FEMA Form 009-0-5, DIRECT TEMPORARY HOUSING PROGRAM Manufactured Housing Unit Revocable License and Receipt for Government Property (Revocable License)
LOCATION |
CURRENT TEXT |
REVISED TEXT |
Page 1, top half (labeled as Part 1, Page 1 in current version) |
(columns on fill in chart)
Name Age Sex
DESCRIPTION OF PROPERTY (Check off boxes) Other__ Manufactured Housing Unit__ Trailer Trailer__ Park Model___ Furnished___ Number of bathrooms___ Number of bedrooms___
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(columns on fill in chart)
Name Relationship Age Sex
Initials of Licensee____
DESCRIPTION OF PROPERTY (Check off boxes) Other__ Manufactured Housing Unit__ Park Model___ Furnished___ Number of bathrooms___ Number of bedrooms___ |
Page 1, bottom half (labeled as Part 1, Page 1 in current version) |
Old statement wording.
I understand that FEMA is allowing me to use the above unit under a revocable license for the temporary housing of my household because: the President has declared a major disaster or emergency in my state; I am not able to live in my pre-disaster primary residence due to this event; and FEMA has determined my household to be eligible for housing assistance under 42 U.S.C. 5174 and 44 CFR 206.110-118. I understand that, if not revoked earlier, this license will automatically expire 18 months from the date of the President's declaration of a major disaster or emergency.
I acknowledge receiving the above unit as temporary housing for my household's use only. I understand that my household's continued use of this unit is subject to the attached "Conditions for Use of Government Property", as well as FEMA's discretionary decision to continue the direct housing assistance program at this location.
I understand that any failure to comply with these "Conditions for Use" or any decision by FEMA to terminate the direct housing program at this location may result in my household being required to vacate this unit and return the unit's keys to FEMA as soon as possible, but no later than the date set forth in a written Notice of Revocation (usually within 15 days of the Notice). I understand that I am signing this form on behalf of all members of my household listed above as authorized users.
______________________ _____ Head of Household Signature Date
_______ _____ Witness Date |
New statement wording.
I acknowledge that FEMA is permitting me, as the Licensee, to use the above manufactured housing unit for direct temporary housing because: the President has declared a major disaster or emergency in my state; I am not able to live in my household's pre-disaster primary residence or obtain adequate alternate housing through no fault of my own due to this event; and FEMA has determined my household to be eligible for direct temporary housing assistance under Section 408 of the Robert T. Stafford Disaster Relief and Emergency Assistance Act, 42 U.S.C. § 5174(c)(1)(B) and FEMA regulations at 44 C.F.R. §§ 206.110-118. If not revoked earlier, this license will automatically expire 18 months from the date of the President's declaration of a major disaster or emergency or at the end of any extension to the 18-month period of assistance granted under 42 U.S.C. § 5174(c)(1)(B)(ii).
I acknowledge receiving keys to the above-described unit as temporary housing for my household's use only.
(No signature lines in new version)
Initials of Licensee____ |
Page. 2. (labeled as “Part 1, Page 2 in the current version).
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Old Statement Wording. (This now appears on page 5 of the new version of the form).
DEPARTMENT OF HOMELAND SECURITY FEDERAL EMERGENCY MANAGEMENT AGENCY RECEIPT FOR GOVERNMENT PROPERTY (Revocable License) INDIVIDUAL AND HOUSEHOLD PROGRAM OWNERSHIP/CONTROL
The U.S. Government owns or leases the temporary housing unit described in the attached "Receipt for Government Property". The unit is federal property, and the U.S. Government retains the right to control its use at all times. This includes the right to revoke my household's license to use the unit at any time with a written notice and to enter the unit to make inspections or repairs with 24 hours notice (no prior notice is required in an emergency as determined by FEMA). I understand that FEMA is providing this unit as a discretionary benefit under 42 U.S.C. 5174 and 44 CFR 206.110-118 and that at any time I may be given a written Notice of Revocation requiring me to vacate the unit and return the units keys to the U.S. Government as soon as possible, but no later than the date set forth in the Notice of Revocation.
