Form FEMA Form 089-0-24 FEMA Form 089-0-24 Request for Fire Management Assistance Sub-Grant

DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY
REQUEST FOR FIRE MANAGEMENT ASSISTANCE SUBGRANT

O.M.B. No. 1660-0058
Expries August 31, 2011

PAPERWORK BURDEN DISCLOSURE NOTICE

Public reporting burden for this form is estimated to average 18 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. Your response is required
to obtain or retain Federal Federal Assistance through FEMA's Fire Management Assistance Grant Program. You are not required to respond to this
collection of information unless a valid OMB control number is displayed on this form. Send comments regarding the accuracy of the burden estimate and
any suggestions for reducing this burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management
Agency, 500 C Street, SW, Washington, DC, 20472, Paperwork Reduction Project (1660-0058). NOTE: Do not send your completed form to the above
address.
1. APPLICANT (Political subivision or eligible applicant)

2. DATE

1a. DUNS NUMBER

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

APPLICANT PHYSICAL LOCATION
1. STREET ADRESS

3. COUNTY

2. CITY

4. STATE

Primary Contact/Applicant's Authorized Agent

5. ZIP CODE

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 government; 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 fire fighting organizations, may be reimbursed
through a contract or compact with an eligible applicant for cost associated with the 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 complex for which a fire management assistance declaration was approved, and located within the
declared area.
FEMA Form 089-0-24, MM/YY

PREVIOUS Form 90-133 OBSOLETE