OMB No.: 1660-0054 Expiration Date: December 31 2012
BURDEN DISCLOSURE NOTICE
FEMA FORM 080-0-3a
Public reporting burden for this form is estimated to average 2.5 hours 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 the form. This collection of information is required to obtain or retain benefits. You are not required to respond to this collection of information unless it displays a valid OMB control number. 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 (1660-1660-0054) NOTE: Do not send your completed form to this address.
You may apply for up to three projects. You must answer all of the project specific questions and specify at least one budget item. The cost figures you provide do not have to be firm quotes from your vendors, but they should be estimated based on research of current prices (i.e., check with at least two vendors for your estimates) before you list your estimated costs. Only whole dollar amounts should be provided (no cents please).
Note: Fields marked with an * are required.
*Select one of the choices listed below. You can apply for a maximum of 3 projects within the Fire Prevention activity. For each additional project, you will need to answer another set of questions. |
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Category |
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General Education Awareness (answer questions below) |
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Code Enforcement/Awareness (answer questions starting on page 17) |
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Fire & Arson Investigation (answer questions starting on page 22) |
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National/State/Regional Programs and Studies (answer questions starting on page 27) |
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In order to help identify what your organization’s current fire prevention and life safety education capabilities are, please answer the following questions. Please be sure to only address your current capabilities; you will answer questions about the proposed project(s) that your application is requesting after completing this section. |
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* 1. Do you currently have a fire prevention and life safety education program? |
○Yes ○No (skip questions below and proceed to page 10) |
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1a. If yes, check all that apply. |
○ Smoke alarm education ○ Smoke alarm distribution ○ Smoke alarm installation ○ Residential sprinklers ○ Fire extinguishers ○ Fire escape planning ○ Burn prevention ○ Juvenile firesetting ○ Disaster preparedness ○ In-school programming ○ Community CPR/first aid ○ Fall prevention ○ Home inspections ○ Other_____________________________ |
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2. For the above selected programs, how it is implemented? Check all that apply. |
○ Door to Door ○ Public advertisement (i.e., media) ○ School visits ○ Brochures/handouts ○ Open Houses ○ Fairs and festivals ○ Local civic organizations ○ Partnerships ○ Other_____________________________ |
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3. Is/are your program(s) targeted at a specific group? |
○ Yes ○ No |
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(continued from previous page)
3a. If yes, check all that apply. |
○ Adults over 65 ○ Children under 14 ○ College/university housing ○ People with disabilities ○ Low-income families, neighborhoods ○ Firefighters ○ Geographic area ○ Other __________________________ |
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4. Does your program address a specific problem? |
○ Yes ○ No |
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4a. If yes, check all that apply |
○ Wildland ○ Community hazard ○ Residential fire issues ○ Arson/criminal activity ○ Carbon monoxide ○ Other __________________________ |
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5. On average, what is the total number of hours of fire prevention and life safety education programs conducted monthly by your organization? |
○ Less than 20 hours ○ Between 20 – 29 hours ○ Between 30 – 39 hours ○ Between 40 – 49 hours ○ 50 hours or more |
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6. Do you evaluate your existing fire prevention and life safety education programs? |
○ Yes ○ No |
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6a. If yes, then how? Check all that apply. |
○ Count/contacts/outputs ○ Pre and post testing ○ Fire data analysis ○ Injury/loss statistics ○ Surveys ○ Other___________________ |
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7. Does your fire prevention and life safety education program have a dedicated coordinator? |
○ Yes ○ No |
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7a. If yes, is that person certified to a recognized state or national standard? |
○ Yes ○ No |
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7b. If no, will you be requesting funds to hire and/or certify a dedicated coordinator in your grant request? |
○ Yes ○ No |
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General Education/Awareness (continued)
You will now answer questions and provide a narrative statement based on your proposed General Education/Awareness project. Even if you answered No to question 1, answer the questions below.
Note: Fields marked with an * are required.
