Form FEMA Form 080-0-4a FEMA Form 080-0-4a Staffing for Adequate Fire and Emergency Response Hiring

OMB No.: 1660-NW78 Expiration Date:

BURDEN DISCLOSURE NOTICE

FEMA Form 080-0-4a

Public reporting burden for this form is estimated to average 7.5 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-NEW) NOTE: Do not send your completed form to this address.

Hiring or Rehiring Activity

Please provide the following additional information regarding your Fire Department. Note: National, State or Local Volunteer Firefighter Interest Organizations are not eligible for this activity.

Note: Fields marked with an * are required.

Hiring Firefighters
*1. Select which line-item below best describes your organization and the NFPA standard you are attempting to meet.
NFPA Requirements
Check One	NFPA Standard (see the Program Guidance for more detail regarding these standards)	Department Characteristics	Demographic		Assembly Staffing	Response Time		Frequency of Time
○	1710	Career	With Aerial		15	8 min		90%
○	1710	Career	Without Aerial		14	8 min		90%
○	1720 - Urban	Urban Combo/Vol	> 1,000 pop/mi2		15	9 min		90%
○	1720 – Suburban	Suburban Combo/Vol	500 – 1,000 pop/mi2		10	10 min		80%
○	1720 – Rural	Rural Combo/Vol	< 500 pop/mi2		6	14 min		80%
○	1720 - Remote	Remote Combo/Vol	Travel > 8 mi		4	n/a		90%
* 2a. In your best estimate, with your current staffing levels and without having to use overtime to fill the vacant positions, how often does your organization meet the NFPA assembly requirements detailed in the table above? Retention Applicants: Answer this question as you would IF the layoff’s had been executed prior to the start of the application period.				○ Never (0%) ○ Rarely (1 - 19%) ○ Sometimes (20 - 39%) ○ Half of the time (40 - 59%) ○ Very often (60 - 79%) ○ Most of the time (80 - 99%) ○ Always (100%)
* 2b. With the additional or restored staffing requested in this application, how often do you anticipate that your organization will meet the NFPA assembly requirements detailed in the table above?				○ Never (0%) ○ Rarely (1 - 19%) ○ Sometimes (20 - 39%) ○ Half of the time (40 - 59%) ○ Very often (60 - 79%) ○ Most of the time (80 - 99%) ○ Always (100%)
* 3a. Given your current staffing levels, without using overtime to fill vacant positions, and given the number of structure fires indicated in the "Department Call Volume" section of your application, what is the average actual staffing level on your first arriving engine company or vehicle capable of initiating suppression activities? (Up to one decimal e.g., 2.5) Retention Applicants: Answer this question as you would IF the layoff’s had been executed prior to the start of the application period. (Up to one decimal e.g., 2.5)

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* 3b. With the additional or restored staffing requested in this application and given the number of structure fires indicated in the "Department Call Volume" box of your application, what will be the average actual staffing level on your first arriving engine company or vehicle capable of initiating suppression activities? (Up to one decimal e.g., 2.5)
* 4. Is your request for hiring firefighters based on a risk analysis and/or a staffing needs analysis?				○ Yes ○ No
If Yes, describe how the analysis was conducted, attach additional sheet if necessary.
* 5. If awarded a grant for hiring additional firefighters, will you provide them with an entry-level physical in accordance with NFPA 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments, 2003 Edition, Chapter 6?		○ Yes, NFPA 1582 compliant ○ No, but will provide other physicals not to NFPA 1582 specifications ○ No
* 6. Do you currently provide annual medical/physical exams in accordance with NFPA 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments 2003 Edition, Chapter 6?		○ Yes, NFPA 1582 compliant ○ No, but will provide other physicals not to NFPA 1582 specifications ○ No
* 7. Will the personnel hired meet the minimum local or State EMS training and certification requirements, as designated by your agency?		○ Yes ○ No ○ N/A - do not provide EMS
* 8a. Do you assure that your organization will, to the extent practicable, seek, recruit, and hire members of racial and ethnic minority groups and women to increase their ranks within your department?			○ Yes ○ No
* 8b. If so, explain what efforts your organization has instituted and how successful those efforts have been. If not, explain what policies and procedures you will implement to assure that, to the extent possible, you will seek, recruit, and hire minorities and women. If additional space is needed for your response, please include it in the Narrative section of your application.

