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

O.M.B. No. 1660-0058
Expires September 30, 2014

DEPARTMENT OF HOMELAND SECURITY

Federal Emergency Management Agency

REQUEST FOR FIRE MANAGEMENT ASSISTANCE SUBGRANT
PAPERWORK BURDEN DISCLOSURE NOTICE
Public reporting burden for this data collection 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 data needed, and completing and submitting this form.
This collection of information is required to obtain or retain benefits. 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 the burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management
Agency,500 C Street, SW., Room 7NE, Washington, DC 20472-3100, Paperwork Reduction Project (1660-0058) NOTE: Do not send your
completed form to this address.
1. APPLICANT (Political subivision or eligible applicant)

2. DATE

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. EMAIL ADDRESS

7. EMAIL 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 (08/14)

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