DUTY TO MEET CONTINUING ELIGIBILITY REQUIREMENTS FEMA requires all recipients of direct housing assistance under its temporary housing program to continue to meet, certify, and/or document their compliance with, the criteria for eligibility for such assistance in order to continue receiving the assistance. I understand that the eligibility requirements for temporary housing assistance are set forth in 44 CFR 206.110-118 and that, if FEMA determines I have not met these requirements, I will be given a written Notice of Revocation requiring me to vacate the unit and return the units keys to the U.S. Government as soon as possible, but no later than the date set forth in the Notice of Revocation.
DUTY TO OBTAIN/ACCEPT ALTERNATE HOUSING I understand that FEMA requires all recipients of direct housing assistance under its temporary housing program to obtain and occupy permanent housing at the earliest possible time. I agree to make a diligent effort to obtain permanent housing as soon as possible and to establish a permanent housing plan for my household. I also agree that, if FEMA determines adequate alternate housing is available, my household will accept that alternate housing and leave this temporary housing unit as soon as possible, but no later than the date set forth in a written Notice of Revocation.
DUTY TO COMPLY WITH ENFORCEMENT OR REMOVAL ACTION I acknowledge that I and the listed occupants will comply with any written notice requiring me to vacate the unit by moving out of the temporary housing unit, removing all personal property, and returning the unit's keys to the U.S. Government no later that the date set forth in the notice. I also agree to be responsible for my household's personal property which is placed in the unit at my sole risk and to remove it promptly from the unit upon a written notice requiring me to vacate the unit. I acknowledge that, if I do not comply with a written notice requiring me to vacate the unit, the U.S. Government may take steps to remove the members of my household and their personal property from the unit using any enforcement authorities deemed appropriate. I understand that FEMA reserves the right to assess charges and fees if I fail to comply with enforcement or removal action (44CFR 206.117(b)(1)(ii)(H)). I agree to hold harmless the U.S. Government and any of its agencies, agents, contractors, and subcontractors, for damages of any type whatsoever either to property or persons resulting from such enforcement actions.
DUTY OF INSURED APPLICANTS TO REIMBURSE FEMA I understand that FEMA requires all recipients of direct housing assistance under its temporary housing program to offset the value of the direct assistance provided by FEMA against any insurance proceeds or recoveries they receive. If my household is eligible for any payments or allowances from private insurance that can be used for temporary housing needs, such as Additional Living Expenses (ALE), I agree to file a claim for such insurance benefits and to pay FEMA for the cost of using this temporary housing unit (as determined by FEMA) up to the limits of the insurance recovery for monthly housing expenses.
DUTY TO PAY CHARGES/DAMAGES Damages may include any charges deemed appropriate by FEMA for failing to vacate the unit and return its keys to the U.S. Government by the date set forth in a written Notice of Revocation, as well as any charges, such as legal fees, associated with enforcement actions to remove my household from the unit. I agree to pay FEMA for damages resulting from the violation of any of the rules set forth below or from the failure to comply with any of these "Conditions for Use".
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New Statement Wording. (What was formerly on page 2 has been moved to page 5).
REVOCABLE LICENSE TERMS AND FEMA REGULATIONS & POLICIES Licensee Compliance. Maintaining this Revocable License to use the unit is based on the Licensee remaining eligible for continued FEMA direct temporary housing assistance and complying with the Individuals and Households Program Conditions for Use of Government Property, attached as Appendix A to this Revocable License, and any other rules provided and incorporated in this Revocable License. Failure to comply will require the Licensee's household to vacate this unit and return the unit's keys to FEMA no later than the date set forth in a written Notice of Revocation (generally within 15 days of the Notice or less than 15 days when the violation poses a health or safety hazard).
