Forms Revision Chart for FEMA Form 010-0-12 (English)

FEMA Form 010-0-12, (English) Application for Continued Temporary Housing Assistance

LOCATION	CURRENT TEXT	REVISED TEXT
Page 1, Paragraph 4	Delete “auto-generated”	Replace with “filled-in”
Page 1, Paragraph 5	Delete “auto-generated”	Replace with “filled-in”
Page 1, Paragraph 5	Delete “you may move on”	Replace with “please continue”
Page 1, Paragraph 7	“Current Phone”	Format change – underline “Current Phone”
Page 1, Paragraph 8	Delete “monetary”	Replace with “dollar”
Page 1, Paragraph 9	Next to the appropriate "Expense" enter the dollar amount of your bill or payment.	Format change – unbold text
Page 1, Paragraph 10, 1st sentence	Delete “the”	Replace with “each”
Page 1, Paragraph 10, after 1st sentence add new sentence	Insert new text.	Insert: This would include documents such as your mortgage statement, rent receipts and utility bills.
Page 1, Paragraph 10	Shade in the circle next to the "Expense" indicating that you have attached the document to your application. You must submit documentation that can be validated; otherwise the amount will not be accepted.	Format change – unbold text
Page 1, Paragraph 10	Delete “validated”	Replace with “verified”
Page 1, Paragraph 11	Delete “To ensure proper calculation and evaluation of your Housing Costs, please”	Replace with “Under Payment Cycle,”
Page 2, Paragraph 2	Delete the colon – “Housing Cost:”	Replace with “Housing Cost”
Page 2, Paragraph 3	Delete the colon – “Housing Unit:”	Replace with “Housing Unit”
Page 2, Paragraph 3	Delete “hotel, motel”	No new language will be inserted.
Page 2, Paragraph 4	Delete “If you are in a Housing Unit”	No new language will be inserted.
Page 2, Paragraph 4, 1st sentence	Insert new language - copy of your written and signed lease,	Insert and bold “written and signed”
Page 2, Paragraph 4	Insert new language - The lease must be signed by the applicant or co-applicant and the landlord.	Insert new language - The lease must be signed by the applicant or co-applicant and the landlord.
Page 2, Paragraph 5	Delete “residing”	Replace with “currently living with you”
Page 2, Paragraph 5	Delete “current”	No new language will be inserted.
Page 2, Paragraph 6, 1st sentence	Delete “validate any”	Replace with “verify each dollar”
Page 2, Paragraph 6, 1st sentence	Delete “the frequency at which the”	Replace with “how often each”
Page 2, Paragraph 6, 2nd sentence	Delete “In the pay cycle box, please shade in the circle that is applicable.”	Replace with “Shade in the circle indicating you have attached a document to your application.”
Page 2, Paragraph 7, 1st sentence	Delete “To ensure proper calculation and evaluation of your Households Income, please”.	No new language will be inserted.
Page 2, Paragraph 7, 1st sentence	Delete “you are”	Replace with “each individual is”
Page 2, Paragraph 7, 1st sentence	Insert new language at the end of 1st sentence “paid by his or her employer.”	Insert new language at the end of 1st sentence “paid by his or her employer.”
Page 2, Paragraph 7, 2nd sentence	Delete “you have”	Replace with “an individual has”
Page 2, Paragraph 7, 2nd sentence	Delete “yourself”	Replace with “them”
Page 2, Paragraph 7	Format change – unbold text	Format change – unbold text
Page 2, Paragraph 8	Format change – unbold text	Format change – unbold text
Page 2, Paragraph 8	Delete “your” and make Pay Cycle lower case	Replace with “the” and “pay cycle”
Page 2, Paragraph 9	Format change – unbold text	Format change – unbold text
Page 2, Paragraph 9	Delete “FEMA will calculate the income to a Monthly cycle”	No new language will be inserted.
Page 2, Paragraph 10	Delete “Persons”	Replace with “All Individuals”
Page 2, Paragraph 10	Delete “Residing”	Replace with “Living”
Page 2, Paragraph 10	Delete “Bi-Monthly”	Replace with “Twice Monthly”
Page 2, Paragraph 11	Delete the colon – “Income means:”	Replace with “Income means”
Page 2, Paragraph 12	Delete “post-disaster”	Replace with “permanent”
Page 2, Paragraph 15	Insert new text at the end of the paragraph “(e.g. pay stubs, mortgage statements, lease, utility bills, rent receipts, etc.)”	Insert new text at the end of the paragraph “(e.g. pay stubs, mortgage statements, lease, utility bills, rent receipts, etc.)”
Page 3, Privacy Act Statement	Delete existing statement and replace with this statement: AUTHORITY: The Robert T. Stafford Disaster Relief and Emergency Assistance Act as amended, 42 U.S.C. §§ 5121 -5207; The Homeland Security Act of 2002, 6 U.S.C. §§ 311-321j; Reorganization Plan No. 3 of 1978; 4 U. S.C. §§ 2904 and 2906; 4 C.F.R. § 206.2(a)(27); the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (Pub. L. 104-193); and Exec. Order No. 13411. DHS asks for your SSN pursuant to the Debt Collection Improvement Act of 1996, 31 U.S.C. §§ 3325(d) and 7701(c) (1). PRINCIPAL PURPOSE(S): FEMA collects and maintains your information in order to determine eligibility for and administer financial assistance under a Presidentially-declared disaster. Additionally, FEMA may review your information for quality assurance purposes to assess FEMA's disaster assistance customer service. ROUTINE USE(S): FEMA may be share your personal information contained in your disaster assistance file outside of FEMA as generally permitted under 5 U.S.C. § 552a(b) of the Privacy Act of 1974, as amended. This includes sharing your personal information with federal, state, tribal, local agencies and voluntary organizations to enable you to receive additional disaster assistance, to prevent duplicating your benefits, as necessary and authorized by routine uses published in DHS/FEMA-008 Disaster Recovery Assistance Files Notice of System of Records, 78 Fed. Reg. 25,282 (Apr. 30, 2013) and upon written request, by agreement or as required by law.
Page 3, Important Notice	Insert “Temporary Housing”	“….Continued Temporary Housing Assistance.”
Page 3, Important Notice	Delete “Recovery Strategy”	Replace with “Permanent Housing Plan”
Page 3, Important Notice	Insert “rent receipts”	Insert “….current lease, rent receipts/cancelled checks…”
Page 3, Item 7	Delete “of Expenses”	No new language will be inserted.
Page 4, Item 9	Delete “Persons”	Replace with “All Individuals”
Page 4, Item 9	Delete “Residing”	Replace with “Living”
Page 4, Item 9	Delete “Bi-Monthly”	Replace with “Twice Monthly”
Page 4, Item 10	Delete “Recovery Strategy”	No new language will be inserted.
Page 4, Item 10	Insert “pre-disaster”	Insert “I am a pre-disaster RENTER…”
Page 4, Item 10	Insert “pre-disaster”	Insert “I am a pre-disaster HOMEOWNER…”
Page 4, Item 11	Capitalization. Capitalize “continued”	Insert “Continued”
Page 4, Item 11, 4th bullet	Delete “means”	Replace with “ability”