Form FEMA Form 009-0-12 FEMA Form 009-0-12 Ready for Occupancy

DEPARTMENT OF HOMELAND SECURITY

Federal Emergency Management Agency

OMB Control Number: 1660-NEW

READY FOR OCCUPANCY STATUS

Expiration Date: MM/DD/YYYY

PAPERWORK BURDEN DISCLOSURE NOTICE
Public reporting burden for this form is estimated to average 20 minutes per response. The burden estimate includes the time for reviewing
instructions, searching existing data sources, gathering and maintaining the needed data, and completing, reviewing, and submitting the form.
This collection of information is mandatory. You are not required to respond to this collection of information unless a valid OMB control number
appears in the upper right corner of this form. Send comments regarding the 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-NEW). Please do not send your completed survey to the above
address.
PRIVACY ACT STATEMENT
AUTHORITY: The Robert T. Stafford Disaster Relief and Emergency Assistance Act as amended, 42 U.S.C. § 5174 and Title 44 C.F.R. Part
206.117.
PRINCIPAL PURPOSE(S): This information is being collected for the primary purpose of advising FEMA Individual Assistance applicants of the
requirements to occupy temporary housing units, of the requirements for final sales of the unit if FEMA offers a sale program for its temporary
housing units as part of its direct housing program under a Presidentially-declared disaster.
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 the routine uses published in DHS/FEMA - 008 Disaster
Recovery Assistance Files System of Records, 78 Fed. Reg. 25282 (Apr. 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 the requested disaster-related temporary housing assistance.
FEMA RFO Checklist
Contract #:

Task Order #:

Type of MHU:

Date of Inspection:

Address:

City:

MHU Barcode:

MHU VIN:

Inspector Name:

Inspector Signature:

Phone Number:

FEMA Monitor Name:

FEMA Monitor Signature:

Phone Number:

UFAS CONUS:
Note: Descriptions in this document are for reference only. The requirements are found in the contract. Descriptions in this document do not
supersede any of the requirements in the contract.
EXTERIOR

INITIALS

ITEM

DESCRIPTION

YES

NO

N/A

UNKNOWN

CONTRACTOR
CERTIFICATION

FEMA
MONITOR

PLACING/SECURING
BLOCKING

Blocking done according to the Solicitation, state
or local entity requirements, and/or manufacturer
specifications

LEVEL

Is the MHU level

TIE DOWNS

Is the MHU tied down safely and securely

ANCHORING

Is the MHU anchored safely and securely

UTILITIES
WATER

Is the water piping connected and working
properly

SEWER

Is the sewage system connected properly (check
slope, etc.) and in working condition

ELECTRIC

Are all the electrical components working
properly

FEMA FORM 009-0-129 (2/15)

REPLACES FEMA Form 90-24

Page 1 of 5

READY FOR OCCUPANCY STATUS
ENTRY
STEP

Is the entry component installed and safe to use

PLATFORM STAIR

Is the entry component installed and safe to use

RAMP

Is the entry component installed and safe to use

DOOR/LOCKS

Are the exterior locks and door functioning
properly

EXTERIOR STRUCTURE
WINDOWS

Are all windows present and functional

ROOF

Is the roof in good condition

SIDING

Is the siding in good condition

EXTERIOR MISCELLANEOUS
FIXTURES

Are all fixtures present and functioning properly

OUTLETS

Are all outlets functioning properly

GFCI

Are GFCI outlets functioning properly

HEAT TAPE

Is heat tape functioning properly

ITEM

DESCRIPTION

YES

NO

N/A

UNKNOWN

CONTRACTOR
CERTIFICATION

FEMA
MONITOR

INTERIOR
KITCHEN
FLOOR

Is the floor in good condition

WALLS

Are the walls in good condition

CEILING

Is the ceiling in good condition

LIGHTING

Are all lighting components functioning properly

OUTLETS

Are all outlets functioning properly

CABINETS

Are all cabinets in good condition

SINK

Is the sink functioning properly

EXTINGUISHER

Is the fire extinguisher present and in working
condition

FURNISHINGS

Are all the furnishings in good condition

BLINDS

Are all blinds present and in good condition

APPLIANCES
RANGE

Is the range functioning properly

REFRIGERATOR

Is the refrigerator functioning properly

MICROWAVE

Is the microwave functioning properly

RANGE HOOD

Is the range hood functioning properly

WATER HEATER

Is the water heater functioning properly

CLEAN AND MAKE
READY

Is the unit clean

LIVING ROOM
FLOOR

Is the floor in good condition

WALLS

Are the walls in good condition

FEMA FORM 009-0-129 (2/15)