WHEN SERVED WITH A NOTICE OF REVOCATION OR NOTICE TO SURRENDER POSSESSION, THE LICENSEE'S HOUSEHOLD MUST COMPLY OR FACE POTENTIAL LEGAL ACTION INITIATED BY FEMA. Penalty Fee. As authorized in 44 C.F.R. § 206.117(b)(1)(ii)(F) and (H), FEMA may revoke this license before the period of assistance ends; and if the Licensee's household still occupies the unit after the license to occupy the unit is revoked or after the initial 18-month or extended period of direct housing assistance ends, FEMA will charge a penalty fee. FEMA will provide notice of any penalty fee imposed upon the Licensee, including any interest and administrative costs. These costs will be charged to the Licensee each month until the household gives FEMA possession of the unit, removes all personal property, and returns the keys to FEMA. Damage Fee. As authorized in 44 C.F.R. § 206.117(b)(1)(ii)(H), FEMA may charge the Licensee for the cost of damage to the unit beyond normal wear and tear that results from a violation of any terms, rules, or conditions provided and incorporated in this Revocable License. Rent. As authorized in 42 U.S.C. § 5174(c)(1)(B)(iii) and 44 C.F.R. § 206.117(b)(1)(ii)(F), FEMA may extend direct housing assistance for [insert disaster] beyond [insert date]. If the period of assistance is extended, FEMA will charge the Licensee rent each month until the Licensee's household vacates the unit; and this license will automatically be extended on the same terms to the end of the period of assistance, unless it is revoked by FEMA. FEMA will provide the Licensee notice of the rent amount and extended time period for the temporary housing program.
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Page 3 (labeled as Part 2, Page 1 in current version) |
Old statement wording. (This section has been moved to pages 8 and 9 of the new version).
RULES FOR USE OF HOUSING UNIT I understand that any violation of the rules listed below may result in my household being required to vacate the temporary housing unit and return the unit's keys to FEMA immediately. I agree to follow these rules and to pay FEMA for any damages resulting from the violation of any of these rules. I understand that I and all members of my household must:
A. Pay all utility charges, including deposits, for the housing unit, if applicable. B. Keep the unit, any furnishings, and the surrounding area in a clean and orderly condition, less ordinary wear and tear, and assure that items or debris of any kind which may cause a possible fire hazard are not placed near the unit. C. Notify FEMA when any damage or defect is found in the unit. D. Not make any major repairs, additions, structural alterations, or changes to the unit and any furnishings without FEMA's prior written consent. E. Not make any changes to the area surrounding the unit without FEMA's prior written consent, except that FEMA's consent is not required for altering the surrounding area on private property when the property owner is the unit's occupant or when the private property owner's prior written consent has been obtained. F. Not move the unit to another location. G. Provide a right of entry signed by the landowner for any private property site when requested by FEMA and allow FEMA onto the property for inspections, repairs, or removal of the unit. H. Not allow any lien or obligation to attach to this license or to the unit. I. Not change the locks or install any security system without FEMA's prior written consent, or otherwise impede access by FEMA. J. Not allow any additional people (other than those listed as authorized users above) to live in the unit and notify FEMA within 7 days in writing of any change in this list of authorized users. K. Not transfer or assign this license to any person except to another authorized user listed above. L. Use the unit continuously as housing and notify FEMA immediately in writing if leaving the unit for any period of time greater than 30 days. M. Respect the rights and privacy of other individuals in any group site or commercial park, which includes not causing or permitting any disturbing noises, any objectionable or improper conduct, or any dangerous activities. N. Comply with all rules for a group site or commercial park AND comply with all relevant local ordinances for any private property site. O. Not engage in any illegal/criminal behavior or allow any illegal/criminal behavior to occur in the housing unit or the surrounding area. FOR CONTINUED USE OF HOUSING UNIT DURING EXTENSIONS (44 CFR 206.117(b)(1)(ii)(F)) I understand that if FEMA authorizes an extension of the Temporary Housing Program, the conditions set forth in this license will remain in full effect. I understand that if I remain in the unit during an extension, FEMA reserves the right to charge me rent for the unit at the Fair Market Rate. FEMA Form 009-0-5, AUG 12 REPLACES ALL PREVIOUS FEMA Form 90-69D Part -2 Page 1 Head of Household Signature of Authorized User |
New statement wording.
