be subject to a civil penalty of not less               Telephone No.:                                Date:
                 than $10,000 and not more than $100,000 for each such failure.

Federal Use Only:                                                                                                         Authorized for Local Reproduction
                                                                                                                          Standard Form - LLL
                              WORKSHEET FOR BUDGET NARRATIVE
                             NONCONSTRUCTION PROGRAMS                                   OBJECT CLASS CATEGORY:            Personnel                   Page 1 of 10 pages

1. PROGRAM AGENCY AND ORGANIZATION          2. FEDERAL GRANT OR OTHER IDENTIFYING       3. RECIPIENT ORGANIZATION (Name and complete address, including zip code)
ELEMENT TO WHICH REPORT IS SUBMITTED        NUMBER ASSIGNED



4. EMPLOYER IDENTIFICATION                  5. RECIPIENT ACCOUNT NUMBER OR I.D. NO.     6. BUDGET PERIOD             7. Mark "X" in Appropriate Box
                                                                                           (Month, Day, Year)             New Budget
                                                                                        Beginning Date:                   Revised Budget. Enter Grant Number in Box 2 above
                                                                                        Ending Date:                   Date of Budget Revision:
8. PROGRAM AND CFDA NUMBER:                 9. FUNCTION:                              10. ACTIVITY:                       11. TASK:



12.


                    (a)                                    (b)                  (c)                    (d)                         (e)
                                            POSITION                 POSITION                                    DATE
POSITION TITLE                              NUMBER                   TYPE               HIRE                       VACANCY




Comments:
             Page 1 of 10 pages                                                                 CHECK POINT

ddress, including zip code)
                                                                            TOTAL STATE & FEDERAL PERSONNEL                       0.00
                                                                            FROM WORKSHEET

                                                                            TOTAL STATE & FEDERAL PERSONNEL               #REF!
                                                                            FROM FEMA FORMS 20-20
Enter Grant Number in Box 2 above
                                                                            DIFFERENCE                                    #REF!




                                                                                         (i)                        (j)                           (k)
                                                                              % OF      TOTAL STATE &     % OF      TOTAL STATE &         % OF    TOTAL STATE &
                        (f)               (g)                  (h)           SALARY      FEDERAL SAL.    SALARY      FEDERAL SAL.        SALARY    FEDERAL SAL.
         DATE OF SALARY                                                               83.534                      83.534
         INCREASE                   WORK YEARS           ANNUAL SALARY                SLA 100                     SLA 50




                                                 0.000               0.00                         0.00                            0.00                      0.00
         (l)                         (m)                       (n)                         (o)                         (p)
 % OF    TOTAL STATE &     % OF      TOTAL STATE &     % OF    TOTAL STATE &     % OF      TOTAL STATE &     % OF      TOTAL STATE &
SALARY    FEDERAL SAL.    SALARY      FEDERAL SAL.    SALARY    FEDERAL SAL.    SALARY      FEDERAL SAL.    SALARY      FEDERAL SAL.
                                   83.011                                                83.505                      83.550
                                   SARA                                                  DPIG                        NDSP




                   0.00                        0.00                      0.00                        0.00                        0.00
           (q)                         (r)                         (s)                         (t)                         (u)
 % OF      TOTAL STATE &     % OF      TOTAL STATE &     % OF      TOTAL STATE &     % OF      TOTAL STATE &     % OF      TOTAL STATE &
SALARY      FEDERAL SAL.    SALARY      FEDERAL SAL.    SALARY      FEDERAL SAL.    SALARY      FEDERAL SAL.    SALARY      FEDERAL SAL.
         83.105                      83.535                      83.536                      83.536                      83.549
         CAP-SSSE                    MAP                         FMA PL                      FMA TA                      CSEPP O&M




                     0.00                        0.00                        0.00                        0.00                        0.00
           (v)                         (w)
 % OF      TOTAL STATE &     % OF
SALARY      FEDERAL SAL.    SALARY
         83.549
         CSEPP PROC                  Non-Federal




                     0.00                          0.00
Instructions for Worksheet for Budget Narrative Nonconstruction Programs
Object Class Category: Personnel
1. Enter Program Agency and Organization element to which report is submitted
2. Enter Federal Grant or other assigned identifying number
3. Enter Recipient Organizatin (name and complete address, including zip code
4. Enter Employer Identification
5. Enter Recipient account number or identification number
6. Enter beginning and ending dates of budget period (month, day, year)
7. Select either the New Budget box or the Revised Budget box (enter date of budget revision)
8. Enter program and CFDA numbers
9. Enter function
10.Enter activity
11.Enter task
12a.Enter position title
12b.Enter position number
12c.Enter position type
12d.Enter hire date
12e.Enter vacancy date
12f.Enter date of salary increase
12g.Enter work years
12h.Enter annual salary
12i.Enter percent of salary and total State and Federal salary (SLA 100)
12j.Enter percent of salary and total State and Federal salary (SLA 50)
12k.Enter percent of salary and total State and Federal salary
12l.Enter percent of salary and total State and Federal salary
12m.Enter percent of salary and total State and Federal salary (SARA)
12n.Enter percent of salary and total State and Federal salary
12o.Enter percent of salary and total State and Federal salary (DPIG)
12p.Enter percent of salary and total State and Federal salary (NDSP)
12q.Enter percent of salary and total State and Federal salary (CAP-SSSE)
12r.Enter percent of salary and total State and Federal salary (MAP)
12s.Enter percent of salary and total State and Federal salary (FMA PL)
12t.Enter percent of salary and total State and Federal salary (FMA TA)
12u.Enter percent of salary and total State and Federal salary (CSEPP O&M)
12v.Enter percent of salary and total State and Federal salary (CSEPP PROC)
12w.Enter percent of salary and total State and Federal salary (Non-Fedreal)
Enter comments
                              WORKSHEET FOR BUDGET NARRATIVE
                             NONCONSTRUCTION PROGRAMS                                            OBJECT CLASS CATEGORY:              Fringe Benefits             Page 2 of 10 pages

1. PROGRAM AGENCY AND ORGANIZATION              2. FEDERAL GRANT OR OTHER IDENTIFYING            3. RECIPIENT ORGANIZATION (Name and complete address, including zip code)
ELEMENT TO WHICH REPORT IS SUBMITTED            NUMBER ASSIGNED



4. EMPLOYER IDENTIFICATION                      5. RECIPIENT ACCOUNT NUMBER OR I.D. NO.          6. BUDGET PERIOD               7. Mark "X" in Appropriate Box
                                                                                                    (Month, Day, Year)               New Budget
                                                                                                 Beginning Date:                     Revised Budget. Enter Grant Number in Box 2 above
                                                                                                 Ending Date:                     Date of Budget Revision:
8. PROGRAM AND CFDA NUMBER:                     9. FUNCTION:                                 10. ACTIVITY:                           11. TASK:




OPTION #1
12.                                                       (b)                     (c)
                    (a)                                 83.534                  83.534
                                                        SLA 100                 SLA 50
TOTAL SALARY                                                      0.00                    0.00                           0.00                            0.00

PERCENTAGE APPLIED

FRINGE BENEFITS

OPTION #2
13.
            (a)                    (b)                    (c)                     (d)
                                                        83.534                  83.534
DESCRIPTION                     AMOUNT                  SLA 100                 SLA 50




                                         0.00                     0.00                    0.00                           0.00                            0.00

                                 TOTAL                            0.00                    0.00                           0.00                            0.00

Comments:
             Page 2 of 10 pages                                            CHECK POINT
ddress, including zip code)
                                                      TOTAL FRINGE BENEFITS                              0.00
                                                      FROM WORKSHEET

                                                      TOTAL FRINGE BENEFITS                    #REF!
                                                      FROM FEMA FORMS 20-20
Enter Grant Number in Box 2 above
                                                      DIFFERENCE                               #REF!




