Form FEMA Form 089-5 FEMA Form 089-5 PSGP Investment Justification

SENSITIVE
SECURITY
INFORMATION

DEPARTMENT OF HOMELAND SECURITY

Federal Emergency Management Agency
PORT SECURITY GRANT PROGRAM INVESTMENT JUSTIFICATION

OMB Control Number: 1660-0114
Expiration: 01/31/2017

PAPERWORK BURDEN DISCLOSURE NOTICE
FEMA Form 089-5
Public reporting burden for this data collection is estimated to average 15 hours 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,
500 C Street, SW., Washington, DC 20472-3100, Paperwork Reduction Project (1660-0114) NOTE: Do not send your completed form to this
address.
PRIVACY NOTICE
The collection of this information is authorized by Section 102 of the Maritime Transportation Security Act of 2002, as amended by 46 U.S.C.
§ 70107.
This information is being collected for the primary purpose of facilitating correspondence between the grant applicant and the Department of
Homeland Security and for determining eligibility and administration of FEMA Preparedness Grant Programs, specifically, the Port Security
Grant Program.
All information required to make award recommendations is provided to the United States Coast Guard (USCG), field reviewers which may
include local partners and the Department of Transportation (DOT) Maritime Administration (MARAD). Information may also be provided to
Federal partners including USCG, MARAD, and the Transportation Security Administration (TSA) for subsequent review. Non-disclosure
agreements are required of reviewers.
The disclosure of information on this form is voluntary; however, failure to provide the information requested may delay or prevent the
organization from receiving grant funding.
Warning: Please follow the Notice of Funding Opportunity Guidance while completing this form.

DRAFT
PART I - INVESTMENT HEADING

ORGANIZATION NAME (Legal Name Listed On The SF-424):

TYPE OF ORGANIZATION:

STATE OR TERRITORY IN WHICH THE PROJECT WILL BE
IMPLEMENTED:

STATE OR LOCAL AGENCY:

OTHER:

PROJECT'S CAPTAIN OF THE PORT ZONE:

INVESTMENT JUSTIFICATIONS (Ex. 1 of 1):

of

PART II - BASIC PROJECT INFORMATION
PROJECT TITLE:

PROJECT SERVICE(S)/EQUIPMENT SUMMARY:

IS THIS PROJECT EXEMPT FROM THE REQUIRED COST SHARE OUTLINED IN 46 U.S.C. 70107?
IF YES, IDENTIFY THE COST SHARE EXEMPTION :
FEDERAL SHARE:

COST SHARE:

TOTAL PROJECT COST:

(Total Project Cost x 0.75)

(Total Project Cost x 0.25)

(Fed Share/0.75; or Cost Share/0.25)

PROJECT CATEGORY:

NEW CAPABILITY OR MANAGEMENT/SUSTAINMENT:

WARNING: This record contains Sensitive Security Information that is controlled under 49 CFR parts 15 and 1520. No part of this record may be
disclosed to persons without a "need to know", as defined in 49 CFR parts 15 and 1520, except with the written permission of the Administrator of
the Transportation Security Administration or the Secretary of Transportation. Unauthorized release may result in civil penalty or other action. For
U.S. government agencies, public disclosure is governed by 5 U.S.C. 552 and 49 CFR parts 15 and 1520.

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PART III - ELIGIBILITY INFORMATION
PLEASE REVIEW THE NOTICE OF FUNDING OPPORTUNITY AND 46 U.S.C. 70107
WHICH PLAN(S) APPLIES TO YOUR
ORGANIZATION?:

AREA MARITIME SECURITY PLAN:

FACILITY SECURITY PLAN:

PORT-WIDE RISK MANAGEMENT PLAN:

VESSEL SECURITY PLAN:

IF NONE OF THE ABOVE ARE APPLICABLE, PLEASE LIST OTHER PORT RELATED SECURITY PLANS OR
CIRCUMSTANCES THAT APPLY TO THIS PROJECT AND YOUR ORGANIZATION:

ACTIVE PARTICIPANT OF AN AREA MARITIME
SECURITY COMMITTEE?
IS THE PROJECT SITE OWNED BY
YOUR ORGANZITION?