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* 9a. Does your organization currently have a policy ensuring that firefighters in positions filled under the SAFER grants are not discriminated against for, or prohibited from, engaging in volunteer firefighting activities in another jurisdiction during off-duty hours.	○ Yes ○ No
* 9b. If so, explain what efforts your organization has instituted and how successful those efforts have been. If not, explain what policies and procedures you will implement to assure that, to the extent possible, this requirement will be met. If additional space is needed for your response, please include it in the Narrative section of your application.
* 10. Does your department currently have a policy in place to recruit and hire veterans?	○ Yes ○ No
10b. If yes, please provide a brief description of the policy in place.

Add Budget Item

Please provide the following information.

Note: Fields marked with an * are required.

Hiring Budget Item
* What is the type of position being filled with this Hiring activity line item? Note: Only one type of position can be requested per line item. If you are seeking funding for more than one type of position or vacancy, you MUST enter each one separately by filling out an additional set of Add Budget Item pages. You can however have multiple line items for each position type and this should be used when the salary and benefits are different for each position/activity being requested.	○ Rehiring laid-off firefighters who have already been separated from employment ○ Retaining firefighters who have received official notice of layoff action, as defined in the Program Guidance, but who have not been separated from employment as of the time of application ○ Hiring firefighters into positions that have been lost due to attrition (retirement, voluntary separation, termination) as of the time of application ○ Hiring new firefighters to enhance compliance with the applicable sections of NFPA 1710/1720 as described in the Program Guidance.
If you selected the rehiring or the retention activity option above, have you issued layoff notices for the positions? If yes, you will be required to attach copies of the official, signed, and issued layoff notices that correspond to the number of positions being requested. You must attach copies of the official, signed, and issued layoff notices that correspond to the positions being requested in this line item. You may attach multiple documents if needed. If no, you cannot apply under the rehiring activity. If applying under the retention activity and have not issued layoff notices, please contact the help desk at 1.866.274.0960 for instructions on completing this question. Please be sure you have read and understand the eligibility requirements for the rehire and retention activities in program guidance.			○ Yes ○ No
* How many full-time firefighter positions, including job-shares, are you requesting? (Whole Numbers only) Note: Applicants requesting positions under the rehiring of firefighters activity (e.g., rehire, retention, or attrition) can request up to the number of positions that have been laid-off, received official notification of layoff action, or vacated due to attrition as described in the program guidance. Please note, if the positions being requested were not previously job-shared, then you will not be eligible to job-share these positions if awarded. “Full-time" is considered 2,080 hours or more worked per year and entitles the employee to receive benefits earned by the other full-time employees in the organization. “Job-share” is the term used to describe the hiring of more than one person to fill one full-time position. Part-time positions are less than 2,080 hours per year. Often part-time employees do not earn benefits or do not earn them at the same rate or level as full-time employees.
If you are requesting to fund a position that will be "shared" by more than one individual (e.g., job-shared), on an additional sheet please indicate how many individuals will fill that position, provide an explanation as to why the position will be shared, and indicate whether or not this position is currently being job-shared. For applicants who are applying under the rehire, retention, and/or attrition activities, if the positions being requested were not previously job-shared, then you will not be eligible to job-share these positions if awarded. Note: The number of individuals that may fill a job-share position is limited to the number of shifts deployed by the applicant.
* What are the anticipated two year costs per requested Firefighter? (whole numbers only)		Base Salary: $ Benefits Cost: $
		Year 2 Salary: $ Year 2 Benefits: $

Budget

Personnel

Personnel - The costs in this area will cover personnel costs within your department, if they are allowed. (The program narrative should list the employee title, hours x hourly rate.)