                        (f)              (g)                 (h)                (i)              (j)              (k)             (l)
                    83.011                                 83.505             83.550           83.105           83.535          83.536
                     SARA                                   DPIG              NDSP            CAP-SSSE           MAP            FMA PL
                                  0.00         0.00                 0.00               0.00              0.00            0.00            0.00




                       (g)               (h)                 (i)                (j)              (k)              (l)            (m)
                    83.011                                 83.505             83.550           83.105           83.535          83.536
                     SARA                                   DPIG              NDSP            CAP-SSSE           MAP            FMA PL




                                  0.00         0.00                 0.00               0.00              0.00            0.00            0.00

                                  0.00         0.00                 0.00               0.00              0.00            0.00            0.00
 (m)                (n)              (o)              (p)
83.536            83.549           83.549
FMA TA          CSEPP O&M        CSEPP PROC       Non-Federal
         0.00            0.00             0.00              0.00




  (n)               (o)              (p)              (q)
83.536            83.549           83.549
FMA TA          CSEPP O&M        CSEPP PROC       Non-Federal
                                                            0.00
                                                            0.00
                                                            0.00
                                                            0.00
                                                            0.00
                                                            0.00
                                                            0.00
                                                            0.00
         0.00             0.00             0.00             0.00

         0.00             0.00             0.00             0.00
Instructions for Worksheet for Budget Narrative Nonconstruction Programs
Object Class Category: Fringe Benefits
1. Enter Program Agency and Organization element to which report is submitted
2. Enter Federal Grant or other assigned identifying number
3. Enter Recipient Organizatin (name and complete address, including zip code
4. Enter Employer Identification
5. Enter Recipient account number or identification number
6. Enter beginning and ending dates of budget period (month, day, year)
7. Select either the New Budget box or the Revised Budget box (enter date of budget revision)
8. Enter program and CFDA numbers
9. Enter function
10.Enter activity
11.Enter task
Option #1
12a.Enter total salary, percentage applied and fringe benefits
12b.Enter percent of salary and total State and Federal salary (SLA 100)
12c.Enter percent of salary and total State and Federal salary (SLA 50)
12d.Enter percent of salary and total State and Federal salary
12e.Enter percent of salary and total State and Federal salary
12f.Enter percent of salary and total State and Federal salary (SARA)
12g.Enter percent of salary and total State and Federal salary
12h.Enter percent of salary and total State and Federal salary (DPIG)
12i.Enter percent of salary and total State and Federal salary (NDSP)
12j.Enter percent of salary and total State and Federal salary (CAP-SSSE)
12k.Enter percent of salary and total State and Federal salary (MAP)
12l.Enter percent of salary and total State and Federal salary (FMA PL)
12m.Enter percent of salary and total State and Federal salary (FMA TA)
12n.Enter percent of salary and total State and Federal salary (CSEPP O&M)
12o.Enter percent of salary and total State and Federal salary (CSEPP PROC)
12p.Enter percent of salary and total State and Federal salary (Non-Federal)
Option #2
13a.Enter description
13b.Enter amount
13c.Enter percent of salary and total State and Federal salary (SLA 100)
13d.Enter percent of salary and total State and Federal salary (SLA 50)
13e.Enter percent of salary and total State and Federal salary
13f.Enter percent of salary and total State and Federal salary
13g.Enter percent of salary and total State and Federal salary (SARA)
13h.Enter percent of salary and total State and Federal salary
13i.Enter percent of salary and total State and Federal salary (DPIG)
13j.Enter percent of salary and total State and Federal salary (NDSP)
13k.Enter percent of salary and total State and Federal salary (CAP-SSSE)
13l.Enter percent of salary and total State and Federal salary (MAP)
13m.Enter percent of salary and total State and Federal salary (FMA PL)
13n.Enter percent of salary and total State and Federal salary (FMA TA)
13o.Enter percent of salary and total State and Federal salary (CSEPP O&M)
13p.Enter percent of salary and total State and Federal salary (CSEPP PROC)
13q.Enter percent of salary and total State and Federal salary (Non-Federal)
Enter comments
                              WORKSHEET FOR BUDGET NARRATIVE
                             NONCONSTRUCTION PROGRAMS                                   OBJECT CLASS CATEGORY:             Travel                      Page 3 of 10 pages

1. PROGRAM AGENCY AND ORGANIZATION          2. FEDERAL GRANT OR OTHER IDENTIFYING       3. RECIPIENT ORGANIZATION (Name and complete address, including zip code)
ELEMENT TO WHICH REPORT IS SUBMITTED        NUMBER ASSIGNED



4. EMPLOYER IDENTIFICATION                  5. RECIPIENT ACCOUNT NUMBER OR I.D. NO.     6. BUDGET PERIOD              7. Mark "X" in Appropriate Box
                                                                                           (Month, Day, Year)              New Budget
                                                                                        Beginning Date:                    Revised Budget. Enter Grant Number in Box 2 above
                                                                                        Ending Date:                    Date of Budget Revision:
8. PROGRAM AND CFDA NUMBER:                 9. FUNCTION:                              10. ACTIVITY:                        11. TASK:




12.                                                TOTAL                                         MILEAGE
                                                                                                                                (c X d X e) =
                    (a)                               (b)                    (c)              (d)               (e)                    (f)
                                            TOTAL NUMBER           NUMBER OF          NUMBER OF      MILEAGE
DESCRIPTION OF TRAVEL                       OF TRAVELERS           TRAVELERS          MILES/TRAVELER RATE               TOTAL MILEAGE
                                                                                                                                                0.00
                                                                                                                                                0.00
                                                                                                                                                0.00
                                                                                                                                                0.00
                                                                                                                                                0.00
                                                                                                                                                0.00
                                                                                                                                                0.00
                                                                                                                                                0.00
                                                                                                                                                0.00
                                                                                                                                                0.00
                                                                                                                                                0.00
                                                                                                                                                0.00
                                                                                                                                                0.00
                                                                                                                                                0.00
                                                                                                                                                0.00
                                                                                                                                                0.00
                                                                                                                                                0.00
                                                                                                                                                0.00
                                                                                                                                                0.00
                                                                                                                                                0.00
                                                                                                                                                0.00

Comments:
             Page 3 of 10 pages                                          CHECK POINT
ddress, including zip code)
                                                   TOTAL TRAVEL                                      0.00
                                                   FROM WORKSHEET

                                                   TOTAL TRAVEL                             #REF!
                                                   FROM FEMA FORMS 20-20
Enter Grant Number in Box 2 above
                                                   DIFFERENCE                               #REF!




