FEMA Form 009-0-111A Quarterly Reporting Tool

OMB No. 1660-0076

Expiration Date: _____

                                                                              

PAPERWORK REDUCTION ACT BURDEN DISCLOSURE NOTICE

FEMA Form 009-0-111A

Public reporting burden for this spreadsheet is estimated to average 50 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 the spreadsheet. This collection of information is required to obtain or retain a benefit.  You are not required to respond to this collection of information unless it displays a valid OMB control number near the title of the electronic collection instrument, or for on-line applications, on the first screen viewed by the respondents.  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 (1660-0076) NOTE: Do not send your completed form to this address.

Instructions to Grantees and Sub-Grantees for Quarterly Progress Reports for FEMA’s Hazard Mitigation Grant Program (HMGP)

The HMGP Quarterly Progress Report tool is designed to provide the information required by FEMA under 44 C.F.R. § 206.438(c) and any corresponding FEMA/State Agreement(s).

The following fields are completed by FEMA personnel and no action is required by the Grantee:

Region, State, Disaster Number, Sub-grantee Name, Sub-grantee ID (FIPS #), Project Number, Latest Amendment Number, Project Type, Project Title, Total Eligible, Federal Share Obligated, Date Obligated, Calculation of UDO, Excess funds Yes/No, and Deobligation Amount.

The following fields must be completed by the Grantee and/or Sub-Grantee for ongoing HMGP projects (as defined by 44 C.F.R. § 206.438(c)) and in accordance with any corresponding FEMA/State Agreement(s). Each Quarterly Report must include information regarding each property acquired within the reporting period.

Sub-grantee Expenditures To Date	Total amount paid by the Sub-grantee to accomplish the work described in the HMGP application.
Total Grantee Drawdown	Per project, Federal funds drawn down by Grantee
Date of Last Drawdown	Per project, date of last drawdown of Federal funds.
Federal Funds Disbursed	Per project, disbursed to the Sub-grantees by the Grantee
Date Final Payment Made to Sub-grantee	Per project, final payment made, if applicable. Project is ready for closeout.
Approved Completion Date	Latest approved Period of Performance/Project completion including time extension.
Time Ext.	Has a time extension been granted? Yes/No.
Pct. Work Complete	Description of the status of the project. Examples; In Design, In Bid Process, 10%, 25% etc.
Actual Completion Date	Date project completed, if applicable.
FOR ACQUISITION PROJECTS: LIST ALL PROPERTIES ACQUIRED THIS QUARTER	List all addresses of properties that have gone to closing even if Sub-grant is open.

PRIVACY ACT STATEMENT

AUTHORITY: The Robert T. Stafford Disaster Relief and Emergency Assistance Act at 42 U.S.C. § 5170c.

PRINCIPAL PURPOSE(S): This information being collected via Excel Spreadsheet is for the primary purpose of monitoring status of Grantees’ disaster Hazard Mitigation Grant.

ROUTINE USE(S): The information on this form may be disclosed as generally permitted under the Freedom of Information Act, 5 U.S.C. 552, and 5 U.S.C. § 552a(b) of the Privacy Act of 1974, as amended. This includes using this information as necessary and authorized by routine uses published in DHS/FEMA-009 Hazard Mitigation Assistance Grants Programs System of Records, 77 Fed. Reg. 17,783 (July 23, 2012) 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 disaster services and/or assistance.

FEMA FORM 009-0-111A