Approved Privacy Act Statement

Privacy Act Statement
Authority: Sections 203 and 404 of the Robert T. Stafford Disaster Relief and Emergency
Assistance Act, as amended, 42 U.S.C. § 5133 and 42 U.S.C. § 5170c; § 1366 of the National
Flood Insurance Act, (NFIA) as amended, 42 § U.S.C. 4104c; § 1323 of the NFIA, 42 U.S.C. §
4030; and § 1361A of the NFIA, 42 U.S.C. § 4102a.
Purpose: The information is being collected for the purpose of formalizing the purchase offer
valuation of a property subject to mitigation and to ensure that recipients of Hazard Mitigation
Assistance funds for the acquisition and demolition of these properties understand that their
participation is strictly voluntary.
Routine Uses: The information on this form may be disclosed as generally permitted under 5
U.S.C. § 552a (b) of the Privacy Act of 1974, as amended.
Disclosure: The disclosure of information on this form is voluntary; however, failure to provide
the information requested may delay or prevent FEMA from being able to provide Hazard
Mitigation Assistance for the acquisition and demolition of the structure for the purposes of
mitigation. The signed voluntary participation statement will be forwarded to the State/applicant
and the paper form will be contained in the grant application.