Form FEMA Form 90-120 FEMA Form 90-120 Special Consideration Questions

DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY

SPECIAL CONSIDERATION QUESTIONS
APPLICANT

PROJECT NAME

PA ID NO.

PROJECT NO.

O.M.B. NO. 1660-0017
Expires December 31, 2011
DATE

LOCATION

Form must be filledout - for each project.
1. Does the damaged facility or item of work have insurance and/or is it an insurable risk? (e.g., buildings, equipment, vehicles, etc.)
Yes
No
Unsure
Comments
2. Is the damaged facility located within a floodplain or coastal high hazard area/or does ti have an impact on a floodplain or wetland?
Yes
No
Unsure
Comments
3. Is the damaged facility or item of work located within or adjacent to a Coastal Barrier Resource System Unit or an Otherwise Protected rea?
Yes
No
Unsure
Comments
4. Will the proposed facility repairs/reconstruction change the pre-disaster condition? (e.g., footprint, material, location, capacity, use or function)
Yes
No
Unsure
Comments
5. Dose the applicant have a hazard mitigation proposal or would the applicant like technical assistance for a hazard mitigation proposal?
Yes
No
Unsure
Comments
6. Is the damaged facility on the National Register of Historic Places or the state historic listing? Is it older than 50 years? Are there other, sililar
Yes
No
Unsure
buildings near the site?
Comments

7. Are there any pristine or undisturbed areas on, or near, the project site? Are there large tracts of forestland?
Yes
No
Unsure
Comments

8. Are there any hazardous materials at or adjacnt to the damaged facility and/or item of work?
Yes
No
Unsure
Comments

9.Are there any other environmental or controversial issues associated with the damaged facility and/or item of work?
Yes
No
Unsure
Comments

FEMA Form 90-120, FEB 09

PREVIOUS EDITION OBSOLETE

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Public reporting burden for this form is estimated to average 30 minutes per response. The burden estimate includes the time for reviewing
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accuracy of the burden estimate and any suggestions for reducing this burden to: Information Collections Management, Department of
Homeland Security, Federal Emergency Management Agency, 500 C Street, SW, Washington, DC, 20472, Paperwork Reduction Project
(1660-0017). Please do not send your completed survey to the above address.