HOLD HARMLESS AGREEMENT I hereby release, discharge, and waive any action, either legal or equitable, that might arise out of any activities on the premises of the unit or the surrounding area. I agree to hold harmless the U.S. Government and any of its agencies, agents, contractors, and subcontractors, for damages of any type whatsoever either to property or persons resulting from its furnishing of housing assistance to my household. (this section was on page 4, labeled as Part 2, Page 2 of the current version).
ACKNOWLEDGEMENT I acknowledge that I AM NOT A TENANT and have been granted use of this government property through a Revocable License to use government property for temporary housing because my pre-disaster primary residence is unavailable due to damage from a Federally-declared disaster. As the Licensee, I agree to comply with any written Notice of Revocation requiring me to vacate the unit, remove all personal property, and return the unit's keys to FEMA no later than the date established in the Notice. (this section was on page 4, labeled as Part 2, Page 2 of the current version).
I acknowledge that FEMA will impose a MONTHLY PENALTY FEE against me, the Licensee, until the unit is returned to FEMA if:
(1) this license is revoked by FEMA for any reason (e.g., if my household is determined ineligible for continued FEMA temporary housing assistance or my household violates the terms and conditions of this license or other rules of the site where the unit is located); (2) FEMA decides to terminate the housing program for this location; or (3) my household remains in the unit beyond the conclusion of the initial 18-month or extended period of assistance for [insert disaster] on [insert date].
The rules and procedures governing such Federal disaster assistance are set forth in the Robert T. Stafford Disaster Relief and Emergency Assistance Act, P.L. 93-288, codified at 42 U.S.C. §§ 5121-5207, and at 44 CFR Part 206. (this section was on page 4, labeled as Part 2, Page 2 of the current version).
_____________________________________ Signature of Applicant, Co-Applicant, License
_____ Date
_______ _____ Witness Date
Initials of Licensee____ |
Page 4 (labeled as Part 2, Page 2 in current version) |
Old Statement Wording
HOLD HARMLESS AGREEMENT I hereby release, discharge, and waive any action, either legal or equitable, that might arise out of any activities on the premises of the temporary housing unit or the surrounding area. I agree to hold harmless the U.S. Government and any of its agencies, agents, contractors, and subcontractors, for damages of any type whatsoever either to property or persons resulting from its furnishing of housing assistance to my household. (This is now on page 3 of the revised version).
ACKNOWLEDGEMENT I understand that I am not a tenant, but have merely been granted a revocable license to use government property for temporary housing while my pre-disaster primary residence is unavailable because it was damaged in a federally-declared major disaster or emergency. I understand that the rules and procedures governing such federal disaster assistance are set forth in the Robert T. Stafford Disaster Relief and Emergency Assistance Act, P.L. 93-288, codified at 42 U.S.C. 5121-5207, and at 44 CFR Part 206. I am signing this form on behalf of all members of my household. (This is now on page 3 of the revised version).
______________________ _____ Head of Household Signature Date
_______ _____ Witness Date
PRIVACY ACT STATEMENT AUTHORITY: The Robert T. Stafford Disaster Relief and Emergency Assistance Act as amended, 42 U.S.C. § 5121-5207 and 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 Executive Order 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): This information is being collected for the primary purpose of determining eligibility and administrating financial assistance under a Presidentially-declared disaster. Additionally, information may be reviewed within FEMA for quality assurance purposes and used to assess FEMA's customer service to disaster assistance applicants. ROUTINE USE(S): The information on this form may be shared outside of FEMA as generally permitted under 5 U.S.C. § 552a(b) of the Privacy Act of 1974, as amended. This includes sharing this information with state, tribal, local and voluntary organizations to enable you to receive additional disaster assistance and as necessary and authorized by routine uses published in DHS/FEMA-008 Disaster Recovery Assistance Files System of Records , 78 Fed. Reg. 25,282 (April 30, 2013), and upon written request, by agreement, or as required by law. DISCLOSURE: The disclosure of information on this form is voluntary; however, failure to provide the information requested may delay or prevent the individual from receiving disaster assistance.