N/A

IS THIS APPLICATION ON BEHALF OF ANOTHER
ENTITIY OR SUBMITTED AS A CONSORTIUM?
IF THE PROJECT SITE IS NOT OWNED OR OPERATED BY YOUR
ORGANIZATON, PLEASE EXPLAIN YOUR ORGANIZATION'S RELATION TO
THE PROJECT SITE:

N/A

IS THE PROJECT SITE OPERATED
BY YOUR ORGANZITION?
IS THE PROJECT SITE A FACILITY OR VESSEL THAT IS REGULATED UNDER THE MARITIME TRANSPORTATION
SECURITY ACT (MTSA) OF 2002, AS AMENDED?
STATE AND LOCAL AGENCIES ONLY - IS YOUR AGENCY REQUIRED TO PROVIDE PORT SECURITY SERVICES TO MTSA
REGULATED FACILITIES?
STATE AND LOCAL AGENCIES ONLY - ARE YOU THE PRIMARY RESPONDING AGENCY TO MTSA REGULATED FACILITY?
PART IV - POINT(S) OF CONTACT FOR ORGANIZATION
SIGNATORY AUTHORITY FOR ENTERING INTO A GRANT AWARD AUTHORIZED REPRESENTATIVE FOR THE MANAGEMENT OF
AGREEMENT
THE PROJECT

DRAFT

NAME:

NAME:

ORGANIZATION:

ORGANIZATION:

ADDRESS:

ADDRESS:

PHONE:

PHONE:

E-MAIL:

E-MAIL:
PART V - PHYSICAL LOCATION OF PROJECT

The intent of this section is to verify the primary location the project is being implemented to address the PSGP and port area priorities. The
applicant's primary area of responsibility for utilizing the project should be identified. This includes training, exercises, interoperable systems,
vessel equipment and regionally beneficial projects. Secondary areas of responsibility are not considered the project location. Please identify
the location from which the project will be implemented/deployed (the applicant facility address), such as fire or police departments or MTSA
regulated facility.

PHYSICAL ADDRESS OF THE PROJECT LOCATION:

BRIEF DESCRIPTION OF THE PROJECT LOCATION:

Street Address:
City:
State:

Zip Code:

LATITUDE & LONGITUDE:
WARNING: This record contains Sensitive Security Information that is controlled under 49 CFR parts 15 and 1520. No part of this record may be
disclosed to persons without a "need to know", as defined in 49 CFR parts 15 and 1520, except with the written permission of the Administrator of
the Transportation Security Administration or the Secretary of Transportation. Unauthorized release may result in civil penalty or other action. For
U.S. government agencies, public disclosure is governed by 5 U.S.C. 552 and 49 CFR parts 15 and 1520.

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SENSITIVE SECURITY INFORMATION
STATE AND LOCAL AGENCIES ONLY - ROLE IN PROVIDING LAYERED PROTECTION OF REGULATED ENTITIES
DESCRIBE YOUR ORGANIZATION'S SPECIFIC ROLES, RESPONSIBILITIES AND ACTVITIES IN DELIVERING LAYERED PROTECTION.

DRAFT

WARNING: This record contains Sensitive Security Information that is controlled under 49 CFR parts 15 and 1520. No part of this record may be
disclosed to persons without a "need to know", as defined in 49 CFR parts 15 and 1520, except with the written permission of the Administrator of
the Transportation Security Administration or the Secretary of Transportation. Unauthorized release may result in civil penalty or other action. For
U.S. government agencies, public disclosure is governed by 5 U.S.C. 552 and 49 CFR parts 15 and 1520.

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SENSITIVE SECURITY INFORMATION
PART VI - ALL AGENCIES/ORGANIZATION - IMPORTANT FEATURES
DESCRIBE ANY OPERATIONAL ISSUES YOU DEEM IMPORTANT TO THE CONSIDERATION OF YOUR APPLICATION (e.g.,
interrelationship of your operations with other eligible high-risk ports, Memorandum of Understanding (MOU) or Memorandum of Agreement
(MOA), Etc.). PLEASE LIST ALL AGENCIES WITH WHOM YOU HAVE A MARITIME SECURITY MOU OR MOA.

DRAFT

WARNING: This record contains Sensitive Security Information that is controlled under 49 CFR parts 15 and 1520. No part of this record may be
disclosed to persons without a "need to know", as defined in 49 CFR parts 15 and 1520, except with the written permission of the Administrator of
the Transportation Security Administration or the Secretary of Transportation. Unauthorized release may result in civil penalty or other action. For
U.S. government agencies, public disclosure is governed by 5 U.S.C. 552 and 49 CFR parts 15 and 1520.

