Form FEMA Form 064-0-9 FEMA Form 064-0-9 Independent Study Course Enrollment Application

DEPARTMENT OF HOMELAND SECURITY

Federal Emergency Management Agency

FINAL EXAM NOTICE

OMB Control Number 1660-0046

Expires 03/31/2017

FEMA Form 064-0-9

Emergency Management Institute’s (EMI) Independent Study Course Enrollment Application Privacy Act Statement

Pursuant to 5 U.S.C. § 552a(e)(3), this Privacy Act Statement serves to inform you of why DHS is requesting the information on this form.

AUTHORITY: Collection of the information solicited on this form is authorized by the Robert T. Stafford Disaster Relief and Emergency Act, 42 U.S.C. §§ 5121-5207, Public Law 93-288, as amended.

PURPOSE: The primary purpose for soliciting this information is to register and enroll applicants in EMI independent study courses. FEMA is requesting this information as part of the EMI Independent Study Course Application process.

ROUTINE USES: The information solicited on this form may be made available as a "routine use" to state, local, tribal, and territorial governments to assist the Department of Homeland Security in registering and enrolling their employees in EMI independent study courses. The information may be made available to State Training Officers (STOs) to track and approve enrollment requests for EMI independent study courses for their respective governments. A complete list of the routine uses can be found in the system of records notice associated with this form, "Department of Homeland Security/Federal Emergency Management Agency - DHS/FEMA-011 Training and Exercise Programs System of Records." The Department's system of records notices can be found on the Department's website at http://www.dhs.gov/system-records-notices-sorns.

CONSEQUENCES OF FAILURE TO PROVIDE INFORMATION: Furnishing this information is voluntary; however, failure to provide this information may prevent enrollment in your selected EMI course.

Public Burdon Disclose Notice

Public reporting burden for this data collection is estimated to average .5 hours per response for the forms completed electronically or .75 hours for forms manually completed. 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. 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, Paperwork Reduction Project (1660-0046) NOTE: Do not send your completed form to this address.

Notice:

As of April 1, 2015, FEMA’s Emergency Management Institute (EMI) no longer accepts social security numbers (SSN) for exam submission. Instead, FEMA has implemented a student identification (SID) number. You will be required to obtain and use the SID to take the final exam. If you do not yet have a SID number, follow these steps to register for one.

If you have already registered, enter your SID and last name below.

*Student Identification (SID) Number:

* Last Name (Use the last name that you used when signing up for your SID):

Completion of this final examination is an individual effort

If you are found to have cheated on an exam, the penalty may include--but is not limited to--expulsion; foreclosure from future classes for a specified period; forfeiture of certificate for course/courses enrolled in at National Emergency Training Center (NETC) in accordance with NETC Instruction 119-22. A letter notifying your sponsoring organization of misconduct will be sent by the appropriate official at NETC.

I agree that completion of this examination will be an individual effort.

EMI takes protecting your personal information seriously. We encrypt your information using SSL, and all of your information is maintained in a secure government database system.

Organizations are encouraged to establish procedures to ensure completion of the final examination is an individual effort. Personnel within an organization who feel that test answers are being improperly provided should follow their organization's measures for reporting unethical conduct.

Please note that this page will "time out" in 25 minutes if there is no activity on the page. Prior to timing out, you will be given an opportunity to request more time. If the page has timed out, you will be redirected to the IS Course List. If you click the back button, your test will not be processed.

Required Student Information