Copy of Application provided to State prior to submission

OMB Number: 1660-0113

Expiration Date: 10/31/2013

FEMA Form Number: None

Paperwork Burden Disclosure Notice

Public reporting burden for this form is estimated to average 10 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 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 (1660-0113) NOTE: Do not send your completed form to this address.

Intergovernmental Review

Is an intergovernmental review required?

Yes No

If yes, applicants must contact their State’s Single Point of Contact (SPOC) to determine if the program has been selected for State review and comply with the State’s process under Executive Order 12372. Names and addresses of the SPOCs are maintained at the Office of Management and Budget’s (OMB’s) home page at http://www.whitehouse.gov/omb/grants_spoc.