Council Online Profile Registration

FEMA Form 646

OMB No: 1660-0098

Expiration:

PAPERWORK BURDEN DISCLOSURE NOTICE

Citizen Corps Council Registration 

Public reporting burden for this data collection is estimated to average 1 hour 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. 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, 1800 South Bell Street, Arlington, VA 20598-3005, Paperwork Reduction Project (1660-0098) NOTE: Do not send your completed form to this address.

Citizen Corps Council Profile

Please note, this section of the website is for representatives of Citizen Corps Councils to register a new Council or to update their Council Profile information. If you are not an official representative of a Citizen Corps Council, but are interested in participating in Citizen Corps please contact your nearest local or state Council, which can be located by entering your zip code in the [Citizen Corps Council search function.] HYPERLINK THE WORDS IN BRACKETS TO: http://www.citizencorps.gov/cc/searchCouncil.do?submitByZip

By posting information on the National Citizen Corps Website, you will be able to highlight information about your efforts to achieve community resilience, your state and federal partners will be able to share relevant information with you, and interested individuals in your jurisdiction will be able to contact you to get involved.

If you experience any difficulties registering or updating your Council information, please send an email to [email protected]. Thank you.

Start your submission by providing the following information, then hit Next:

Council Name: *

Select Country: *

Select State *

Jurisdiction By: *

Available Assigned

Overlapping Councils Found

Overlapping jurisdictions

One or more approved or pending Councils report that they operate within the jurisdiction(s) you have selected. While you may continue with completing your Citizen Corps Council Profile, we recommend that you contact your State Citizen Corps Program Manager and the Council(s) listed below to discuss coordinating your efforts. Click on any Council in the list to get their contact information.

Click the "Continue With Profile" button below to continue your submission.

State Citizen Corps Program Manager

* Maine Citizen Corps Council

Overlapping local Citizen Corps Council(s)

* SE Region Citizen Corps Council

Citizen Corps Council Representative Contact Information

Please correct the following errors:

* The e-mail provided is invalid.

* You are required to provide a State / Province for the Council's address.

* You are required to provide a City for your address.

* The zip code provided is invalid.

* A properly formatted phone number is required.

The first step in registering a Citizen Corps Council Profile on the national directory is to establish a user account for the Council representative who will be responsible for registering / maintaining your Council Profile on the National Citizen Corps Website. This information will only be shared with other Citizen Corps Councils and Partners.

Please fill in the following contact information.

Please note; all fields marked with a * are required

First Name: *

Middle Initial:

Last Name: *

Title:*

Organization:*

Street Address: *

Street Address Cont.:

City: *

Select Country: *

State: *

Postal Code: * - 4 Digit Zip Ext.

Phone Extension

Phone Number: * Ext:

Email: *

Confirm Email: *

Establish New User Password

You are required to establish a password for the system.

Password changes have the following restrictions:

* A password must be greater than 7 characters

* A password must be different than the current password

* A password must contain at least one digit or one of the following non-character values; @#$%^&+=-

Choose A Password: Confirm That Password:

Citizen Corps Council Contact Information

Please provide the name, address, and contact information for your Citizen Corps Council. If the Council address is the same as your Council representative address, you can automatically fill in these fields by clicking on “Populate from contact info”.

Please note: this information will be posted publicly on the National Citizen Corps Website.

Name, Address, & Description

Council Name: *

Street Address: *

Street Address Cont.

City: *

Select Country: *

State: *

Postal Code: * -

Postal Code extension

Phone Extension

Phone Number: * Ext:

Email: *

Confirm Email: *

Council Web Site: http(s)://www.com

Local Sponsoring Official Information

To be approved, your Citizen Corps Council must have the support of the local elected leadership for your Council's jurisdiction - this could be the Mayor, City/Town Manger, County Commissioner - or the Emergency Management Director for your area.