PAPERWORK BURDEN DISCLOSURE NOTICE Public reporting burden for this data collection 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 this form. This collection of information is required to obtain or retain benefits. You are not required to respond to this collection of information unless a valid OMB control number is displayed on this form. 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, 1800 South Bell Street, Arlington, VA 20598-3005, Paperwork Reduction Project (1660-0002) NOTE: Do not send your completed form to this address. |
New Statement Wording
This part was originally on page 2 (labeled as Part 1, Page 2) of the current version. New “Duties” not in current version are in bold.
APPENDIX A
OWNERSHIP/CONTROL The U.S. Government owns the manufactured housing unit described in this Revocable License and Receipt for Government Property. The unit is government property, and the U.S. Government retains the right to control its use at all times. This includes the right to revoke this license to occupy the unit with written notice and take possession of the unit, as well as the right to enter the unit to make inspections or repairs within 24 hours-notice (no prior notice is required in an emergency as determined by FEMA). FEMA is providing the unit as a discretionary benefit under 42 U.S.C. § 5174 and 44 C.F.R. §§ 206.110-118 and at any time the Licensee may be given a written Notice of Revocation requiring the Licensee's household to vacate the unit, remove all personal property, and return the unit's keys to the U.S. Government no later than the date set forth in the Notice of Revocation (generally within 15 days of the Notice or less than 15 days when the violation poses a health or safety hazard). FEMA reserves the right to take possession of the unit when FEMA determines that repossession of the unit is warranted.
DUTY TO MEET CONTINUING ELIGIBILITY REQUIREMENTS FEMA requires all recipients of temporary housing assistance to provide documentation showing that they are making diligent efforts to obtain permanent housing and to obey all applicable Federal, State, and local laws while occupying a FEMA manufactured housing unit. FEMA requires the Licensee to establish and work towards a realistic permanent housing plan. Eligibility requirements for and regulations governing temporary housing assistance are set forth at 44 C.F.R. §§ 206.110-118. If FEMA determines these requirements have not been met, the license to occupy the unit will be revoked and a written Notice of Revocation will be issued requiring the Licensee's household to vacate the unit, remove all personal property, and return the unit's keys to FEMA no later than the date established in the Notice of Revocation. FEMA may revoke this license to occupy the unit and charge the Licensee a monthly penalty fee for reasons that include, but are not limited to, FEMA determining that: - The period of assistance has expired: For [insert disaster], the period of assistance will expire on [insert date]; - Adequate alternate housing is available to the household; - The household obtained housing assistance through either misrepresentation or fraud; - The household has failed to comply with any term of the Individuals and Households Program Conditions for Use of Government Property or other rules of the site where the unit is located; - The Licensee has not provided verifiable evidence documenting that the household is diligently working towards a permanent housing plan;- The household has caused damage to the unit beyond normal wear and tear; or - The household has engaged in criminal activity, activities that create serious health and safety risks, or any other unlawful or otherwise illegal activities.
DUTY TO OBTAIN/ACCEPT ALTERNATE HOUSING FEMA requires all recipients of temporary housing assistance to obtain and occupy adequate alternate housing at the earliest possible time. The Licensee will establish a permanent housing plan and make every effort to obtain permanent housing for the Licensee's household as soon as possible. If FEMA determines that adequate alternate housing is available, the Licensee will obtain alternate housing and vacate the unit as soon as possible. Refusal to accept adequate alternate housing resources offered by FEMA can result in revocation of this license to occupy the unit. If FEMA determines that the Licensee has failed to diligently seek and obtain adequate alternate housing or to accept such housing resources presented, a written Notice of Revocation will be issued requiring the Licensee's household to vacate the unit, remove all personal property, and return the unit's keys within the timeframe established in the Notice of Revocation.