* 1. Project (select one): |
○ Smoke Alarm (skip questions below and answer questions on page 13) ○ Sprinkler Awareness ○ Public Education ○ Training ○ General Prevention/Awareness ○ Wildland Fire Prevention Programs ○ Risk Assessments ○ Juvenile Firesetter Program ○ Other |
* If you selected Other, above, please specify |
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* 2. Who is the target audience for the planned project? |
○ Children under 14 ○ Adults over 65 ○ Firefighters ○ High risk group ○ Other (explain) _____________________ |
* 3. What is your estimated size of the target audience? |
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* 4. How was this target audience determined? |
○ Formal Assessment ○ Informal Assessment ○ Will Be Conducting Assessment ○ None of the above |
If none of the above, briefly describe the method used to determine target audience. (maximum 800 characters, attach additional sheet if necessary) |
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*5. In the space provided below, please explain your experience and ability in developing and conducting (i.e., timely and satisfactory project completion) past fire prevention and safety projects. Additionally, please demonstrate the experience and expertise you have in managing the type of project you are proposing: (maximum 2,000 characters, attach additional sheet if necessary) |
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6. The narrative portion of the application should contain supporting information that allows for evaluation of this project. If you are applying for a grant in the Fire Prevention and Safety Activity, your Narrative Statement must address the evaluation elements as outlined in the FY2011 Program Guidance. Keep in mind that the evaluation of your application will also be based on a clear understanding of your proposal, your ability to meet the objectives of the program, and your probability of successfully delivering your project to the population targeted. You need to fully explain how the funds will be used to accomplish the goals of your project. To that end, be sure to include descriptions/justification for all budgeted items - items not justified may be disallowed. Your narrative is broken out into 6 separate sections. Each section will address each of the criteria which your application will be evaluated and scored. Images and special characters of formatting (i.e.: quote marks, bold print, bullet points, symbols, etc.) are not allowed. |
*6a. Vulnerability Statement: What is the vulnerability in your community that you have identified? What statistics correspond with and support your project and target audience? Please describe the steps which were taken to determine the vulnerability and target audience and describe the methodology for determining all of the above. (maximum 5,000 characters, attach additional sheet if necessary) |
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*6b. Implementation Plan: Provide details on the implementation plan which discusses the proposed project’s goals and objectives. What are the methods and specific steps that will be used to achieve the goals and objectives? If applicable, what examples can you provide of marketing efforts to promote the project? Who will deliver the project and what partnerships may be involved? How will the materials or deliverables be distributed? (maximum 5,000 characters, attach additional sheet if necessary) |
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(continued on next page)
*6c. Evaluation Plan: Will the proposed project be periodically evaluated for its impact on the community? If yes, describe the methodology and steps you plan to take in order to conduct the evaluation. (maximum 5,000 characters, attach additional sheet if necessary) |
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*6d. Cost Benefit: Does your project demonstrate a high benefit for the cost incurred? Are the costs associated with the project are reasonable for the target audience that will be reached? If so, demonstrate the above in addition to the cost benefits and how you plan to maximize the level of funding that goes directly into the delivery of the project. (maximum 2,500 characters, attach additional sheet if necessary) |
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*6e. Sustainability: Is it your organization’s intent to deliver this program after the grant performance period? If so, how will the overall activity be sustained and what are the long-term benefits? Examples of sustainable projects can be illustrated through the long-term benefits derived from the delivery of the project, the presence of non-federal partners likely to continue the effort, or the demonstrated long-term commitment of the applicant. (maximum 2,500 characters, attach additional sheet if necessary) |
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6f. Additional Comments: If you have any additional comments about your project, please provide them here. (maximum 3,000 characters, attach additional sheet if necessary) |
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Only answer these questions if you are applying for a Smoke Alarm Campaign under General Education/Awareness. To add a Budget Item for General Education/Awareness, proceed to page 16.
Note: Fields marked with an * are required.