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SENSITIVE SECURITY INFORMATION
PART VII - INVESTMENT JUSTIFICATION ABSTRACT
WHAT WILL THIS PROJECT INVESTMENT FUND (i.e. vessels, radios, cameras, construction, contracts, fencing, etc.)?

ARE ANY PROJECT ITEMS ON THE CONTROLLED
EQUIPMENT LIST
(please reference FEMA Information Bulletin 407):

IF YES, PLEASE PROVIDE THE AUTHORIZED EQUIPMENT LIST
(AEL) NUMBER(S) FOR
CONTROLLED EQUIPMENT:

SUMMARIZE THE PROPOSED INVESTMENT JUSTIFICATION.
THE FOLLOWING MUST BE INCLUDED:
• DESCRIBE HOW THIS INVESTMENT ADDRESSES THE CAPTAIN OF THE PORT'S PRIORITIES
• EXPLAIN HOW THIS INVESTMENT WILL ACHIEVE A MORE SECURE AND RESILIENT PORT AREA
• IDENTIFY ASSETS BEING REQUESTED
• IDENTIFY SIMILAR ASSETS THAT ALREADY EXIST

DRAFT

WARNING: This record contains Sensitive Security Information that is controlled under 49 CFR parts 15 and 1520. No part of this record may be
disclosed to persons without a "need to know", as defined in 49 CFR parts 15 and 1520, except with the written permission of the Administrator of
the Transportation Security Administration or the Secretary of Transportation. Unauthorized release may result in civil penalty or other action. For
U.S. government agencies, public disclosure is governed by 5 U.S.C. 552 and 49 CFR parts 15 and 1520.

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SENSITIVE SECURITY INFORMATION
PART VIII - NATIONAL PRIORITIES
IDENTIFY ONE NATIONAL PRIORITY THIS INVESTMENT MOST CLOSELY SUPPORTS:

DESCRIBE HOW, AND THE EXTENT THIS INVESTMENT JUSTIFICATION MEETS ONE OR MORE OF THE NATIONAL PRIORITIES.
THE FOLLOWING MUST BE INCLUDED:
• HOW THIS INVESTMENT ADDRESSES VULNERABILITIES IDENTIFIED WITHIN AN AREA MARITIME SECURITY PLAN, FACILITY
SECURITY PLAN, VESSEL SECURITY PLAN, OR OTHER IDENTIFIED PLAN(S).

DRAFT

WARNING: This record contains Sensitive Security Information that is controlled under 49 CFR parts 15 and 1520. No part of this record may be
disclosed to persons without a "need to know", as defined in 49 CFR parts 15 and 1520, except with the written permission of the Administrator of
the Transportation Security Administration or the Secretary of Transportation. Unauthorized release may result in civil penalty or other action. For
U.S. government agencies, public disclosure is governed by 5 U.S.C. 552 and 49 CFR parts 15 and 1520.

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SENSITIVE SECURITY INFORMATION
PART IX - NATIONAL PREPAREDNESS GOAL
IDENTIFY ONE CORE CAPABILITY THIS INVESTMENT MOST CLOSELY SUPPORTS:

PART X - IMPLEMENTATION PLAN
PROVIDE A HIGH-LEVEL TIMELINE OF MILESTONES FOR THE IMPLEMENTATION OF THIS INVESTMENT, SUCH AS PLANNING,
TRAINING, EXERCISES, AND MAJOR ACQUISITIONS OR PURCHASES. UP TO 10 MILESTONES MAY BE SUBMITTED.
THE FOLLOWING MUST BE INCLUDED:
• MAJOR MILESTONES OR RELEVANT INFORMATION THAT IS CRITICAL TO THE SUCCESS OF THE INVESTMENT
• MAJOR TASKS THAT WILL NEED TO OCCUR (E.G. DESIGN AND DEVELOPMENT, CONTRACTUAL AGREEMENTS,
PROCUREMENT, DELIVERY, INSTALLATION AND PROJECT COMPLETION)

DRAFT

WARNING: This record contains Sensitive Security Information that is controlled under 49 CFR parts 15 and 1520. No part of this record may be
disclosed to persons without a "need to know", as defined in 49 CFR parts 15 and 1520, except with the written permission of the Administrator of
the Transportation Security Administration or the Secretary of Transportation. Unauthorized release may result in civil penalty or other action. For
U.S. government agencies, public disclosure is governed by 5 U.S.C. 552 and 49 CFR parts 15 and 1520.

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