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Thank you for your interest in Citizen Corps and in making yourself and your community safer, stronger, and better prepared to manage any emergency situation.
By submitting this form, you are agreeing to the release of your name, address, and contact information to the state and local Citizen Corps Councils for the area in which you live and to the organizations that manage the programs in which you have indicated an interest. You will also receive email updates about the Department of Homeland Security, the Federal Emergency Management Agency, and the National Office of Citizen Corps. If you do not agree, please do not click on the subscribe button below.
FEMA Form 646-0, OMB No. 1660-0099, Expiration Date: 12/31/2012
Privacy Act Statement
In compliance with the Privacy Act of 1974, the following information is provided: the collection of this information is authorized by 5 U.S.C. 301 and Section 2, Executive Order 13254, January 29, 2002. The primary purpose of the form is to provide a means of communication with individuals who have indicated an interest in the Citizen Corps mission and in specific areas of volunteer service. Providing this information is voluntary. All information submitted by a user is available to Citizen Corps (including individual State and Local Citizen Corps Councils), USA Freedom Corps, those entities in which user expresses an interest, and other entities as specified in the Notice published at 67 FR 30685-01 (May 7, 2002).
PAPERWORK BURDEN DISCLOSURE NOTICE
Public reporting burden for this data collection is estimated to average 5 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. 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 (1660-0099) NOTE: Do not send your completed form to this address.