                                    TAXI / LIMO                                           AIRFARE                                          PER D
                                                         (g X h) =                                               (j X k) =
                       (g)                (h)               (i)               (j)             (k)                   (l)              (m)
         NUMBER OF                  TAXI LIMO                           NUMBER OF      AIRFARE PER                             NUMBER OF
         TRAVELERS                  PER TRAVELER   TOTAL TAXI LIMO      TRAVELERS      TRAVELER             TOTAL AIRFARE      TRAVELERS
                                                                 0.00                                                   0.00
                                                                 0.00                                                   0.00
                                                                 0.00                                                   0.00
                                                                 0.00                                                   0.00
                                                                 0.00                                                   0.00
                                                                 0.00                                                   0.00
                                                                 0.00                                                   0.00
                                                                 0.00                                                   0.00
                                                                 0.00                                                   0.00
                                                                 0.00                                                   0.00
                                                                 0.00                                                   0.00
                                                                 0.00                                                   0.00
                                                                 0.00                                                   0.00
                                                                 0.00                                                   0.00
                                                                 0.00                                                   0.00
                                                                 0.00                                                   0.00
                                                                 0.00                                                   0.00
                                                                 0.00                                                   0.00
                                                                 0.00                                                   0.00
                                                                 0.00                                                   0.00
                                                                 0.00                                                   0.00
             PER DIEM                                             MISCELLANEOUS                                 TOTAL
                                      (m X n X o) =                                    (q X r) =            (f + i + l + p + s) =
       (n)              (o)                (p)              (q)          (r)              (s)                        (t)                  (u)
                 NUMBER OF DAYS                       NUMBER OF   MISC COSTS      TOTAL
PER DIEM         PER TRAVELER     TOTAL PER DIEM      TRAVELERS   PER TRAVELER    MISC COSTS              TOTAL COST                PRIORITY
                                               0.00                                                0.00                      0.00
                                               0.00                                                0.00                      0.00
                                               0.00                                                0.00                      0.00
                                               0.00                                                0.00                      0.00
                                               0.00                                                0.00                      0.00
                                               0.00                                                0.00                      0.00
                                               0.00                                                0.00                      0.00
                                               0.00                                                0.00                      0.00
                                               0.00                                                0.00                      0.00
                                               0.00                                                0.00                      0.00
                                               0.00                                                0.00                      0.00
                                               0.00                                                0.00                      0.00
                                               0.00                                                0.00                      0.00
                                               0.00                                                0.00                      0.00
                                               0.00                                                0.00                      0.00
                                               0.00                                                0.00                      0.00
                                               0.00                                                0.00                      0.00
                                               0.00                                                0.00                      0.00
                                               0.00                                                0.00                      0.00
                                               0.00                                                0.00                      0.00
                                               0.00                                                0.00                      0.00
  (v)            (w)            (x)            (y)            (z)           (aa)           (ab)            (ac)            (ad)
TRAVEL         TRAVEL         TRAVEL         TRAVEL         TRAVEL         TRAVEL         TRAVEL         TRAVEL           TRAVEL
COSTS          COSTS          COSTS          COSTS          COSTS          COSTS          COSTS          COSTS            COSTS
 83.534         83.534                                      83.011                        83.505          83.550           83.105
SLA 100         SLA 50                                       SARA                          DPIG           NDSP           CAP-SSSE




        0.00           0.00           0.00           0.00           0.00           0.00           0.00            0.00            0.00
 (ae)           (af)           (ag)             (ah)             (ai)
TRAVEL         TRAVEL         TRAVEL          TRAVEL            TRAVEL         (v thru ai) =       (t - aj) =
COSTS          COSTS          COSTS            COSTS            COSTS               (aj)              (ak)
83.535         83.536         83.536           83.549           83.549
 MAP           FMA PL         FMA TA         CSEPP O&M        CSEPP PROC         TOTAL           DIFFERENCE
                                                                                          0.00           0.00
                                                                                          0.00           0.00
                                                                                          0.00           0.00
                                                                                          0.00           0.00
                                                                                          0.00           0.00
                                                                                          0.00           0.00
                                                                                          0.00           0.00
                                                                                          0.00           0.00
                                                                                          0.00           0.00
                                                                                          0.00           0.00
                                                                                          0.00           0.00
                                                                                          0.00           0.00
                                                                                          0.00           0.00
                                                                                          0.00           0.00
                                                                                          0.00           0.00
                                                                                          0.00           0.00
                                                                                          0.00           0.00
                                                                                          0.00           0.00
                                                                                          0.00           0.00
                                                                                          0.00           0.00
        0.00           0.00           0.00             0.00             0.00              0.00           0.00
Instructions for Worksheet for Budget Narrative Nonconstruction Programs
Object Class Category: Travel
1. Enter Program Agency and Organization element to which report is submitted
2. Enter Federal Grant or other assigned identifying number
3. Enter Recipient Organizatin (name and complete address, including zip code
4. Enter Employer Identification
5. Enter Recipient account number or identification number
6. Enter beginning and ending dates of budget period (month, day, year)
7. Select either the New Budget box or the Revised Budget box (enter date of budget revision)
8. Enter program and CFDA numbers
9. Enter function
10.Enter activity
11.Enter task
12a.Enter description of travel
Total
12b.Enter total number of travelers
12c.Enter number of travelers
Mileage
12d.Enter number of miles per traveler
12e.Enter mileage rate
12f.Enter total mileage ((c x d x e) = f)
12g.Enter number of travelers
Taxi/Limo
12h.Enter taxi limo per traveler
12i.Enter total taxi limo ((g x h) = i)
Airfare
12j.Enter number of travelers
12k.Enter airfare per traveler
12l.Enter total airfare ((j x k) = l)
Per Diem
12m.Enter number of travelers
12n.Enter per diem
12o.Enter number of days per traveler
12p.Enter total per diem ((m x n x o) = p)
Miscellaneous
12q.Enter number of travelers
12r.Enter miscellaneous costs per traveler
12s.Enter total miscellaneous costs ((q x r) = s)
Total
12t.Enter total cost ((f + i + l + p + s) = t)
12u.Enter priority
12v.Enter travel costs (SLA 100)
12w.Enter travel costs (SLA 50)
12x.Enter travel costs
12v.Enter travel costs
12z.Enter travel costs (SARA)
12aa.Enter travel costs
12ab.Enter travel costs (DPIG)
12ac.Enter travel costs (NDSP)
12ad.Enter travel costs (CAP-SSSE)
12ae.Enter travel costs (MAP)
12af.Enter travel costs (FMA PL)
12ag.Enter travel costs (FMA TA)
12ah.Enter travel costs (CSEPP O&M)
12ai.Enter travel costs (CSEPP PROC)
Enter total ((v thru ai) = aj)
Enter difference ((t - aj) = ak)
Enter comments
                              WORKSHEET FOR BUDGET NARRATIVE
                             NONCONSTRUCTION PROGRAMS                                   OBJECT CLASS CATEGORY:                  Equipment                   Page 4 of 10 pages

1. PROGRAM AGENCY AND ORGANIZATION          2. FEDERAL GRANT OR OTHER IDENTIFYING       3. RECIPIENT ORGANIZATION (Name and complete address, including zip code)
ELEMENT TO WHICH REPORT IS SUBMITTED        NUMBER ASSIGNED



4. EMPLOYER IDENTIFICATION                  5. RECIPIENT ACCOUNT NUMBER OR I.D. NO.     6. BUDGET PERIOD                   7. Mark "X" in Appropriate Box
                                                                                           (Month, Day, Year)                   New Budget
                                                                                        Beginning Date:                         Revised Budget. Enter Grant Number in Box 2 above
                                                                                        Ending Date:                         Date of Budget Revision:
8. PROGRAM AND CFDA NUMBER:                 9. FUNCTION:                              10. ACTIVITY:                             11. TASK:



12.                                                                                                                                         (f)
                                                                                            (b X c) =                                EQUIPMENT
                    (a)                               (b)                    (c)               (d)                   (e)               COSTS
                                                                                                                                       83.534
DESCRIPTION OF EQUIPMENT                    UNIT COST              QUANTITY           TOTAL COST                PRIORITY              SLA 100
                                                                                                        0.00
                                                                                                        0.00
                                                                                                        0.00
                                                                                                        0.00
                                                                                                        0.00
                                                                                                        0.00
                                                                                                        0.00
                                                                                                        0.00
                                                                                                        0.00
                                                                                                        0.00
                                                                                                        0.00
                                                                                                        0.00
                                                                                                        0.00
                                                                                                        0.00
                                                                                                        0.00
                                                                                                        0.00
                                                                                                        0.00
                                                                                                        0.00
                                                                                                        0.00
                                                                                                        0.00
                                                                                                        0.00                                        0.00

Comments:
             Page 4 of 10 pages                                              CHECK POINT
ddress, including zip code)
                                                         TOTAL EQUIPMENT COSTS                           0.00
                                                         FROM WORKSHEET

                                                         TOTAL EQUIPMENT COSTS                   #REF!
                                                         FROM FEMA FORMS 20-20
Enter Grant Number in Box 2 above
                                                         DIFFERENCE                              #REF!