You will now answer questions and provide a narrative statement based on your proposed General Education/Awareness Smoke Alarm project. |
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* 1. Project |
Smoke Alarm Campaign |
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*2. Who is the target audience for the planned project? |
○ Children under 14 ○ Adults over 65 ○ Firefighters ○ High risk group ○ Other (explain) _____________________ |
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* 3. What is your estimated size of the target audience? (whole numbers only) |
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* 4. How was this target audience determined? |
○ Formal Assessment ○ Informal Assessment ○ Will Be Conducting Assessment ○ None of the above |
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If None of the above, briefly describe the method used to determine target audience. (maximum 800 characters, attach additional sheet if necessary) |
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* 5. Will you install the alarms? |
○ Yes ○ No |
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If no, describe the plan to ensure the alarms will be installed: (maximum 800 characters, attach additional sheet if necessary) |
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* 6. Describe the type of alarms that will be installed and the rationale for this selection: (maximum 800 characters, attach additional sheet if necessary) |
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*7. In the space provided below, please explain your experience and ability in developing and conducting (i.e., timely and satisfactory project completion) past fire prevention and safety projects. Additionally, please demonstrate the experience and expertise you have in managing the type of project you are proposing: (maximum 2,500 characters, attach additional sheet if necessary) |
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8. The narrative portion of the application should contain supporting information that allows for evaluation of this project. If you are applying for a grant in the Fire Prevention and Safety Activity, your Narrative Statement must address the evaluation elements as outlined in the FY2011 Program Guidance. Keep in mind that the evaluation of your application will also be based on a clear understanding of your proposal, your ability to meet the objectives of the program, and your probability of successfully delivering your project to the population targeted. You need to fully explain how the funds will be used to accomplish the goals of your project. To that end, be sure to include descriptions/justification for all budgeted items - items not justified may be disallowed. Your narrative is broken out into 6 separate sections. Each section will address each of the criteria which your application will be evaluated and scored. Images and special characters of formatting (i.e.: quote marks, bold print, bullet points, symbols, etc.) are not allowed. |
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*8a. Vulnerability Statement : What is the vulnerability in your community that you have identified? What statistics correspond with and support your project and target audience? Please describe the steps which were taken to determine the vulnerability and target audience and describe the methodology for determining all of the above. (maximum 5,000 characters, attach additional sheet if necessary) |
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*8b. Implementation Plan: Provide details on the implementation plan which discusses the proposed project’s goals and objectives. What are the methods and specific steps that will be used to achieve the goals and objectives? If applicable, what examples can you provide of marketing efforts to promote the project? Who will deliver the project and what partnerships may be involved? How will the materials or deliverables be distributed? (maximum 5,000 characters, attach additional sheet if necessary) |
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(continued on next page)
*8c. Evaluation Plan: Will the proposed project be periodically evaluated for its impact on the community? If yes, describe the methodology and steps you plan to take in order to conduct the evaluation. (maximum 5,000 characters, attach additional sheet if necessary) |
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*8d. Cost Benefit: Does your project demonstrate a high benefit for the cost incurred? Are the costs associated with the project are reasonable for the target audience that will be reached? If so, demonstrate the above in addition to the cost benefits and how you plan to maximize the level of funding that goes directly into the delivery of the project. (maximum 2,500 characters, attach additional sheet if necessary) |
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*8e. Sustainability: Is it your organization’s intent to deliver this program after the grant performance period? If so, how will the overall activity be sustained and what are the long-term benefits? Examples of sustainable projects can be illustrated through the long-term benefits derived from the delivery of the project, the presence of non-federal partners likely to continue the effort, or the demonstrated long-term commitment of the applicant. (maximum 2,500 characters, attach additional sheet if necessary) |
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8f. Additional Comments: If you have any additional comments about your project, please provide them here. (maximum 3,000 characters, attach additional sheet if necessary) |
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Please provide the following information about the program you want funded. You must have at least one budget item for each project.
Note: For each budget item, attach an additional sheet.
Note: Fields marked with an * are required.
* Item: |
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Select Object Class: (see page 6 for definitions) |
○ Personnel ○ Fringe Benefits ○ Travel ○ Equipment ○ Supplies ○ Contractual ○ Construction ○ Indirect Charges ○ Other |
If you selected “Other” above, please specify: |
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* Number of units: (whole number only) |
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* Cost per unit: (whole dollar amounts only) |
$ |
Description The space to the right should be used to provide further clarification on the costs (i.e. personnel costs: number of hours/rate/staff; or meeting costs: number of meetings/days/attendees; travel costs, etc.) and types of items that you are requesting. Budget justification should be included in the project narrative. (maximum 800 characters, attach additional sheet if necessary) |
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Please answer these questions only if you are applying for a Code Enforcement/Awareness project. For all other Fire Prevention projects, see page 8. For Research and Development projects, see page 33.
Note: Fields marked with an * are required.