REPLACES FEMA Form 90-24

Page 2 of 5

READY FOR OCCUPANCY STATUS
CEILING

Is the ceiling in good condition

LIGHTING

Are all lighting components functioning properly

OUTLETS

Are all outlets functioning properly

FURNISHINGS

Are all furnishings in good condition

BLINDS

Are all blinds present and in good condition

SMOKE/STROBES

Is the smoke alarm functioning properly

CLEAN AND MAKE
READY

Is the unit clean

BATHROOM 1
FLOOR

Is the floor in good condition

WALLS

Are the walls in good condition

CEILING

Is the ceiling in good condition

LIGHTING

Are all lighting components functioning properly

OUTLETS

Are all outlets functioning properly

FURNISHINGS

Are all furnishings in good condition

ITEM

DESCRIPTION

YES

NO

N/A

UNKNOWN

CONTRACTOR
CERTIFICATION

FEMA
MONITOR

BATHROOM 1 (CONTINUED)
BLINDS

Are all blinds present and in good condition

SMOKE/STROBES

Is the smoke alarm functioning properly

CLEAN AND MAKE
READY

Is the unit clean

BATHROOM 2
FLOOR

Is the floor in good condition

WALLS

Are the walls in good condition

CEILING

Is the ceiling in good condition

VENT FAN

Is vent fan functioning properly

DOOR

Is the door in good condition

LIGHTING

Are all lighting components functioning properly

OUTLETS

Are all outlets functioning properly

CABINETS

Are all cabinets in good condition

BLINDS

Are all blinds present and in good condition

SMOKE/STROBES

Is the smoke alarm functioning properly

FIXTURES

Are all fixtures present and functioning properly

SHOWER

Is the tub/shower in good condition and
functioning properly

COMMODE

Is the commode functioning properly

SINK

Is the sink in good condition and functioning
properly

CLEAN AND MAKE
READY

Is the unit clean

FEMA FORM 009-0-129 (2/15)

REPLACES FEMA Form 90-24

Page 3 of 5

READY FOR OCCUPANCY STATUS
BEDROOM 1
FLOOR

Is the floor in good condition

WALLS

Are the walls in good condition

CEILING

Is the ceiling in good condition

DOOR

Is the door in good condition

LIGHTING

Are all lighting components functioning properly

OUTLETS

Are all outlets functioning properly

FURNISHINGS

Are all furnishings in good condition? Are the
mattresses new

BLINDS

Are all blinds present and in good condition

SMOKE/STROBES

Is the smoke alarm functioning properly

CLEAN AND MAKE
READY

Is the unit clean

BEDROOM 2
FLOOR

Is the floor in good condition

WALLS

Are the walls in good condition

ITEM

DESCRIPTION

YES

NO

N/A

UNKNOWN

CONTRACTOR
CERTIFICATION

FEMA
MONITOR

BEDROOM 2 (CONTINUED)
CEILING

Is the ceiling in good condition

DOOR

Is the door in good condition

LIGHTING

Are all lighting components functioning properly

OUTLETS

Are all outlets functioning properly

FURNISHINGS

Are all furnishings in good condition

BLINDS

Are all blinds present and in good condition

SMOKE/STROBES

Is the smoke alarm functioning properly

CLEAN AND MAKE
READY

Is the unit clean

BEDROOM 3
FLOOR

Is the floor in good condition

WALLS

Are the walls in good condition

CEILING

Is the ceiling in good condition

DOOR

Is the door in good condition

LIGHTING

Are all lighting components functioning properly

OUTLETS

Are all outlets functioning properly

FURNISHINGS

Are all furnishings in good condition

BLINDS

Are all blinds present and in good condition

SMOKE/STROBES

Is the smoke alarm functioning properly

CLEAN AND MAKE
READY

Is the unit clean

FEMA FORM 009-0-129 (2/15)

REPLACES FEMA Form 90-24

Page 4 of 5

HALLWAY
FLOOR

Is the floor in good condition

WALLS

Are the walls in good condition

CEILING

Is the ceiling in good condition

HVAC

Is the door in good condition

SMOKE/STROBES

Is the smoke alarm functioning properly

DRYER VENT
INSTALLED

Is the dryer vent functioning properly

CLEAN AND MAKE
READY

is the unit clean

ADDITIONAL COMMENTS

FEMA FORM 009-0-129 (2/15)

REPLACES FEMA Form 90-24

Page 5 of 5