                       (g)                  (h)                 (i)               (j)             (k)              (l)             (m)
                 EQUIPMENT               EQUIPMENT          EQUIPMENT         EQUIPMENT        EQUIPMENT        EQUIPMENT       EQUIPMENT
                   COSTS                   COSTS              COSTS             COSTS            COSTS            COSTS           COSTS
                   83.534                                                       83.011                            83.505          83.550
                   SLA 50                                                        SARA                              DPIG           NDSP




                                  0.00            0.00                0.00              0.00             0.00            0.00            0.00
   (n)             (o)             (p)             (q)             (r)              (s)
EQUIPMENT       EQUIPMENT       EQUIPMENT       EQUIPMENT       EQUIPMENT       EQUIPMENT        (f thru s) =            (d - t) =
  COSTS           COSTS           COSTS           COSTS           COSTS           COSTS               (t)                  (u)
  83.105          83.535          83.536          83.536          83.549          83.549
 CAP-SSSE          MAP            FMA PL          FMA TA        CSEPP O&M       CSEPP PROC        TOTAL                DIFFERENCE
                                                                                                                0.00            0.00
                                                                                                                0.00            0.00
                                                                                                                0.00            0.00
                                                                                                                0.00            0.00
                                                                                                                0.00            0.00
                                                                                                                0.00            0.00
                                                                                                                0.00            0.00
                                                                                                                0.00            0.00
                                                                                                                0.00            0.00
                                                                                                                0.00            0.00
                                                                                                                0.00            0.00
                                                                                                                0.00            0.00
                                                                                                                0.00            0.00
                                                                                                                0.00            0.00
                                                                                                                0.00            0.00
                                                                                                                0.00            0.00
                                                                                                                0.00            0.00
                                                                                                                0.00            0.00
                                                                                                                0.00            0.00
                                                                                                                0.00            0.00
         0.00            0.00            0.00            0.00            0.00             0.00                  0.00            0.00
Instructions for Worksheet for Budget Narrative Nonconstruction Programs
Object Class Category: Equipment
1. Enter Program Agency and Organization element to which report is submitted
2. Enter Federal Grant or other assigned identifying number
3. Enter Recipient Organizatin (name and complete address, including zip code
4. Enter Employer Identification
5. Enter Recipient account number or identification number
6. Enter beginning and ending dates of budget period (month, day, year)
7. Select either the New Budget box or the Revised Budget box (enter date of budget revision)
8. Enter program and CFDA numbers
9. Enter function
10.Enter activity
11.Enter task
12a.Enter description of equipment
12b.Enter unit cost
12c.Enter quantity
12d.Enter total cost ((b x c) = d)
12e.Enter priority
12f.Enter equipment costs (SLA 100)
12g.Enter equipment costs (SLA 50)
12h.Enter equipment costs
12i.Enter equipment costs
12j.Enter equipment costs (SARA)
12k.Enter equipment costs
12l.Enter equipment costs (DPIG)
12m.Enter equipment costs (NDSP)
12n.Enter equipment costs (CAP-SSSE)
12o.Enter equipment costs (MAP)
12p.Enter equipment costs (FMA PL)
12q.Enter equipment costs (FMA TA)
12r.Enter equipment costs (CSEPP O&M)
12s.Enter equipment costs (CSEPP PROC)
Enter total ((f thru s) = t)
Enter difference ((d - t) = u)
Enter comments
                              WORKSHEET FOR BUDGET NARRATIVE
                             NONCONSTRUCTION PROGRAMS                                   OBJECT CLASS CATEGORY:            Supplies                    Page 5 of 10 pages

1. PROGRAM AGENCY AND ORGANIZATION          2. FEDERAL GRANT OR OTHER IDENTIFYING       3. RECIPIENT ORGANIZATION (Name and complete address, including zip code)
ELEMENT TO WHICH REPORT IS SUBMITTED        NUMBER ASSIGNED



4. EMPLOYER IDENTIFICATION                  5. RECIPIENT ACCOUNT NUMBER OR I.D. NO.     6. BUDGET PERIOD             7. Mark "X" in Appropriate Box
                                                                                           (Month, Day, Year)             New Budget
                                                                                        Beginning Date:                   Revised Budget. Enter Grant Number in Box 2 above
                                                                                        Ending Date:                   Date of Budget Revision:
8. PROGRAM AND CFDA NUMBER:                 9. FUNCTION:                              10. ACTIVITY:                       11. TASK:



12.
                                                                                                                              (b X c) =
                    (a)                               (b)                    (c)                      (d)                        (e)


DESCRIPTION OF SUPPLIES                     UNIT COST              QUANTITY           UNIT DESCRIPTION            TOTAL COST
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00

Comments:
             Page 5 of 10 pages                                           CHECK POINT
ddress, including zip code)
                                                     TOTAL SUPPLY COSTS                               0.00
                                                     FROM WORKSHEET

                                                     TOTAL SUPPLY COSTS                      #REF!
                                                     FROM FEMA FORMS 20-20
Enter Grant Number in Box 2 above
                                                     DIFFERENCE                              #REF!




                                      (g)                   (h)                (i)             (j)             (k)             (l)
                                    SUPPLY               SUPPLY              SUPPLY          SUPPLY          SUPPLY          SUPPLY
                        (f)         COSTS                COSTS               COSTS           COSTS           COSTS           COSTS
                                     83.534               83.534                                             83.011
         PRIORITY                   SLA 100              SLA 50                                               SARA




                                              0.00                 0.00               0.00            0.00            0.00            0.00
 (m)              (n)               (o)              (p)             (q)             (r)              (s)              (t)
SUPPLY          SUPPLY            SUPPLY           SUPPLY          SUPPLY          SUPPLY           SUPPLY           SUPPLY
COSTS           COSTS             COSTS            COSTS           COSTS           COSTS             COSTS           COSTS
83.505           83.550            83.105          83.535          83.536          83.536            83.549          83.549
 DPIG            NDSP            CAP-SSSE           MAP            FMA PL          FMA TA          CSEPP O&M       CSEPP PROC




         0.00             0.00              0.00            0.00            0.00            0.00            0.00             0.00
(g thru t) =            (e - u) =
    (u)                    (v)


 TOTAL                DIFFERENCE
               0.00            0.00
               0.00            0.00
               0.00            0.00
               0.00            0.00
               0.00            0.00
               0.00            0.00
               0.00            0.00
               0.00            0.00
               0.00            0.00
               0.00            0.00
               0.00            0.00
               0.00            0.00
               0.00            0.00
               0.00            0.00
               0.00            0.00
               0.00            0.00
               0.00            0.00
               0.00            0.00
               0.00            0.00
               0.00            0.00
               0.00            0.00
Instructions for Worksheet for Budget Narrative Nonconstruction Programs
Object Class Category: Supplies
1. Enter Program Agency and Organization element to which report is submitted
2. Enter Federal Grant or other assigned identifying number
3. Enter Recipient Organizatin (name and complete address, including zip code
4. Enter Employer Identification
5. Enter Recipient account number or identification number
6. Enter beginning and ending dates of budget period (month, day, year)
7. Select either the New Budget box or the Revised Budget box (enter date of budget revision)
8. Enter program and CFDA numbers
9. Enter function
10.Enter activity
11.Enter task
12a.Enter description of supplies
12b.Enter unit cost
12c.Enter quantity
12d.Enter unit description
12e.Enter total cost ((b x c) = e)
12f.Enter priority
12g.Enter supplies costs (SLA 100)
12h.Enter supplies costs (SLA 50)
12i.Enter supplies costs
12j.Enter supplies costs
12k.Enter supplies costs (SARA)
12l.Enter supplies costs
12m.Enter supplies costs (DPIG)
12n.Enter supplies costs (NDSP)
12o.Enter supplies costs (CAP-SSSE)
12p.Enter supplies costs (MAP)
12q.Enter supplies costs (FMA PL)
12r.Enter supplies costs (FMA TA)
12s.Enter supplies costs (CSEPP O&M)
12t.Enter supplies costs (CSEPP PROC)
Enter total ((g thru t) = u)
Enter difference ((e - u) = v)
Enter comments
                              WORKSHEET FOR BUDGET NARRATIVE
                             NONCONSTRUCTION PROGRAMS                                   OBJECT CLASS CATEGORY:            Contractual                 Page 6 of 10 pages