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Category |
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Code Enforcement/Awareness |
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In order to help identify what your organization’s current Code Enforcement/Awareness capabilities are, please answer the following questions. Please be sure to only address your current capabilities; you will answer questions about the proposed project(s) that your application is requesting after completing this section. |
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* 1. What nationally recognized building and fire code(s) and editions has your community adopted? Check all that apply. |
○ N/A (proceed to questions on page 17) |
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○ NFPA (cite editions):
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○ ICC (cite editions):
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○ State:
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○ Local:
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○ Other:
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2. What tools are used to support and enforce inspections? Check all that apply. |
○ Code books ○ Regular inspection cycle ○ Educated staff ○ Other_____________________________ |
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3. Does your jurisdiction enforce adopted building and/or fire codes on new construction? |
○ Yes ○ No |
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4. Does your jurisdiction enforce adopted building and/or fire codes on existing construction? |
○ Yes ○ No |
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5. Are those individuals assigned to conduct inspections certified? |
○ Yes ○ No |
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5a. If yes, to what level? |
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5b. If no, will you be requesting funds for training in your grant request? |
○ Yes ○ No |
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6. Does your jurisdiction measure its code enforcement efforts? |
○ Yes ○ No |
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6a. If yes, then how? Check all that apply. |
○ Count ○ Number of violations ○ Violations corrected ○ Fire data analysis ○ Other___________________ |
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7. Does your jurisdiction inspect all commercial and high risk properties? |
○ Commercial ○ High-risk ○ Both ○ Neither |
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You will now answer questions and provide a narrative statement based on your proposed Code Enforcement/Awareness project. If you have multiple Code Enforcement/Awareness projects, use separate sheets of paper for each.
Note: Fields marked with an * are required.
Code Enforcement/Awareness Project Information |
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* 1. Project |
Code Enforcement/Awareness |
If you are submitting more than one Code Enforcement/Awareness project, please provide a project title (i.e.: commercial inspections, update code books, etc). |
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* 2. Who is the target audience for the planned project? |
○ Children under 14 ○ Adults over 65 ○ Firefighters ○ High risk group ○ Other (explain) _____________________ |
* 3. What is your estimated size of the target audience? (whole numbers only) |
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* 4. How was this target audience determined? |
○ Formal Assessment ○ Informal Assessment ○ Will Be Conducting Assessment ○ None of the above |
Briefly describe method used (required if selected other than “None of the above” above) (maximum 800 characters, attach additional sheet if necessary) |
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*5. In the space provided below, please explain your experience and ability in developing and conducting (i.e., timely and satisfactory project completion) past fire prevention and safety projects. Additionally, please demonstrate the experience and expertise you have in managing the type of project you are proposing: (maximum 2,000 characters, attach additional sheet if necessary) |
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(continued on next page)
6. The narrative portion of the application should contain supporting information that allows for evaluation of this project. If you are applying for a grant in the Fire Prevention and Safety Activity, your Narrative Statement must address the evaluation elements as outlined in the FY2011 Program Guidance. Keep in mind that the evaluation of your application will also be based on a clear understanding of your proposal, your ability to meet the objectives of the program, and your probability of successfully delivering your project to the population targeted. You need to fully explain how the funds will be used to accomplish the goals of your project. To that end, be sure to include descriptions/justification for all budgeted items - items not justified may be disallowed. Your narrative is broken out into 6 separate sections. Each section will address each of the criteria which your application will be evaluated and scored. Images and special characters of formatting (i.e.: quote marks, bold print, bullet points, symbols, etc.) are not allowed. |
*6a. Vulnerability Statement : What is the vulnerability in your community that you have identified? What statistics correspond with and support your project and target audience? Please describe the steps which were taken to determine the vulnerability and target audience and describe the methodology for determining all of the above. (maximum 5,000 characters, attach additional sheet if necessary) |
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*6b. Implementation Plan: Provide details on the implementation plan which discusses the proposed project’s goals and objectives. What are the methods and specific steps that will be used to achieve the goals and objectives? If applicable, what examples can you provide of marketing efforts to promote the project? Who will deliver the project and what partnerships may be involved? How will the materials or deliverables be distributed? (maximum 5,000 characters, attach additional sheet if necessary) |
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(continued on next page)
*6c. Evaluation Plan: Will the proposed project be periodically evaluated for its impact on the community? If yes, describe the methodology and steps you plan to take in order to conduct the evaluation. (maximum 5,000 characters, attach additional sheet if necessary) |
|
*6d. Cost Benefit: Does your project demonstrate a high benefit for the cost incurred? Are the costs associated with the project are reasonable for the target audience that will be reached? If so, demonstrate the above in addition to the cost benefits and how you plan to maximize the level of funding that goes directly into the delivery of the project. (maximum 2,500 characters, attach additional sheet if necessary) |
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*6e. Sustainability: Is it your organization’s intent to deliver this program after the grant performance period? If so, how will the overall activity be sustained and what are the long-term benefits? Examples of sustainable projects can be illustrated through the long-term benefits derived from the delivery of the project, the presence of non-federal partners likely to continue the effort, or the demonstrated long-term commitment of the applicant. (maximum 2,500 characters, attach additional sheet if necessary) |
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6f. Additional Comments: If you have any additional comments about your project, please provide them here. (maximum 3,000 characters, attach additional sheet if necessary) |
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Please provide the following information about the program you want funded. You must have at least one budget item for each project.