Please note: this information will not be posted publicly on the National Citizen Corps Website

Sponsoring Official Contact Information

First Name: *

Middle Initial:

Last Name: *

Title:*

Organization:*

Street Address: *

Street Address Cont.:

City: *

Select Country: *

State: *

Postal Code: * -

Postal Code extension

Phone Extension

Phone Number: * Ext:

Email:*

Confirm Email: *

Public Information About Your Council

In addition to posting contact information for your Citizen Corps Council, we would like to include information about your Council membership and your community’s preparedness activities on the National Citizen Corps Website.

Council History: Month & year your Council was started (month / year drop down)

Citizen Corps Council:

The purpose of the Citizen Corps Council is to foster collaboration between government and civic leaders from all sectors to develop goals and strategies for community resilience tailored to specific community vulnerabilities and population. The membership of the Council should reflect the population composition, the hazard profile, and the infrastructure of the community.

Please select all organizations that participate in your Citizen Corps Council.

Elected Leadership

Mayor, City/Town Manager, County/Parish Elected Leader

Emergency Responders

Emergency Management

Law Enforcement

Fire Service

Emergency Medical Services

Public Health Service

Hospitals and Health Care Facilities

Emergency Communications (e.g. Alerts/Warning Systems, PSAP / 911 Call Centers)

Hazard Materials Coordinator

Public Works

Public Utilities

Other

Government / Government-Sponsored Organizations

Public Schools System / School Board

Community College / Public Universities

Land-grant Institution Extension Agent (Extension Disaster Education Network)

Transportation

Ports and Waterways

Agriculture

Prisons / Correctional Facilities

Uniformed Armed Forces / National Guard

Human Services Agencies (e.g. aging, disability, low income)

Public Housing

Building Codes and Permits

Veterans Affairs

Post Office

Internal Revenue Service

Surveyor's Office

Weather Service / NOAA

Local Emergency Planning Committees

Community Emergency Response Teams

Medical Reserve Corps

Volunteers in Police Service

Fire Corps

Neighborhood Watch and other Watch Programs

AmeriCorps / Senior Corps / Learn and Serve / VISTA

Other

Civic Organization / Private Non-Profit Representatives

Volunteer Response Organizations

• American Red Cross

• Voluntary/Community Organizations Active in Disaster (VOAD / COAD)

• American Radio Relay League (ARRL) / Amateur Radio Emergency Service (ARES) / Radio Amateur Civil Emergency Services (RACES) / other

• Salvation Army

• Other

Civic Organizations (Rotary, American Legion, VFW)

Volunteer Center

Chamber of Commerce / Jaycees

Neighborhood / Community / Homeowners Associations

Parent Teacher Associations

211 Services

Humane Society / Animal Advocacy

Youth-Based Organizations

Language / Cultural Organizations

Disability Advocacy Organizations

Other

Private Sector

Privately Owned Critical Infrastructure (e.g. power, transportation)

Entertainment / Sports Venues

Shopping Centers / Malls

Private Schools / Universities

Private Hospitals / Assisted Living Facilities

Private Security Firms

Insurance

Banking / Mortgage Institutions

Hotel / Tourism

Media

Legal

Other

Faith or Interfaith-Based Organizations

Faith or Interfaith-Based Organizations

Places of Worship

Other

Philanthropic Organizations

United Way

Community Foundation

Other

Preparing the Public and Organizations in the Community

Educating and involving the public is a critical element of community resilience. Please provide information on what your community is doing to elevate the knowledge, skills, and participation of community residents to prepare for community threats and hazards.

How does your community ensure residents have the information, skills, supplies they need to be prepared for community threats and hazards? Please check all that apply.

Preparedness Action Public education materials Training/Demonstrations

Local alerts/warnings:

Protective response for no-notice hazards:

Family Plan:

Supplies in multiple locations:

First Aid:

CPR / AED:

Local information on evacuating:

Local information on sheltering:

Guidance on drills:

Mitigation measures for property:

Prevention measures (crime):

Prevention measures (public health):

Cyber safety measures:

Other:

For which hazards do you provide public education/training?

All-hazards

Natural disasters

Public Heath

Crime

Hazardous Materials

Nuclear / Radiological Events

Terrorism

Household Emergencies

Other

In which locations do you offer training/demonstrations in preparedness?

