FEMA Form 070-0-0- National Fire Department Census

National Fire Department Census Survey

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USFA Home > Fire Service > National Fire Department Census > Survey

National Fire Department Census Survey
O.M.B. No. 1660-0070 Expires June 30, 2012
Required fields are marked with an *

Survey Completed By
1. Name *

2. Phone Number *

 555-555-5555

3. Fax Number

 555-555-5555

4. Email Address *

Fire Department Information
5. Fire Department ID

12345

6. Name *

7. Headquarters Address *

9. City *

10. State

Pennsylvania

11. Zip Code *

 12345-1234

12. County *

13. Mailing Address

15. PO Box

PO Box

16. City *

17. State *

https://www.usfa.fema.gov/applications/census/survey.cfm[10/13/2011 11:53:15 AM]

National Fire Department Census Survey

18. Zip Code *

 12345-1234

19. HQ Phone *

 555-555-5555

20. HQ Fax

 555-555-5555

21. E-mail

22. Website

23. Number of Stations *

24. Organization Type: *

Local (includes career, combination, and volunteer)
State Government
Transportation Authority or Airport F.D.
Federal Government - Executive Branch Agency
Federal Government - DOD
Private or industrial fire brigade
Contract fire department
Other
Unknown

25. Is your fire department the primary agency responsible for community Emergency Management (EM)?: *

Yes
No
If No, then what agency is the primary agency responsible for emergency management in your community?

Emergency Management (EM) - Integration and coordination of all-hazards mitigation, prevention,
preparedness, response, and recovery activities within a community for all (or most) agencies such as fire,
EMS, public works, public information, volunteer service, etc.

26. Population Protected: *

 (no commas, please)
Provide the total permanent resident population protected by your department

27. Source of information: *

U.S. Census
Estimate
Other
Unknown

28. Area Protected: *

 Square Miles (no commas, please)
Provide an estimate of the total primary response area in square miles protected by your department.

Staff  (numeric values only with no commas)
29. Active Firefighters:

Career(s) *

Volunteer(s) *

Paid per Call(s) *

32. Non Firefighting:

Civilian Employee(s) *

https://www.usfa.fema.gov/applications/census/survey.cfm[10/13/2011 11:53:15 AM]

National Fire Department Census Survey

Non Firefighting Volunteer(s) *

Specialized Services Provided (check all that apply)
34. Specialized Services

Wildfire/Urban-Wildland

Vehicle Extraction

Airport/Aviation
Fireboat

Technical Rescue
Fire Inspection/Code Enforce

EMS transport
EMS Non transport

Fire Prevention/Pub Ed.
Training Academy

Basic Life Support
Advanced Life Support

Fire Investigation
Sworn

HAZMAT Team (Technician)

Juvenile Firestarter

United States Fire Administration Programs
35. Is your fire department familiar with United States Fire Administration programs and publications? *

Yes
No

If yes, How? (check all that apply)

Web Site http://www.usfa.dhs.gov/
Publications
National Fire Academy Courses
National Fire Incident Reporting System (NFIRS)
Public Fire Education Programs
Other

Additional Station Addresses
36. Additional Station Addresses

If you entered a number greater than 1 in Question 23, would you like to provide additional station
addresses?
Yes
No

Next »

Paperwork Burden Disclosure Notice
Public reporting burden for this data collection is estimated to average 25 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
survey. You are not required to respond to this collection of information unless a valid OMB control number is displayed on this survey. 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, Washington, DC 20472,
Paperwork Reduction Project (1660-0070) NOTE: Do not send your completed form to this address.
FEMA FORM 75-100

Census Last Updated: October 13, 2011
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U.S. Fire Administration, 16825 S. Seton Ave., Emmitsburg, MD 21727 | USNG: 18SUJ00529652
(301) 447-1000
Fax: (301) 447-1346
Admissions Fax: (301) 447-1441

https://www.usfa.fema.gov/applications/census/survey.cfm[10/13/2011 11:53:15 AM]

Contact Us

National Fire Department Census Survey

https://www.usfa.fema.gov/applications/census/survey.cfm[10/13/2011 11:53:15 AM]