Note: For each budget item, attach an additional sheet.
Note: Fields marked with an * are required.
* Item: |
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Select Object Class: (see page 6 for definitions) |
○ Personnel ○ Fringe Benefits ○ Travel ○ Equipment ○ Supplies ○ Contractual ○ Construction ○ Indirect Charges ○ Other |
If you selected “Other” above, please specify: |
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* Number of units: (whole number only) |
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* Cost per unit: (whole dollar amounts only) |
$ |
Description: The space to the right can be used to provide further clarification on the costs (i.e. personnel costs: number of hours/rate/staff; or meeting costs: number of meetings/days/attendees; travel costs, etc.) and types of items that you are requesting. Budget justification should be included in the project narrative. (maximum 800 characters, attach additional sheet if necessary) |
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Please answer these questions only if you are applying for a Fire & Arson Investigation project. For all other Fire Prevention projects, see page 8. For Research and Development projects, see page 33.
Note: Fields marked with an * are required.
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Category |
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Fire & Arson Investigation Capabilities |
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In order to help identify what your organization’s current Fire & Arson Investigation capabilities are, please answer the following questions. Please be sure to only address your current capabilities; you will answer questions about the proposed project(s) that your application is requesting after completing this section. |
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* 1. Do you investigate every fire beyond origin and cause? |
○ Yes ○ No (if no, skip to page 23) |
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2. Are those assigned to conduct fire investigations certified? |
○ Yes ○ No |
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2a. If yes, to what level? |
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2b. If no, will you be requesting funds for training in your grant request? |
○ Yes ○ No |
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3. Does your jurisdiction measure its fire investigations/arson enforcement efforts? |
○ Yes ○ No |
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3a. If yes, then how? Check all that apply: |
○ Number of investigations ○ Number of prosecutions ○ Number of convictions ○ Other___________________ |
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You will now answer questions and provide a narrative statement based on your proposed Fire & Arson Investigation project.
Note: Fields marked with an * are required.
Fire & Arson Investigation Project Information |
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* 1. Project |
Fire & Arson Investigation |
If you are submitting more than one Fire & Arson Investigation project, please provide a project title (i.e.: commercial inspections, update code books, etc). |
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* 2. Who is the target audience for the planned project? |
○ Children under 14 ○ Adults over 65 ○ Firefighters ○ High risk group ○ Other (explain) _____________________ |
* 3. What is your estimated size of the target audience? (whole numbers only) |
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* 4. How was this target audience determined? |
○ Formal Assessment ○ Informal Assessment ○ Will Be Conducting Assessment ○ None of the above |
Briefly describe method used (required if selected other than “None of the above” above) (maximum 800 characters, attach additional sheet if necessary) |
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*5. In the space provided below, please explain your experience and ability in developing and conducting (i.e., timely and satisfactory project completion) past fire prevention and safety projects. Additionally, please demonstrate the experience and expertise you have in managing the type of project you are proposing: (maximum 2,000 characters, attach additional sheet if necessary) |
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(continued on next page)
6. The narrative portion of the application should contain supporting information that allows for evaluation of this project. If you are applying for a grant in the Fire Prevention and Safety Activity, your Narrative Statement must address the evaluation elements as outlined in the FY2011 Program Guidance. Keep in mind that the evaluation of your application will also be based on a clear understanding of your proposal, your ability to meet the objectives of the program, and your probability of successfully delivering your project to the population targeted. You need to fully explain how the funds will be used to accomplish the goals of your project. To that end, be sure to include descriptions/justification for all budgeted items - items not justified may be disallowed. Your narrative is broken out into 6 separate sections. Each section will address each of the criteria which your application will be evaluated and scored. Images and special characters of formatting (i.e.: quote marks, bold print, bullet points, symbols, etc.) are not allowed. |