Benefits

Fringe Benefits - Fringe benefits in the form of regular compensation paid to employees during periods of authorized absences from the job, such as vacation leave, sick leave, military leave, and the like, are allowable, provided such costs are absorbed by all organization activities in proportion to the relative amount of time or effort actually devoted to each. Fringe benefits in the form of employer contributions or expenses for social security, employee insurance, workmen's compensation insurance, pension plan costs, and the like, are allowable, provided such benefits are granted in accordance with established written organization policies. Such benefits, whether treated as indirect costs or as direct costs, shall be distributed to particular awards and other activities in a manner consistent with the pattern of benefits accruing to the individuals or group of employees whose salaries and wages are chargeable to such awards and other activities. Costs incurred for providing the employee with uniforms, personal protective equipment, training, etc. are not eligible under the benefits category.

Hiring or Rehiring of Firefighters:
There is a two-year period of performance for grants awarded under the Hiring of Firefighters Category. Should the actual salary and benefits costs requested for reimbursement exceed awarded Federal funds, the grantee would be obligated to pay 100 percent of those costs. Therefore, please be sure you have provided accurate salary and benefit information and have confirmed this information with your Human Resources and/or Financial Office.

Budget Matrix

The online application will automatically fill out the Budget Matrix. Paper applicants should use the formulas to fill in the blocks.

Budget Matrix
	First 12-Month Period	Second 12-Month Period	Total
Personnel	Base salary on page 16	Year 2 salary on page 16	Sum of all Personnel blocks
Benefits	Benefits cost on page 16	Year 2 benefits on page 16	Sum of all Benefits blocks
Total	Sum of boxes above	Sum of boxes above	Sum of all Total blocks to the left

Bottom of Form

Narrative Statement for Hiring or Rehiring of Firefighters

The narrative statements must provide all the information necessary for you to justify your needs and for FEMA to make an award decision. A panel of peer reviewers performs the second phase of the applications’ evaluations by using the narrative statements below, along with the answers to the general questions and the activity-specific questions, to determine the worthiness of the request for an award.

Please ensure that your narrative clearly addresses each of the following evaluation criteria elements to the best of your ability. Each element will be evaluated independently by the peer review panelist. The relative weight of the evaluation criteria in the determination of the grant award is listed below.
You may either type your project narrative statements in the spaces provided below; or create the text in your word processing system and then copy it into the appropriate spaces provided below. Please note the narrative block does not allow for formatting. Do not type your narrative using only capital letters. Additionally, do not include tables, special fonts (i.e., quote marks, bullets, etc), or graphs.
Note: Fields marked with an * are required. Statements 1 - 3 are limited to 6000 characters each; Statement 4 is limited to 4000 characters, Statements 5 and 6 are limited to 2000 characters each.

Hiring or Rehiring of Firefighters Narrative

* Element #1 - Project Description (30%): This statement should describe the following:     

● Why the applicant needs the grant funds;     

● How the requested firefighters will be used within the department;     

● A description of the specific benefit these firefighters will provide for the fire department and community.     

● If the applicant is requesting funding under the rehiring of firefighters activity, the narrative should provide details as to when and why the vacancies occurred and how the vacancies have affected the service to the community.     

● Applications must also discuss how the grant would enhance the department’s ability to protect critical infrastructure.

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* Element #2 - Impact on Daily Operations (30%): This statement should explain how the community and current firefighters are at risk without the requested firefighters, and to what extent that risk will be reduced if the applicant is awarded. What impact will the newly funded positions have on NFPA?

* Element #3 - Financial Need (30%): This statement should explain the applicant’s organizational budget and its inability to address the need without federal assistance, including other actions the applicant has taken to meet their staffing needs.

* Element #4 - Cost/Benefit (10%): This statement should explain, as clearly as possible, what benefits your department and/or your community will realize if the project described is funded (i.e. anticipated savings and/or efficiencies).

* Element #5 - Performance (Additional Consideration): Applicants should explain whether they have a proven track record for timely project completion and satisfactory performance in other AFG, FP&S, and SAFER awards.

* Element #6 - Additional Information: If you have any additional comments you would like to include about your organization or this application, please provide them here.