1. PROGRAM AGENCY AND ORGANIZATION          2. FEDERAL GRANT OR OTHER IDENTIFYING       3. RECIPIENT ORGANIZATION (Name and complete address, including zip code)
ELEMENT TO WHICH REPORT IS SUBMITTED        NUMBER ASSIGNED



4. EMPLOYER IDENTIFICATION                  5. RECIPIENT ACCOUNT NUMBER OR I.D. NO.     6. BUDGET PERIOD             7. Mark "X" in Appropriate Box
                                                                                           (Month, Day, Year)             New Budget
                                                                                        Beginning Date:                   Revised Budget. Enter Grant Number in Box 2 above
                                                                                        Ending Date:                   Date of Budget Revision:
8. PROGRAM AND CFDA NUMBER:                 9. FUNCTION:                              10. ACTIVITY:                       11. TASK:



12.
                                                                                                                              (b X c) =
                    (a)                               (b)                    (c)                      (d)                        (e)


NARRATIVE DESCRIPTION                       UNIT COST              QUANTITY           UNIT DESCRIPTION            TOTAL COST
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00

Comments:
             Page 6 of 10 pages                                          CHECK POINT
ddress, including zip code)
                                                     TOTAL CONTRACTUAL COSTS                          0.00
                                                     FROM WORKSHEET

                                                     TOTAL CONTRACTUAL COSTS                  #REF!
                                                     FROM FEMA FORMS 20-20
Enter Grant Number in Box 2 above
                                                     DIFFERENCE                               #REF!




                                        (g)                (h)                (i)              (j)               (k)              (l)
                                    CONTRACTUAL       CONTRACTUAL        CONTRACTUAL       CONTRACTUAL       CONTRACTUAL      CONTRACTUAL
                        (f)            COSTS             COSTS              COSTS             COSTS             COSTS            COSTS
                                       83.534            83.534                                                 83.011
         PRIORITY                     SLA 100            SLA 50                                                  SARA




                                              0.00                0.00              0.00              0.00             0.00             0.00
    (m)              (n)              (o)              (p)              (q)              (r)              (s)              (t)
CONTRACTUAL      CONTRACTUAL      CONTRACTUAL      CONTRACTUAL      CONTRACTUAL      CONTRACTUAL      CONTRACTUAL      CONTRACTUAL
   COSTS            COSTS            COSTS            COSTS            COSTS            COSTS            COSTS            COSTS
   83.505           83.550           83.105           83.535           83.536           83.536           83.549           83.549
    DPIG            NDSP            CAP-SSSE           MAP             FMA PL           FMA TA         CSEPP O&M        CSEPP PROC




          0.00             0.00             0.00             0.00             0.00             0.00             0.00             0.00
(g thru t) =            (e - u) =
    (u)                    (v)


 TOTAL                DIFFERENCE
               0.00            0.00
               0.00            0.00
               0.00            0.00
               0.00            0.00
               0.00            0.00
               0.00            0.00
               0.00            0.00
               0.00            0.00
               0.00            0.00
               0.00            0.00
               0.00            0.00
               0.00            0.00
               0.00            0.00
               0.00            0.00
               0.00            0.00
               0.00            0.00
               0.00            0.00
               0.00            0.00
               0.00            0.00
               0.00            0.00
               0.00            0.00
Instructions for Worksheet for Budget Narrative Nonconstruction Programs
Object Class Category: Contractual
1. Enter Program Agency and Organization element to which report is submitted
2. Enter Federal Grant or other assigned identifying number
3. Enter Recipient Organizatin (name and complete address, including zip code
4. Enter Employer Identification
5. Enter Recipient account number or identification number
6. Enter beginning and ending dates of budget period (month, day, year)
7. Select either the New Budget box or the Revised Budget box (enter date of budget revision)
8. Enter program and CFDA numbers
9. Enter function
10.Enter activity
11.Enter task
12a.Enter narrative description
12b.Enter unit cost
12c.Enter quantity
12d.Enter unit description
12e.Enter total cost ((b x c) = e)
12f.Enter priority
12g.Enter contractual costs (SLA 100)
12h.Enter contractual costs (SLA 50)
12i.Enter contractual costs
12j.Enter contractual costs
12k.Enter contractual costs (SARA)
12l.Enter contractual costs
12m.Enter contractual costs (DPIG)
12n.Enter contractual costs (NDSP)
12o.Enter contractual costs (CAP-SSSE)
12p.Enter contractual costs (MAP)
12q.Enter contractual costs (FMA PL)
12r.Enter contractual costs (FMA TA)
12s.Enter contractual costs (CSEPP O&M)
12t.Enter contractual costs (CSEPP PROC)
Enter total ((g thru t) = u)
Enter difference ((e - u) = v)
Enter comments
                               WORKSHEET FOR BUDGET NARRATIVE
                              NONCONSTRUCTION PROGRAMS                                      OBJECT CLASS CATEGORY:            SLA Counties                Page 7 of 10 pages

1. PROGRAM AGENCY AND ORGANIZATION              2. FEDERAL GRANT OR OTHER IDENTIFYING       3. RECIPIENT ORGANIZATION (Name and complete address, including zip code)
ELEMENT TO WHICH REPORT IS SUBMITTED            NUMBER ASSIGNED



4. EMPLOYER IDENTIFICATION                      5. RECIPIENT ACCOUNT NUMBER OR I.D. NO.     6. BUDGET PERIOD             7. Mark "X" in Appropriate Box
                                                                                                 (Month, Day, Year)           New Budget
                                                                                            Beginning Date:                   Revised Budget. Enter Grant Number in Box 2 above
                                                                                            Ending Date:                   Date of Budget Revision:
8. PROGRAM AND CFDA NUMBER:                     9. FUNCTION:                              10. ACTIVITY:                       11. TASK:



A.              B.                                                                          C.                        NUMBER OF PAID PERSONNEL
                                                                                                                                                               (1 + 2) =
                (State or Local Organization)                                                              (1)                      (2)                           (3)
TEN             NAME OF APPLICANT                                                           FULL TIME                 PART TIME                       TOTAL




                                          GRAND TOTAL                                                       0                                     0
             Page 7 of 10 pages                                              CHECK POINT
ddress, including zip code)
                                                           TOTAL SLA COUNTIES COSTS                      0.00
                                                           FROM WORKSHEET

                                                           TOTAL SLA COUNTIES COSTS                      0.00
                                                           FROM FEMA FORM 20-20
Enter Grant Number in Box 2 above
                                                           DIFFERENCE                                    0.00