Neighborhoods

Schools

Places of Worship

Workplace

Civic / Non-profit Organizations

Community events

Other

For which targeted populations do you provide public education/training?

General public

Frail elderly

Youth

Pet Owners

Diverse Language and Cultures

Economic Factors

People with Disabilities

Other

For which types of drills and exercises do you offer guidance?

Building evacuations

Community evacuations

Sealing a room (aerosol protections)

Sheltering in place (staying where you are)

Community sheltering (mass care shelters)

Continuity of Operations

Other

How do you increase public awareness of personal preparedness?

Website

Printed materials

Posters/Displays

Radio announcements

Television announcements

Talking points for community leaders

Other

Does your community participate in National Preparedness Month?

Yes No

Volunteer Opportunities

Is there a process for individuals to register interest in volunteering to support community safety and disaster preparedness in your area? Yes No If there is a website to register for local volunteer opportunities, please provide a link:

In which areas are there volunteer opportunities in your jurisdiction?

Preparedness Outreach

First Aid / CPR / AED Training

Emergency Management

Fire Service

Law Enforcement

Public Health and Medical Services

Human Services

Transportation Safety

Communications

Search and Rescue

Critical Infrastructure Protection

Public Works

Agriculture

Public Lands / Public Spaces

Language and Cultural Outreach

Pet/Animal Issues

Other

Does your jurisdiction have volunteer programs for surge capacity disaster response roles? Yes/No

Do surge capacity volunteers receive training in the Incident Command System? Yes/No

Have volunteers from your jurisdiction helped to respond to disasters in your area? Yes No

Have volunteers from your jurisdiction helped to respond to disasters outside of your area? Yes No

Does your jurisdiction include volunteers with a response role in community/government response exercises? Yes No

Does your jurisdiction include the general public in community/government response exercises?

Yes No

Awards and Recognition

How does your Citizen Corps Council recognize the contributions of volunteers and community leaders?

Awards ceremony

Public acknowledgement through newspapers or other media

Presidential Volunteer Service Award

Other

Additional Information – Not Publicly Accessible

In addition the information on your Citizen Corps Council that will be posted on the public National Citizen Corps Website, we would like to request some more detailed information about your Council activities.

Please note: Answers to the following questions will NOT be posted on the public website, but will be posted on the password protected section of the site - accessible only to other Citizen Corps Councils and Partners. This data will help us all better understand how Citizen Corps is being implemented around the country and will help with growing and expanding community preparedness efforts.

Council Administration

How often does your Citizen Corps Council meet?

Monthly

Quarterly

Bi-Annually

Annually

As needed

Other:

What is the participation of the local Emergency Manager?

Chairs the Council

Very involved

Somewhat involved

Provides an endorsement only

Is not at all involved

Other:

What is the participation of the local elected leader?

Chairs the Council

Very involved

Somewhat involved

Provides an endorsement only

Is not at all involved

Other:

The Citizen Corps Council Point of Contact posted on the public website is:

A local government employee

An employee of a non-profit organization

A private sector employee

A volunteer

Other ___________

Approximately what percentage of the Council Point of Contact's time is devoted to Citizen Corps?

No Time

25% of the Time

50% of the Time

75% of the Time

100% of the Time

Does your Citizen Corps Council the following (check all that apply):

____ Charter

____ Executive Order

____ By-laws

Please consider emailing the above documents to [email protected] to be posted as a resource on the National Citizen Corps Website.

Is your Council registered as a 501c3 organization or is it associated with a 501c3 organization? Yes No

How do you fund your activities? Check all that apply.