DUTY TO COOPERATE WITH FEDERAL REPRESENTATIVES A FEMA representative will contact the Licensee or other Authorized User to schedule regular appointments to review the Licensee's eligibility to continue occupying the unit and to assist in establishing a realistic housing plan. The Licensee must cooperate with FEMA representatives. This includes making the Licensee or other Authorized User available for regularly scheduled appointments, at which time the Licensee or other Authorized User will be expected to provide documentation, allow access to the unit and to the pre-disaster residence, if applicable, in order to demonstrate that progress is being made towards achieving a permanent housing plan and eligibility requirements for continued temporary housing assistance are being met. Failure to demonstrate progress on a permanent housing plan or to meet eligibility requirements will result in the revocation of this license to occupy the unit.
Initials of Licensee____ |
Page 5 |
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New Statement Wording:
This part was originally on page 2 (labeled as Part 1, Page 2) of the current version. New “Duties” not in current version are in bold.
DUTY TO COMPLY WITH ENFORCEMENT OR REMOVAL ACTION The Licensee and the Authorized Users will comply with any written Notice of Revocation requiring the Licensee's household to vacate the unit by moving out of the unit, removing all personal property, and returning the unit's keys to the FEMA no later than the date set forth in the Notice of Revocation. The Licensee is responsible for the household's personal property, which is placed in the unit at the sole risk of the Licensee, and for removing it from the unit upon receiving a written Notice of Revocation. FEMA may take steps to take possession of the unit and remove all Authorized Users and personal property from the unit using any enforcement authorities deemed appropriate, upon failure to comply with the date established in the Notice of Revocation. The Licensee agrees to hold harmless the U.S. Government and any of its agencies, agents, contractors, and subcontractors, for damage of any type whatsoever either to property or persons resulting from such enforcement actions. DUTY OF INSURED APPLICANTS TO REIMBURSE FEMA FEMA requires all recipients of temporary housing assistance under its temporary housing assistance program to offset the value of the direct assistance provided by FEMA against any insurance proceeds or recoveries they receive. If the Licensee's household is eligible for any payments or allowances from private insurance that can be used for temporary housing needs, such as Additional Living Expenses, the Licensee or other Authorized User will file a claim for such insurance benefits and pay FEMA for the cost (up to Fair Market Rent) of using the unit (as determined by FEMA) up to the limits of the insurance recovery for monthly housing expenses. DUTY TO PAY PENALTY FEES Penalty Fees may include any fees deemed appropriate by FEMA for failing to vacate the unit, remove all personal property, and return the keys to FEMA by the date set forth in a written Notice of Revocation, plus administrative costs, interest, and legal fees associated with enforcement actions to remove my household from the unit. The Licensee shall pay FEMA for any fees imposed for a violation of any of the rules set forth in the Individuals and Households Program Conditions for Use of Government Property or other rules of the site where the unit is located.