ERSONNEL                                                   WORK YEARS                             D.             DIRECTOR               E.                TOTAL ESTIMATED EXPENS
                   (1 + 2) =                                                    (4 + 5) =
                      (3)                     (4)               (5)                  (6)          SLA           PAID                         (1)               (2)
      TOTAL                             PROFESSIONAL       CLERICAL          TOTAL                PAID          OTHER       VOLUNTEER   PERSONNEL         TRAVEL
                                    0                                                      0.00
                                    0                                                      0.00
                                    0                                                      0.00
                                    0                                                      0.00
                                    0                                                      0.00
                                    0                                                      0.00
                                    0                                                      0.00
                                    0                                                      0.00
                                    0                                                      0.00
                                    0                                                      0.00
                                    0                                                      0.00
                                    0                                                      0.00
                                    0                                                      0.00
                                    0                                                      0.00
                                    0                                                      0.00
                                    0                                                      0.00
                                    0                                                      0.00
                                    0                                                      0.00
                                    0                                                      0.00
                                    0                                                      0.00
                                    0                                                      0.00
                                    0                                                      0.00
                                    0               0.00              0.00                 0.00                                                    0.00              0.00
STIMATED EXPENSES
                          (1 + 2 + 3) =
           (3)                  (4)
      ALL OTHER         TOTAL
                                      0.00
                                      0.00
                                      0.00
                                      0.00
                                      0.00
                                      0.00
                                      0.00
                                      0.00
                                      0.00
                                      0.00
                                      0.00
                                      0.00
                                      0.00
                                      0.00
                                      0.00
                                      0.00
                                      0.00
                                      0.00
                                      0.00
                                      0.00
                                      0.00
                                      0.00
                 0.00                 0.00
Instructions for Worksheet for Budget Narrative Nonconstruction Programs
Object Class Category: Contractual
1. Enter Program Agency and Organization element to which report is submitted
2. Enter Federal Grant or other assigned identifying number
3. Enter Recipient Organizatin (name and complete address, including zip code
4. Enter Employer Identification
5. Enter Recipient account number or identification number
6. Enter beginning and ending dates of budget period (month, day, year)
7. Select either the New Budget box or the Revised Budget box (enter date of budget revision)
8. Enter program and CFDA numbers
9. Enter function
10.Enter activity
11.Enter task
A. Enter ten
B. Enter name of applicant
C. Number of paid personnel
C1.Enter number of full time paid personnel
C2.Enter number of part time paid personnel
C3.Enter total number of paid personnel ((1 + 2) = 3)
C. Work Years
C4.Enter professional personnel
C5.Enter clerical personnel
C6.Enter total work years ((4 + 5) = 6)
D. Director
Enter SLA Paid
Enter Paid Other
Enter Volunteer
E.Total Estimated Expenses
E1.Enter Personnel
E2.Enter Travel
E3.Enter All Other
E4.Enter Total ((1 + 2 + 3) = 4)
Enter Grant Total
                              WORKSHEET FOR BUDGET NARRATIVE
                             NONCONSTRUCTION PROGRAMS                                    OBJECT CLASS CATEGORY:              Construction                Page 8 of 10 pages

1. PROGRAM AGENCY AND ORGANIZATION          2. FEDERAL GRANT OR OTHER IDENTIFYING        3. RECIPIENT ORGANIZATION (Name and complete address, including zip code)
ELEMENT TO WHICH REPORT IS SUBMITTED        NUMBER ASSIGNED



4. EMPLOYER IDENTIFICATION                  5. RECIPIENT ACCOUNT NUMBER OR I.D. NO.      6. BUDGET PERIOD               7. Mark "X" in Appropriate Box
                                                                                            (Month, Day, Year)               New Budget
                                                                                         Beginning Date:                     Revised Budget. Enter Grant Number in Box 2 above
                                                                                         Ending Date:                     Date of Budget Revision:
8. PROGRAM AND CFDA NUMBER:                 9. FUNCTION:                               10. ACTIVITY:                         11. TASK:



12.                                                                                                    (d)                          (e)
                                                                                            CONSTRUCTION                    CONSTRUCTION
                    (a)                               (b)                        (c)           COSTS                           COSTS
                                                                                                83.534                         83.534
NARATIVE DESCRIPTION                        TOTAL COST                PRIORITY                 SLA 100                         SLA 50




                                                               0.00                                              0.00                            0.00

Comments:
             Page 8 of 10 pages                                                                  CHECK POINT
ddress, including zip code)
                                                                             TOTAL CONSTRUCTION COSTS                         0.00
                                                                             FROM WORKSHEET

                                                                             TOTAL CONSTRUCTION COSTS                 #REF!
                                                                             FROM FEMA FORMS 20-20
Enter Grant Number in Box 2 above
                                                                             DIFFERENCE                               #REF!




                        (f)                   (g)               (h)                 (i)               (j)               (k)               (l)
              CONSTRUCTION               CONSTRUCTION      CONSTRUCTION       CONSTRUCTION       CONSTRUCTION      CONSTRUCTION      CONSTRUCTION
                 COSTS                      COSTS             COSTS              COSTS              COSTS             COSTS             COSTS
                                                              83.011                                83.505            83.550            83.105
                                                               SARA                                  DPIG              NDSP            CAP-SSSE




                                  0.00              0.00              0.00                0.00              0.00              0.00              0.00
    (m)               (n)               (o)               (p)               (q)
CONSTRUCTION     CONSTRUCTION      CONSTRUCTION      CONSTRUCTION      CONSTRUCTION      (d thru q) =            (b - r) =
   COSTS            COSTS             COSTS             COSTS             COSTS              (r)                   (s)
   83.535           83.536            83.536            83.549            83.549
    MAP             FMA PL            FMA TA          CSEPP O&M         CSEPP PROC        TOTAL                DIFFERENCE
                                                                                                        0.00            0.00
                                                                                                        0.00            0.00
                                                                                                        0.00            0.00
                                                                                                        0.00            0.00
                                                                                                        0.00            0.00
                                                                                                        0.00            0.00
                                                                                                        0.00            0.00
                                                                                                        0.00            0.00
                                                                                                        0.00            0.00
                                                                                                        0.00            0.00
                                                                                                        0.00            0.00
                                                                                                        0.00            0.00
                                                                                                        0.00            0.00
                                                                                                        0.00            0.00
                                                                                                        0.00            0.00
                                                                                                        0.00            0.00
                                                                                                        0.00            0.00
                                                                                                        0.00            0.00
                                                                                                        0.00            0.00
                                                                                                        0.00            0.00
          0.00              0.00              0.00              0.00              0.00                  0.00            0.00
Instructions for Worksheet for Budget Narrative Nonconstruction Programs
Object Class Category: Construction
1. Enter Program Agency and Organization element to which report is submitted
2. Enter Federal Grant or other assigned identifying number
3. Enter Recipient Organizatin (name and complete address, including zip code
4. Enter Employer Identification
5. Enter Recipient account number or identification number
6. Enter beginning and ending dates of budget period (month, day, year)
7. Select either the New Budget box or the Revised Budget box (enter date of budget revision)
8. Enter program and CFDA numbers
9. Enter function
10.Enter activity
11.Enter task
12a.Enter narrative description
12d.Enter total cost
12e.Enter priority
12d.Enter construction costs (SLA 100)
12e.Enter construction costs (SLA 50)
12f.Enter construction costs
12g.Enter construction costs
12h.Enter construction costs (SARA)
12i.Enter construction costs
12j.Enter construction costs (DPIG)
12k.Enter construction costs (NDSP)
12l.Enter construction costs (CAP-SSSE)
12m.Enter construction costs (MAP)
12n.Enter construction costs (FMA PL)
12o.Enter construction costs (FMA TA)
12p.Enter construction costs (CSEPP O&M)
12q.Enter construction costs (CSEPP PROC)
Enter total ((d thru q) = r)
Enter difference ((b - r) = s)
Enter comments
                              WORKSHEET FOR BUDGET NARRATIVE
                             NONCONSTRUCTION PROGRAMS                                   OBJECT CLASS CATEGORY:            Other                         Page 9 of 10 pages

1. PROGRAM AGENCY AND ORGANIZATION          2. FEDERAL GRANT OR OTHER IDENTIFYING       3. RECIPIENT ORGANIZATION (Name and complete address, including zip code)
ELEMENT TO WHICH REPORT IS SUBMITTED        NUMBER ASSIGNED



