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pdfDEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
IPAWS MEMORANDUM OF AGREEMENT (MOA) APPLICATION
OMB Control No. 1660-NEW
Expires: XX-XX-XXXX
PAPERWORK BURDEN DISCLOSURE NOTICE
Public reporting burden for this form is estimated to average 1 hour 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). NOTE: Do not send your completed form to the above
address.
PRIVACY NOTICE
Authorities: Executive Order 13407,”Public Alert and Warning System”
Purpose: FEMA is collecting this information to assess an entity's eligibility to use FEMA's Integrated Public Alert and Warning System
(IPAWS), and to provide access to specific members of the requesting entity to facilitate access to IPAWS.
Routine Uses: The information will be used by and disclosed to DHS personnel or other agents who need the information to assist in activities
related to the use of IPAWS. The information on this form may be disclosed as generally permitted under the Privacy Act of 1974, as amended
(5 U.S.C. § 552). This includes using this information as necessary and authorized by the routine uses published in DHS/ALL-004 General
Information Technology Access Account Records System (GITAARS) (September 29, 2009, 74 Fed. Reg. 49,882, and upon written
request, by agreement, or as required by law.
Disclosure: Furnishing this information is voluntary; however, failure to furnish the requested information may delay or prevent DHS/FEMA
from providing the requested access to its IPAWS system.
Instructions for Organizations Applying for Access to IPAWS-OPEN
DRAFT
NOT
APPROVED
FOR
USE
1. Review the following eligibility criteria to determine if your organization and interoperable software system qualify for access to IPAWSOPEN:
• State, local, tribal, territorial, or federal governmental organization of the United States.
• The interoperable software developer has executed an MOA with FEMA for system testing. See the IPAWS-OPEN Developers list
posted at http://www.fema.gov/library/viewRecord.do?id=5670.
2. If your organization and interoperable software system meet the criteria, complete the Memorandum of Agreement (MOA) application form
and return to [email protected]. Please indicate "Operational COG Application" in the subject line of your email.
3. Notes on the MOA Application
a. Name of Sponsoring Eligible Organization: This organization must meet the eligibility criteria above and be responsible for ensuring the
provisions of the MOA and accompanying Rules of Behavior are enforced. A Collaborative Operating Group (COG) is a term used by IPAWS
to designate an organization that is responsible for coordinating emergency management or incident response activities. A COG may have
members from multiple organizations (e.g., a regional mutual aid organization); however, an official Sponsoring Organization must execute the
MOA on behalf of the COG membership.
b. Name and Title of individual who will sign the MOA on behalf of the Sponsoring Organization: The person who will execute the MOA on
behalf of the Sponsoring Organization should be an individual who has the authority to enter agreements with the United States government on
behalf of the organization.
c. Primary Point of Contact Information: This information pertains to the individual completing the application on behalf of the Sponsoring
Organization. An official email address must be provided.
d. Alternate Point of Contact Information: This information will be only used by FEMA in the event the Primary Point of Contact cannot be
reached.
e. Technical Point of Contact Information: This information pertains to the individual who is responsible for system administration for the
Sponsoring Organization.
f. System Information: Three blank forms are provided to complete interoperable system information, which will be used to populate Appendix
A of the MOA. Complete one form for each interoperable system as needed. (E.g., if only one interoperable system is used, complete only one
form. If additional forms are required, contact the FEMA IPAWS MOA Coordinator.) If necessary, consult your system vendor/developer to
ensure accuracy of the information. Vendor/developer contact information will only be used in the event that technical clarification is required.
4. Next Steps
Once the application has been submitted to the FEMA IPAWS MOA Coordinator, the MOA will be prepared and returned to the Primary Point
of Contact for signature and return by the Sponsoring Organization. It will then be routed to the FEMA IPAWS-OPEN System Owner. Once
executed, a COG ID and digital certificate will be generated and implemented in IPAWS-OPEN. A copy of the executed MOA, COG ID, and
digital certificate will be returned to the Primary Point of Contact.
FEMA FORM 007-0-25
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Page 1 of 5
IPAWS MEMORANDUM OF AGREEMENT (MOA) APPLICATION
Name of Sponsoring Eligible Organization:
DRAFT
NOT
APPROVED
FOR
USE
Individual who will sign the MOA on behalf of the Sponsoring Eligible Organization
Name:
Title:
Email:
Telephone:
Organization:
Physical Address:
City:
State:
Zip Code:
Alabama
Primary Point of Contact
Name:
Title:
Email:
Telephone:
Organization:
Physical Address:
City:
State: Alabama
Zip Code:
Alternate Point of Contact
Name:
Title:
Email:
Telephone:
Organization:
Physical Address:
City:
State:
Zip Code:
Alabama
Technical Point of Contact
Name:
Title:
Email:
Telephone:
Organization:
Physical Address:
State: Alabama
City:
FEMA FORM 007-0-25
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Zip Code:
Page 2 of 5
IPAWS MEMORANDUM OF AGREEMENT (MOA) APPLICATION
Interoperable System 1
DRAFT
NOT
APPROVED
FOR
USE
(The following information will be used to populate Appendix A of the MOA. Please complete one form for each interoperable system
connecting to IPAWS-OPEN.)