DUTY AS TO USE OF HOUSING UNIT (The wording for this heading has been changed from, “Rules for Sue of Housing Unit”)
A. Pay all utility charges, including deposits, for the housing unit, if applicable. B. Keep the unit, any furnishings, and the surrounding area in a clean and orderly condition, less ordinary wear and tear, and assure that items or debris of any kind which may cause a possible fire hazard are not placed near the unit. C. Notify FEMA when any damage or defect is found in the unit. D. Refrain (changed from ‘Not make”) from making any major repairs, additions, structural alterations, or changes to the unit and any furnishings. E. Obtain FEMA's prior written consent if there is a need to restrict the ingress and egress route on a temporary or permanent basis. F. Obtain FEMA's prior written consent for any changes to the area surrounding the unit. FEMA's consent, however, is not required for altering the surrounding area on private property when the property owner is the unit's Authorized User or when the private property owner's prior written consent has been obtained. G. Keep the unit in the location where FEMA has placed it. H. Provide FEMA a right of entry signed by the landowner for any private property site to allow FEMA onto the property for inspections, repairs, or removal of the unit. I. Affirm that the Licensee understands that the unit is government property and cannot be subject to any lien or obligation of the Licensee or Licensee's household. J. Obtain FEMA's prior written consent if there is a need to install any security system, or otherwise impede FEMA's access to the unit. K. Occupy the unit with only those persons named in this license. The Licensee must notify FEMA in writing within seven (7) days if there is a change in Users. L. Not transfer or assign this license to any person except to another Authorized Users listed above, with FEMA's consent. (This is K in the current version)
Initials of Licensee____
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Page 6 |
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New Statement Wording Continuation of page 5. This was on pages 3 and 4 (labeled as Part 2, Page 1 and Page 2) of the current version.
Appendix A Individuals and Households Program Conditions for Use of Government Property
M. Use the unit continuously as housing and notify FEMA immediately in writing if leaving the unit for any period of time greater than 15 consecutive calendar days. Schedule any recertification appointments for a date and time prior to the Licensee's planned absence from the unit of greater than 15 days. N. Not engage in any illegal/criminal behavior or allow any illegal/criminal behavior to occur in the housing unit or the surrounding area. This is letter O in the current version.
O. Respect the rights and privacy of other individuals in any group site or commercial park, which includes not causing or permitting any disturbing noises, any objectionable or improper conduct, or any dangerous activities. This is letter M in the current version.
P. Comply with all rules for a group site or commercial park AND comply with all relevant local ordinances. This is letter N in the current version.
Q and R are new additions. Q. Pet Policy (Subject to further restrictions as required by relevant local ordinances): · Each household may own up to two domesticated indoor pets. · An animal that displays vicious or dangerous behavior is not allowed. · Pets must have current shots and ID tag at all times. · Pets must be leashed when outside the unit and may not be left outside unattended. · No outdoor pet kennels or pens are allowed at group or commercial-park sites. · The Licensee and other Authorized User are responsible for picking up and properly disposing of pet droppings. R. Prohibition on Use of Flammable Products: · All outdoor cooking, fires and fire hazards are prohibited, including, but not limited to: grills, smokers, open pit fires, fireworks, propane tanks, and storage of combustible liquids, solids, or gasses inside or outside the unit. PRIVACY ACT STATEMENT AUTHORITY: The Robert T. Stafford Disaster Relief and Emergency Assistance Act as amended, 42 U.S.C. § 5121-5207 and 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 Executive Order 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): This information is being collected for the primary purpose of determining eligibility and administrating financial assistance under a Presidentially-declared disaster. Additionally, information may be reviewed internally within FEMA for quality control purposes. ROUTINE USE(S): The information on this form may be disclosed as generally permitted under 5 U.S.C. § 552a(b) of the Privacy Act of 1974, as amended. This includes using this information as necessary and authorized by routine uses published in DHS/FEMA-008 Disaster Recovery Assistance Files System of Records, 78 Fed. Reg. 25,282 and upon written request, by agreement, or as required by law. DISCLOSURE: The disclosure of information on this form is voluntary; however, failure to provide the information requested may delay or prevent the individual from receiving disaster assistance.
PAPERWORK BURDEN DISCLOSURE NOTICE Public reporting burden for this data collection is estimated to average 15 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 this form. This collection of information is required to obtain or retain benefits. You are not required to respond to this collection of information unless a valid OMB control number is displayed on this form. 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, 1800 South Bell Street, Arlington, VA 20598-3005, Paperwork Reduction Project (1660-0002) NOTE: Do not send your completed form to this address.
Initials of Licensee____
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File Type | application/msword |
File Title | FF-####, TITLE |
Author | FEMA Employee |
File Modified | 2014-01-31 |
File Created | 2014-01-13 |