4. EMPLOYER IDENTIFICATION                  5. RECIPIENT ACCOUNT NUMBER OR I.D. NO.     6. BUDGET PERIOD             7. Mark "X" in Appropriate Box
                                                                                           (Month, Day, Year)             New Budget
                                                                                        Beginning Date:                   Revised Budget. Enter Grant Number in Box 2 above
                                                                                        Ending Date:                   Date of Budget Revision:
8. PROGRAM AND CFDA NUMBER:                 9. FUNCTION:                              10. ACTIVITY:                       11. TASK:



12.
                                                                                                                              (b X c) =
                    (a)                                (b)                   (c)                      (d)                        (e)                             (f)


NARRATIVE DESCRIPTION                       UNIT COST              QUANTITY           UNIT DESCRIPTION            TOTAL COST                          PRIORITY
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00
                                                                                                                                              0.00

Comments:
                                      CHECK POINT


                 TOTAL OTHER COSTS                              0.00
                 FROM WORKSHEET

                 TOTAL OTHER COSTS                      #REF!
                 FROM FEMA FORMS 20-20

                 DIFFERENCE                             #REF!




  (g)                   (h)                (i)           (j)             (k)            (l)            (m)              (n)
OTHER                 OTHER              OTHER          OTHER          OTHER           OTHER          OTHER           OTHER
COSTS                 COSTS              COSTS          COSTS          COSTS           COSTS          COSTS           COSTS
 83.534               83.534                                           83.011                         83.505          83.550
SLA 100               SLA 50                                            SARA                           DPIG           NDSP




          0.00                 0.00              0.00           0.00            0.00           0.00            0.00            0.00
   (o)              (p)             (q)             (r)              (s)              (t)
 OTHER            OTHER           OTHER           OTHER             OTHER           OTHER          (g thru t) =            (e - u) =
 COSTS            COSTS           COSTS           COSTS             COSTS           COSTS              (u)                   (v)
 83.105           83.535          83.536          83.536            83.549          83.549
CAP-SSSE           MAP            FMA PL          FMA TA          CSEPP O&M       CSEPP PROC        TOTAL                DIFFERENCE
                                                                                                                  0.00            0.00
                                                                                                                  0.00            0.00
                                                                                                                  0.00            0.00
                                                                                                                  0.00            0.00
                                                                                                                  0.00            0.00
                                                                                                                  0.00            0.00
                                                                                                                  0.00            0.00
                                                                                                                  0.00            0.00
                                                                                                                  0.00            0.00
                                                                                                                  0.00            0.00
                                                                                                                  0.00            0.00
                                                                                                                  0.00            0.00
                                                                                                                  0.00            0.00
                                                                                                                  0.00            0.00
                                                                                                                  0.00            0.00
                                                                                                                  0.00            0.00
                                                                                                                  0.00            0.00
                                                                                                                  0.00            0.00
                                                                                                                  0.00            0.00
                                                                                                                  0.00            0.00
           0.00            0.00            0.00            0.00            0.00             0.00                  0.00            0.00
Instructions for Worksheet for Budget Narrative Nonconstruction Programs
Object Class Category: Other
1. Enter Program Agency and Organization element to which report is submitted
2. Enter Federal Grant or other assigned identifying number
3. Enter Recipient Organizatin (name and complete address, including zip code
4. Enter Employer Identification
5. Enter Recipient account number or identification number
6. Enter beginning and ending dates of budget period (month, day, year)
7. Select either the New Budget box or the Revised Budget box (enter date of budget revision)
8. Enter program and CFDA numbers
9. Enter function
10.Enter activity
11.Enter task
12a.Enter narrative description
12b.Enter unit cost
12c.Enter quantity
12d.Enter unit description
12e.Enter total cost ((b x c) = e)
12f.Enter priority
12g.Enter other costs (SLA 100)
12h.Enter other costs (SLA 50)
12i.Enter other costs
12j.Enter other costs
12k.Enter other costs (SARA)
12l.Enter other costs
12m.Enter other costs (DPIG)
12n.Enter other costs (NDSP)
12o.Enter other costs (CAP-SSSE)
12p.Enter other costs (MAP)
12q.Enter other costs (FMA PL)
12r.Enter other costs (FMA TA)
12s.Enter other costs (CSEPP O&M)
12t.Enter other costs (CSEPP PROC)
Enter total ((g thru t) = u)
Enter difference ((e - u) = v)
Enter comments
                              WORKSHEET FOR BUDGET NARRATIVE
                             NONCONSTRUCTION PROGRAMS                                   OBJECT CLASS CATEGORY:             Indirect Costs              Page 10 of 10 pages                                              CHECK POINT
1. PROGRAM AGENCY AND ORGANIZATION          2. FEDERAL GRANT OR OTHER IDENTIFYING       3. RECIPIENT ORGANIZATION (Name and complete address, including zip code)
ELEMENT TO WHICH REPORT IS SUBMITTED        NUMBER ASSIGNED                                                                                                                                         TOTAL INDIRECT COSTS                  #REF!
                                                                                                                                                                                                    FROM WORKSHEET

4. EMPLOYER IDENTIFICATION                  5. RECIPIENT ACCOUNT NUMBER OR I.D. NO.     6. BUDGET PERIOD             7. Mark "X" in Appropriate Box                                                 TOTAL INDIRECT COSTS                  #REF!
                                                                                            (Month, Day, Year)             New Budget                                                               FROM FEMA FORMS 20-20
                                                                                        Beginning Date:                    Revised Budget. Enter Grant Number in Box 2 above
                                                                                        Ending Date:                     Date of Budget Revision:                                                   DIFFERENCE                            #REF!
8. PROGRAM AND CFDA NUMBER:                 9. FUNCTION:                              10. ACTIVITY:                        11. TASK:




OPTION #1
12.
                     (a)                                   (b)                  (c)                    (d)                         (e)                           (f)                  (g)                  (h)               (i)            (j)
EFFECTIVE PERIOD OF RATE                    TOTAL PERSONNEL        NEGOTIATED           INDIRECT COSTS                                                         83.534               83.534                                                83.011
AGREEMENT                                   & FRINGE BENEFITS      RATE                 CLAIMED                                                               SLA 100               SLA 50                                                 SARA
                                                             #REF!                           #REF!                 TOTAL PERSONNEL &                                         0.00            0.00                0.00              0.00   #REF!
                                                                                                                    FRINGE BENEFITS
                                                                                                                   NEGOTIATED RATE

                                                                                                                   INDIRECT COSTS
                                                                                                                   CLAIMED                                                   0.00            0.00                0.00              0.00   #REF!

OPTION #2
13.
                     (a)                                            (b)                                            (c)                                           (d)                  (e)                  (f)               (g)            (h)
EFFECTIVE PERIOD OF RATE                                                                                                                                       83.534               83.534                                                83.011
AGREEMENT                                                        COMMENTS                                                                                     SLA 100               SLA 50                                                 SARA
                                                                                        TOTAL DIRECT CHARGES                                  #REF!                          0.00            0.00                0.00              0.00   #REF!
                                                                                           LESS
                                                                                           LESS
                                                                                           LESS
                                                                                        TOTAL                                                 #REF!                          0.00            0.00                0.00              0.00   #REF!

                                                                                        NEGOTIATED RATE

                                                                                        INDIRECT COSTS CLAIMED                                #REF!                          0.00            0.00                0.00              0.00   #REF!

