Form FEMA Form 010-0-11 FEMA Form 010-0-11 Administration Option Agreement

O.M.B. No. 1660-0061 Expires October 31, 2011
DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY

Individuals and Households Program (IHP) - Other Needs Assistance
ADMINISTRATIVE OPTION SELECTION
Instructions: This form must be completed and submitted to the Federal Emergency Management Agency (FEMA) by November 30
every year.
PRIVACY ACT STATEMENT
AUTHORITY: The Robert T. Stafford Disaster Relief and Emergency Assistance Act as amended, 42 U.S.C. § 5121 -5207 and Reorganization Plan No. 3
of 1978; 4 U.S.C. §§ 2904 and 2906; 4 C.F.R. § 206.2(a)(27); the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (Pub. L.
104-193) and Executive Order 13411. DHS asks for your SSN pursuant to the Debt Collection Improvement Act of 1996, 31 U.S.C. § 3325(d) and § 7701(c)
(1).
PRINCIPAL PURPOSE(S): This information is being collected for the primary purpose of determining eligibility and administering financial assistance under
a Presidentially-declared disaster. Additionally, information may be reviewed internally within FEMA for quality control purposes.
ROUTINE USE(S): 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.
This includes using this information as necessary and authorized by the routine uses published in DHS/FEMA - 008 Disaster Recovery Assistance Files
System of Records (September 24, 2009, 74 FR 48763) and upon written request, by agreement, or as required by law.
DISCLOSURE: Furnishing this information is voluntary; however, failure to furnish the requested may delay or prevent the individual from receiving disaster
assistance.
PAPERWORK BURDEN DISCLOSURE NOTICE
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. 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, 1800 South Bell Street, Arlington, VA 20598-3005,
Paperwork Reduction Project (1660-0061) NOTE: Do not send your completed form to this address.

STATE'S SELECTION AND LINE ITEM MAXIMUM
The State of

selects the following administrative option for the

administration of the Other Needs Assistance provision of the Individuals and Households Program:
FEMA Option: FEMA Administers & Processes.
JOINT Option: State Administers & FEMA Participates:
FEMA Processing System Auto-determination ON
FEMA Processing System Auto-determination OFF
STATE Option: State Administers & Processes.
The State approves the following line item amounts to be awarded for ONA:
Transportation Repair:

$

Transportation Replace (Total loss)

$

Funeral Maximum (Unmet Need):

$

The State approves the additional ONA Personal Property and/or Miscellaneous items. Attached is the list of
additional items, the justification, and situations for use.
This administrative option is agreed upon by:

FEMA AUTHORIZING SIGNATURE

STATE AUTHORIZING SIGNATURE

Governor or Designee
FEMA Form 010-0-11

DATE

Regional Administrator or Designee

DATE

SUMMARY OF THE ADMINISTRATIVE OPTIONS
FEMA OPTION: Under this option, FEMA will be the administrator of Other Needs Assistance. The state shall coordinate ONA activities
with FEMA. FEMA shall be responsible for functional elements 1 through 10.
JOINT OPTION: Under this option, the state will be the administrator of Other Needs Assistance. FEMA shall participate in providing ONA
with the state. FEMA shall be responsible for functional elements 1,2,3,& 8. The state shall be responsible for functional elements
4,5,6,7,9, & 10.
STATE OPTION: Under this option, the state will be the administrator of Other Needs Assistance. The state shall report ONA activities to
FEMA. The state shall be responsible for functional elements 1 through 10.
DESCRIPTION OF FUNCTIONAL ELEMENTS
This section explains the 10 functional elements that must be addressed to successfully implement the Other Needs Assistance mission.
Functional Element 1:
Registration Intake is a systematic procedure for accepting applications (Application/Registration for Disaster
Assistance FEMA Form 90-69) from disaster victims who are in need of Federal disaster assistance. The Procedures must provide for the
acceptance of late applications, up to the prescribed time limitation as described in 44 CFR 206.112.
Functional Element 2:
Inspection Services is a standard procedure for inspecting and verifying individually reported disaster-related
damages, which will be used to determine the level of Federal disaster assistance.
Functional Element 3:
Processing System is a prearranged procedure for making uniformed eligibility determinations, to include
methods for determining cost for personal property and tracking eligibility decisions.
Functional Element 4:

Disbursing Awards is a set procedure for issuing funds to applicants.

Functional Element 5:
Staffing includes the responsibility for having adequate space and an appropriate number of trained personnel.
It also includes the responsibility for having appropriate equipment necessary to process assistance (i.e. computers, phones and facsimile
machines).
Functional Element 6:

Recovery of Funds is an arranged procedure for collecting erroneously awarded funds.

Functional Element 7:

Case Processing is a standard system to process applications and respond to applicant inquiries.

Functional Element 8:

Mail Processing is a standard procedure for sending program decisions and receiving incoming mail.

Functional Element 9:

Appeals is an official protocol for evaluating an applicant request to have a program decision reviewed.

Functional Element 10: Preparation of Closeout Material involves the preparation of the narrative and statistical documents that
compromise a model closeout package. The duties of this function include ensuring that there are no cases pending and that all funds are
reconciled for grants and reimbursement of state expense.
Auto-Determination is the process of allowing the NEMIS business rules to routinely process information received from registrations and
inspections and make an eligibility determination without manual intervention.

ADDITIONAL ONA ITEMS
If the state is requesting additional ONA Personal Property, Essential Tools, and/or Miscellaneous items, list the additional items below,
provide the justification, and situation for use.

Line Item:

ONA Category:

Standard Quantity:

Maximum Quantity Awarded:

Justification/Situations for Use:

FEMA USE ONLY

Approved

Initial

Not Approved

Initial

Line Item:

ONA Category:

Standard Quantity:

Maximum Quantity Awarded:

Justification/Situations for Use:

FEMA USE ONLY

Approved

Initial

Not Approved

Initial

Line Item:

ONA Category:

Standard Quantity:

Maximum Quantity Awarded:

Justification/Situations for Use:

FEMA USE ONLY

Approved

Initial

Not Approved

Initial

Line Item:

ONA Category:

Standard Quantity:

Maximum Quantity Awarded:

Justification/Situations for Use:

FEMA USE ONLY

Approved

Initial

Not Approved

Initial