*6a. Vulnerability Statement : What is the vulnerability in your community that you have identified? What statistics correspond with and support your project and target audience? Please describe the steps which were taken to determine the vulnerability and target audience and describe the methodology for determining all of the above. (maximum 5,000 characters, attach additional sheet if necessary) |
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*6b. Implementation Plan: Provide details on the implementation plan which discusses the proposed project’s goals and objectives. What are the methods and specific steps that will be used to achieve the goals and objectives? If applicable, what examples can you provide of marketing efforts to promote the project? Who will deliver the project and what partnerships may be involved? How will the materials or deliverables be distributed? (maximum 5,000 characters, attach additional sheet if necessary) |
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(continued on next page)
*6c. Evaluation Plan: Will the proposed project be periodically evaluated for its impact on the community? If yes, describe the methodology and steps you plan to take in order to conduct the evaluation. (maximum 5,000 characters, attach additional sheet if necessary) |
|
*6d. Cost Benefit: Does your project demonstrate a high benefit for the cost incurred? Are the costs associated with the project are reasonable for the target audience that will be reached? If so, demonstrate the above in addition to the cost benefits and how you plan to maximize the level of funding that goes directly into the delivery of the project. (maximum 2,500 characters, attach additional sheet if necessary) |
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*6e. Sustainability: Is it your organization’s intent to deliver this program after the grant performance period? If so, how will the overall activity be sustained and what are the long-term benefits? Examples of sustainable projects can be illustrated through the long-term benefits derived from the delivery of the project, the presence of non-federal partners likely to continue the effort, or the demonstrated long-term commitment of the applicant. (maximum 2,500 characters, attach additional sheet if necessary) |
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6f. Additional Comments: If you have any additional comments about your project, please provide them here. (maximum 3,000 characters, attach additional sheet if necessary) |
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Please provide the following information about the program you want funded. You must have at least one budget item for each project.
Note: For each budget item, attach an additional sheet.
Note: Fields marked with an * are required.
* Item: |
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Select Object Class: (see page 6 for definitions) |
○ Personnel ○ Fringe Benefits ○ Travel ○ Equipment ○ Supplies ○ Contractual ○ Construction ○ Indirect Charges ○ Other |
If you selected “Other” above, please specify: |
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* Number of units: (whole number only) |
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* Cost per unit: (whole dollar amounts only) |
$ |
Description: The space to the right can be used to provide further clarification on the costs (i.e. personnel costs: number of hours/rate/staff; or meeting costs: number of meetings/days/attendees; travel costs, etc.) and types of items that you are requesting. Budget justification should be included in the project narrative. (maximum 800 characters, attach additional sheet if necessary) |
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Note: Fields marked with an * are required.
National/State/Regional Programs and Studies Project Information |
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* 1. Project |
○ Firefighter Safety ○ Other |
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* If you selected Other, above, please specify. |
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* 2. Who is the target audience for the planned project? |
○ Children under 14 ○ Adults over 65 ○ Firefighters ○ High risk group ○ Other (explain) _____________________ |
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* 3. What is your estimated size of the target audience? (whole numbers only) |
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* 4. How was this target audience determined? |
○ Formal Assessment ○ Informal Assessment ○ Will Be Conducting Assessment ○ None of the above |
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Briefly describe method used (required if selected other than “None of the above” above) (maximum 800 characters, attach additional sheet if necessary) |
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*5. In the space provided below, please explain your experience and ability in developing and conducting (i.e., timely and satisfactory project completion) past fire prevention and safety projects. Additionally, please demonstrate the experience and expertise you have in managing the type of project you are proposing: (maximum 2,000 characters, attach additional sheet if necessary) |
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(continued on next page)
