Request for Information Letter

U.S. Department of Homeland Security
FEMA MDNPSC
P. O. Box 10055
Hyattsville, MD 20782-7055

Dear Applicant:

The Federal Emergency Management Agency requests the following information in order to process a
review of your account. Please send to the address above or fax to 1-800-827-8112 within 30 days from
receipt of this packet.

___x__ DEBT COLLECTION FINANCIAL STATEMENT (COMPLETE and SIGN

enclosed form)
___x__ BANK STATEMENTS (Most recent checking and savings -- if you have a checking

and/or savings account)
Note: If you do not have bank statements, please provide an alternate form of
income verification (such as pay stubs, SSI, AFDC, Social Security, Retirement,
Unemployment assistance, Disability Statements, and/or Pension)
__x___ MOST RECENT TAX RETURN
__x___ SUMMARY OF MONTHLY EXPENSES -- on the HOUSEHOLD EXPENSE LISTING.

These are regular costs that are NOT included on the debt collection financial statement. These
are expenses that occur monthly or at least regularly such as car insurance, home or renters
insurance, health insurance, life insurance, medical bills, phone bills, cable bills and other regular
costs. PLEASE TRY TO ESTIMATE THE AVERAGE COSTS PER MONTH, EVEN IF THE
COSTS CHANGE EACH MONTH.
Please try to answer all questions on each form.
If you have questions or need help, please call 1-800-816-1122 between 9:00 AM and 8:00 PM, Eastern
Time, Monday through Friday.

Sincerely,
Debt Collection Officer