Homeland Security funding through the State

Other federal funding through State

Direct Federal funding

State government funding

Local government funding

Private Sector donations

Foundations or Philanthropic Organizations

General Fundraising

Other:

Collaborative Planning

Please indicate the topics that have been discussed, reviewed, or revised by your Citizen Corps Council within the past year:

Community Vulnerability / Risk Assessments

Comprehensive Emergency Management Plan

Emergency Operations Plan

Mitigation Plan

Homeland Security Strategy

Continuity of Operations

Alerts and Warnings Systems

Evacuation Planning

Shelter Planning

Integration of non-governmental resources in government protocols

Consideration for persons with functional needs

Exercises

Emergency Support Functions

Please indicate which Emergency Support Functions in the jurisdiction's Emergency Operations Plan formally include non-governmental resources: For information on Emergency Support Functions please visit: http://www.fema.gov/emergency/nrf/

ESF # 1: Transportation Yes No Don't Know

ESF # 2: Communications Yes No Don't Know

ESF # 3: Public Works and Engineering Yes No Don't Know

ESF # 4: Firefighting Yes No Don't Know

ESF # 5: Information and Planning Yes No Don't Know

ESF # 6: Mass Care Yes No Don't Know

ESF # 7: Resource Support Yes No Don't Know

ESF # 8: Health and Medical Support Yes No Don't Know

ESF # 9: Urban Search and Rescue Yes No Don't Know

ESF # 10: Hazardous Materials Yes No Don't Know

ESF # 11: Food Yes No Don't Know

ESF # 12: Energy Yes No Don't Know

Volunteer and Donations Management Annex Yes No Don't Know

Private Sector Annex Yes No Don't Know Other

How have you exercised your emergency plan? Check all that apply.

Table-top exercise

Full scale exercise

Drill

Actual response

Public briefing

Have not exercised the plan

When was the last exercise or actual event?

Within the past 12 months

1-2 years ago

Over 2 years ago

Have not exercises the plan or had an event

Volunteer Opportunities

Does your community maintain a database or electronic listing of volunteers from your jurisdiction?

Yes / No

If you have a database of volunteers, do you track their willingness to deploy outside of the local jurisdiction? Yes No

Does your community conduct background checks on participants in volunteer programs or response efforts? Yes No

Does your community track skills and credentials of volunteers? Yes No

Does your community offer Incident Command System (ICS) training for volunteers with a response role? Yes No

Has your jurisdiction ever used volunteer contributions as a soft match requirement for a grant?

Yes No

How are legal protections offered to volunteers?

Federal Volunteer Protection Act

State Good Samaritan Laws

State Legislation protecting volunteer actions

Through a Local Agency

Not offered

Other:

Evaluation and Assessment

How do you evaluate the impact / success of your efforts?

Conduct surveys

Track data collected from existing sources, e.g. crime reports

Assess performance in exercises

Number of volunteers

Number of volunteer hours

Anecdotal feedback from government/community leaders

Response capabilities in an actual event, e.g. evacuation times, numbers sheltered, number of volunteers

Other:

What is the single greatest factor contributing to the success of your Citizen Corps Council efforts?

Dedicated leadership

Dedicated Council membership

Regularly scheduled meetings

Local government support

State government support

Funding

Public interest

Identify the three greatest obstacles to the success of your Citizen Corps Council efforts?

Insufficient Funding

Low membership involvement

Lack of public interest

Lack of local government support

Infrequent and/or irregular meetings

Lack of dedicated leadership

Insufficient state government support

Identify the three areas your Citizen Corps Council could most use assistance?

Outreach and communicating with the public

Conducting drills and exercises

Data management

Developing/reviewing local emergency response plans

Determining the level of risk in your jurisdiction

Integrating homeland security into emergency plans

Coordination with state and federal agencies

The Citizen Corps Council has had a positive impact on the safety and resiliency of my community.

Strongly Agree

Agree

Neither Agree nor Disagree

Strongly Disagree

Congressional Involvement

Are your Congressional representatives aware of your activities? Yes No

Have your Congressional representatives ever participated in a community preparedness event in your area? Yes No

If any of the above information changes, if you have any questions about Citizen Corps or if you would like to share a success story or a lesson learned, please send an e-mail to [email protected]

By submitting this form, the sender individual or organization consents to release of his or her name, address and contact information only to other communities or partners participating in Citizen Corps. If you do not agree, please click on "Cancel" below.

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July 7, 2009