6. The narrative portion of the application should contain supporting information that allows for evaluation of this project. If you are applying for a grant in the Fire Prevention and Safety Activity, your Narrative Statement must address the evaluation elements as outlined in the FY2011 Program Guidance. Keep in mind that the evaluation of your application will also be based on a clear understanding of your proposal, your ability to meet the objectives of the program, and your probability of successfully delivering your project to the population targeted. You need to fully explain how the funds will be used to accomplish the goals of your project. To that end, be sure to include descriptions/justification for all budgeted items - items not justified may be disallowed. Your narrative is broken out into 6 separate sections. Each section will address each of the criteria which your application will be evaluated and scored. Images and special characters of formatting (i.e.: quote marks, bold print, bullet points, symbols, etc.) are not allowed. |
*6a. Vulnerability Statement: What is the vulnerability in your community that you have identified? What statistics correspond with and support your project and target audience? Please describe the steps which were taken to determine the vulnerability and target audience and describe the methodology for determining all of the above. (maximum 5,000 characters, attach additional sheet if necessary) |
|
*6b. Implementation Plan: Provide details on the implementation plan which discusses the proposed project’s goals and objectives. What are the methods and specific steps that will be used to achieve the goals and objectives? If applicable, what examples can you provide of marketing efforts to promote the project? Who will deliver the project and what partnerships may be involved? How will the materials or deliverables be distributed? (maximum 5,000 characters, attach additional sheet if necessary) |
|
(continued on next page)
*6c. Evaluation Plan: Will the proposed project be periodically evaluated for its impact on the community? If yes, describe the methodology and steps you plan to take in order to conduct the evaluation. (maximum 5,000 characters, attach additional sheet if necessary) |
|
*6d. Cost Benefit: Does your project demonstrate a high benefit for the cost incurred? Are the costs associated with the project are reasonable for the target audience that will be reached? If so, demonstrate the above in addition to the cost benefits and how you plan to maximize the level of funding that goes directly into the delivery of the project. (maximum 2,500 characters, attach additional sheet if necessary) |
|
*6e. Sustainability: Is it your organization’s intent to deliver this program after the grant performance period? If so, how will the overall activity be sustained and what are the long-term benefits? Examples of sustainable projects can be illustrated through the long-term benefits derived from the delivery of the project, the presence of non-federal partners likely to continue the effort, or the demonstrated long-term commitment of the applicant. (maximum 2,500 characters, attach additional sheet if necessary) |
|
6f. Additional Comments: If you have any additional comments about your project, please provide them here. (maximum 3,000 characters, attach additional sheet if necessary) |
|
Please provide the following information about the program you want funded. You must have at least one budget item for each project.
Note: For each budget item, attach an additional sheet.
Note: Fields marked with an * are required.
* Item: |
|
Select Object Class: (see page 6 for definitions) |
○ Personnel ○ Fringe Benefits ○ Travel ○ Equipment ○ Supplies ○ Contractual ○ Construction ○ Indirect Charges ○ Other |
If you selected “Other” above, please specify: |
|
* Number of units: (whole number only) |
|
* Cost per unit: (whole dollar amounts only) |
$ |
Description: The space to the right can be used to provide further clarification on the costs (i.e. personnel costs: number of hours/rate/staff; or meeting costs: number of meetings/days/attendees; travel costs, etc.) and types of items that you are requesting. Budget justification should be included in the project narrative. (maximum 800 characters, attach additional sheet if necessary) |
|
Please total the individual budget items on the previous pages.
Note: Fields marked with an * are required.
Budget Object Class |
|
|
Budget Amount |
Personnel |
$ |
Benefits |
$ |
Travel |
$ |
Equipment |
$ |
Supplies |
$ |
Contractual |
$ |
Construction |
$ |
Other |
$ |
Indirect Charges |
$ |
Indirect Cost Details (complete this section only if you have a Federally approved Indirect Cost Rate agreement). Please note you must add the Indirect Costs as a line item within the Request Details section as they are not automatically calculated. |
|
Agency Indirect Cost Agreement with |
|
Indirect Cost Rate (whole numbers only) |
% |
Agreement Summary (attach an additional sheet if necessary) |
|
Total Federal and Applicant Share |
|
Federal Share |
$ |
Applicant Share |
$ 0 |
Federal Rate Sharing (%) |
100/0 |
(continued on next page)
(continued from previous page)
* Non-Federal Resources (The combined Non-Federal Resources must equal the Applicant Share) |
|
a. Applicant: (whole dollar amounts only) |
$ |
b. State: (whole dollar amounts only) |
$ |
c. Local: (whole dollar amounts only) |
$ |
d. Other Sources: (whole dollar amounts only) |
$ |
If you entered a value in Other Sources other than zero (0), include your explanation below. You can use this space to provide information on the project, cost share match, or if you have an indirect cost agreement with a federal agency. |
|
|
|
Total Budget |
$ |
If you are a Fire Department/District or you are not applying for any projects under Research and Development, please go directly to page 40.
FEMA Form 080-0-3a
| File Type | application/msword |
| Author | akroll |
| Last Modified By | ljohnso3 |
| File Modified | 2012-11-28 |
| File Created | 2012-11-28 |