OPTION #3
14.
                     (a)                                            (b)                                            (c)                                           (d)                  (e)                  (f)               (g)            (h)
EFFECTIVE PERIOD OF RATE                                                                                                                                       83.534               83.534                                                83.011
AGREEMENT                                                        COMMENTS                                                                                     SLA 100               SLA 50                                                 SARA
                                                                                        BASE

                                                                                        NEGOTIATED RATE

                                                                                        INDIRECT COSTS CLAIMED                                 0.00                          0.00            0.00                0.00              0.00            0.00

                                                                                        BASE

                                                                                        NEGOTIATED RATE

                                                                                        INDIRECT COSTS CLAIMED                                 0.00                          0.00            0.00                0.00              0.00            0.00

                                                                                        BASE

                                                                                        NEGOTIATED RATE

                                                                                        INDIRECT COSTS CLAIMED                                 0.00                          0.00            0.00                0.00              0.00            0.00



                                                                                        TOTAL INDIRECT COSTS CLAIMED                                                         0.00            0.00                0.00              0.00   #REF!
                                                                                        TOTAL STATE & FEDERAL INDIRECT COSTS CLAIMED                           #REF!
 (k)             (l)            (m)               (n)              (o)             (p)             (q)              (r)               (s)              (t)
               83.505          83.550           83.105           83.535          83.536          83.536            83.549           83.549
                DPIG           NDSP            CAP-SSSE           MAP            FMA PL          FMA TA          CSEPP O&M        CSEPP PROC       Non-Federal
#REF!          #REF!           #REF!             #REF!           #REF!            #REF!           #REF!            #REF!             #REF!                    0.00




#REF!          #REF!           #REF!            #REF!            #REF!           #REF!           #REF!             #REF!            #REF!                     0.00




 (i)             (j)            (k)               (l)             (m)              (n)             (o)              (p)               (q)
               83.505          83.550           83.105           83.535          83.536          83.536            83.549           83.549
                DPIG           NDSP            CAP-SSSE           MAP            FMA PL          FMA TA          CSEPP O&M        CSEPP PROC
#REF!          #REF!           #REF!             #REF!           #REF!            #REF!           #REF!            #REF!             #REF!




#REF!          #REF!           #REF!            #REF!            #REF!           #REF!           #REF!             #REF!            #REF!




#REF!          #REF!           #REF!            #REF!            #REF!           #REF!           #REF!             #REF!            #REF!



                                                                                                                                                                     (d thru q) =            (c - s) =
 (i)             (j)            (k)               (l)             (m)              (n)             (o)              (p)               (q)              (r)               (s)                    (t)
               83.505          83.550           83.105           83.535          83.536          83.536            83.549           83.549
                DPIG           NDSP            CAP-SSSE           MAP            FMA PL          FMA TA          CSEPP O&M        CSEPP PROC       Non-Federal        TOTAL                DIFFERENCE
                                                                                                                                                                                    0.00            0.00




        0.00            0.00            0.00              0.00            0.00            0.00            0.00             0.00             0.00              0.00

                                                                                                                                                                                    0.00                 0.00




        0.00            0.00            0.00              0.00            0.00            0.00            0.00             0.00             0.00              0.00

                                                                                                                                                                                    0.00                 0.00




        0.00            0.00            0.00              0.00            0.00            0.00            0.00             0.00             0.00              0.00



#REF!          #REF!           #REF!            #REF!            #REF!           #REF!           #REF!             #REF!            #REF!                     0.00
Instructions for Worksheet for Budget Narrative Nonconstruction Programs
Object Class Category: Indirect Costs
1. Enter Program Agency and Organization element to which report is submitted
2. Enter Federal Grant or other assigned identifying number
3. Enter Recipient Organizatin (name and complete address, including zip code
4. Enter Employer Identification
5. Enter Recipient account number or identification number
6. Enter beginning and ending dates of budget period (month, day, year)
7. Select either the New Budget box or the Revised Budget box (enter date of budget revision)
8. Enter program and CFDA numbers
9. Enter function
10.Enter activity
11.Enter task
Option #1
12a.Enter effective period of rate agreement
12b.Enter total personnel and fringe benefits
12c.Enter negotiated rated
12d.Enter indirect costs claimed
12e.Total personnel and fringe benefits negotiated rate and indirect costs claimed
12f.Enter SLA 100
12g.Enter SLA 50
12h.
12i.
12j.Enter SARA
12k.
12l.Enter DPIG
12m.Enter NDSP
12n.Enter CAP-SSSE
12o.Enter MAP
12p.Enter FMA PL
12q.Enter FMA TA
12r.Enter CSEPP O&M
12s.Enter CSEPP PROC
12t.Enter Non-Federal
Option #2
13a.Enter effective period of rate agreement
13b.Enter comments
13c.Enter total direct charges (less), total, negotiated rate, and indirect costs claimed
13d.Enter SLA 100
13e.Enter SLA 50
13f.
13g.
13h.Enter SARA
13i.
13j.Enter DPIG
13k.Enter NDSP
13l.Enter CAP-SSSE
13m.Enter MAP
13n.Enter FMA PL
13o.Enter FMA TA
13p.Enter CSEPP O&M
13q.Enter CSEPP PROC
Option #3
14a.Enter effective period of rate agreement
14b.Enter comments
14c.Enter base, negotiated rate, and indirect costs claimed
14d.Enter SLA 100
14e.Enter SLA 50
14f.
14g.
14h.Enter SARA
14i.
14j.Enter DPIG
14k.Enter NDSP
14l.Enter CAP-SSSE
14m.Enter MAP
14n.Enter FMA PL
14o.Enter FMA TA
14p.Enter CSEPP O&M
14q.Enter CSEPP PROC
14r.Enter Non-Federal
14s.Enter total ((d thru q) = s)
14t.Enter difference ((c - s) = t)
Enter total indirect costs claimed
Enter total State and Federal indirect costs claimed
                                         FEDERAL EMERGENCY MANAGEMENT AGENCY                                                       See reverse for Paperwork                                          OMB No. 3067-0206
                           BUDGET INFORMATION--NONCONSTRUCTION PROGRAMS                                                            Burden Disclosure Notice          Page     of   pages           Expires February 28, 2007

1. PROGRAM AGENCY AND ORGANIZATION                      2. FEDERAL GRANT OR OTHER IDENTIFYING                                 3. RECIPIENT ORGANIZATION (Name and complete address, including zip code)
ELEMENT TO WHICH REPORT IS SUBMITTED                    NUMBER ASSIGNED



4. EMPLOYER IDENTIFICATION                              5. RECIPIENT ACCOUNT NUMBER OR I.D. NO.                               6. BUDGET PERIOD                 7. Mark "X" in Appropriate Box
                                                                                                                                 (Month, Day, Year)                 New Budget
                                                                                                                              Beginning Date:                      Revised Budget. Enter Grant Number in Box 2 above
                                                                                                                              Ending Date:                       Date of Budget Revision:
8. FEDERAL RATE SHARING (%)                                                        (%)                                 (%)                               (%)                                 (%)               Total
9.              PROGRAM ACRONYM
                CFDA NUMBER
10.             a. Personnel
                b. Fringe Benefits
                c. Travel
                d. Equipment
     Object     e. Supplies
      Class     f. Contractual
                g. Construction
                h. Other
                i. Total Direct Charges (10a to 10h)
                j. Indirect Charges
                k. Total (Sum of 10i & 10j)
                l. Federal Share
                   Non-Federal Resources:
                m. Applicant
     Source     n. State
                o. Local
                p. Other Sources
                q. Total (Sum of 10l to 10p)
     Income     r. Program Income
                s. Detail on Indirect Cost
     Indirect      Type of Rate (mark "X" in one box)                                        Provisional-Final                Predetermined                    Fixed with Carry-Forward
      Cost
                Rate:                %                                                       Total Amount of Indirect Cost:                                                          Base:

11. Signature of Authorizing Official                   12. Name and Title (Type or print)                                    13. Telephone Number (Area code, Number and Extension)               Date Report Submitted



FEMA Form 20-20, FEB 01

				
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