Name of Interoperable Software System:
Function:
Is this system intended to be used to issue public alerts for dissemination over the Emergency Alert System (EAS), the Commercial Mobile Alert
Yes
No
System (CMAS) and/or National Weather Service dissemination systems (HazCollect) via IPAWS-OPEN?
(Briefly describe the purpose of the system.)
Host Server Location:
Type of Third Party Software System:
Commercial Off The Shelf Software (COTS)
Company:
Custom Designed Software
Company:
Other
If "Other", please describe:
Data Sensitivity: (Note: Classified systems cannot be connected to IPAWS-OPEN)
Interoperable System 1 does not contain classified data. I understand that IPAWS-OPEN system data is considered Sensitive But
Unclassified (SBU) and this level of security is adequate for our requirements. I also understand that Law Enforcement Sensitive or
Sensitive Personally Identifiable Information (SPII) (such as Social Security Numbers) should not be passed through IPAWS-OPEN.
Data Description: (Describe only data that will be relayed to or retrieved from IPAWS-OPEN.)
Vendor/Developer Contact Information:
Name:
Title:
Email:
Telephone:
FEMA FORM 007-0-25
(8/15)
Page 3 of 5
IPAWS MEMORANDUM OF AGREEMENT (MOA) APPLICATION
Interoperable System 2
DRAFT
NOT
APPROVED
FOR
USE
(The following information will be used to populate Appendix A of the MOA. Please complete one form for each interoperable system
connecting to IPAWS-OPEN.)
Name of Interoperable Software System:
Function:
Is this system intended to be used to issue public alerts for dissemination over the Emergency Alert System (EAS), the Commercial Mobile Alert
Yes
No
System (CMAS) and/or National Weather Service dissemination systems (HazCollect) via IPAWS-OPEN?
(Briefly describe the purpose of the system.)
Host Server Location:
Type of Third Party Software System:
Commercial Off The Shelf Software (COTS)
Company:
Custom Designed Software
Company:
Other
If "Other", please describe:
Data Sensitivity: (Note: Classified systems cannot be connected to IPAWS-OPEN)
Interoperable System 2 does not contain classified data. I understand that IPAWS-OPEN system data is considered Sensitive But
Unclassified (SBU) and this level of security is adequate for our requirements. I also understand that Law Enforcement Sensitive or
Sensitive Personally Identifiable Information (SPII) (such as Social Security Numbers) should not be passed through IPAWS-OPEN.
Data Description: (Describe only data that will be relayed to or retrieved from IPAWS-OPEN.)
Vendor/Developer Contact Information:
Name:
Title:
Email:
Telephone:
FEMA FORM 007-0-25
(8/15)
Page 4 of 5
IPAWS MEMORANDUM OF AGREEMENT (MOA) APPLICATION
Interoperable System 3
DRAFT
NOT
APPROVED
FOR
USE
(The following information will be used to populate Appendix A of the MOA. Please complete one form for each interoperable system
connecting to IPAWS-OPEN.)
Name of Interoperable Software System:
Function:
Is this system intended to be used to issue public alerts for dissemination over the Emergency Alert System (EAS), the Commercial Mobile Alert
Yes
No
System (CMAS) and/or National Weather Service dissemination systems (HazCollect) via IPAWS-OPEN?
(Briefly describe the purpose of the system.)
Host Server Location:
Type of Third Party Software System:
Commercial Off The Shelf Software (COTS)
Company:
Custom Designed Software
Company:
Other
If "Other", please describe:
Data Sensitivity: (Note: Classified systems cannot be connected to IPAWS-OPEN)
Interoperable System 3 does not contain classified data. I understand that IPAWS-OPEN system data is considered Sensitive But
Unclassified (SBU) and this level of security is adequate for our requirements. I also understand that Law Enforcement Sensitive or
Sensitive Personally Identifiable Information (SPII) (such as Social Security Numbers) should not be passed through IPAWS-OPEN.
Data Description: (Describe only data that will be relayed to or retrieved from IPAWS-OPEN.)
Vendor/Developer Contact Information:
Name:
Title:
Email:
Telephone:
FEMA FORM 007-0-25
(8/15)
Page 5 of 5
| File Type | application/pdf |
| File Title | FEMA Form |
| File Modified | 2015-08-20 |
| File Created | 2015-01-28 |