Privacy Act and
Declaration of Eligibility Screen
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Service
Rep:
Please
read the following statement to each Delta Call applicant, as they
will not have heard it from the phone recorded message.
We
are required to provide you with the following Privacy Act
Statement.
The Privacy Act of 1974 protects your
rights as to how FEMA uses and shares your information.
The
Stafford Act and other authorities allow FEMA to collect this
information to determine eligibility and administer financial
assistance as a result of an Emergency or Presidentially declared
disaster.
FEMA may share your information outside of
FEMA with entities such as with States, tribes, local governments,
voluntary organizations, and other organizations in accordance
with published routine uses. FEMA shares this information to
enable you to receive additional disaster assistance and as
necessary to prevent a duplication of benefits and to prevent
future disaster losses.
FEMA may record phone calls
for internal quality assurance purposes. Furnishing your Social
Security Number and other requested information is voluntary,
however, failure to provide may delay or prevent you from
receiving assistance.”
If you knowingly make
false statements to obtain disaster aid, it is a violation of
federal and State laws.
Service
Rep:
In
order to be eligible to receive FEMA Disaster Assistance, a member
of the household must be a citizen, non-citizen national or
qualified alien of the United States. Please feel free to consult
with an attorney or other immigration expert if you have any
questions. By agreeing to continue your registration, you hereby
declare under penalty of perjury, that you are a citizen or
non-citizen national of the United States, a qualified alien of
the United States, or a parent or legal custodian of a child who
is a minor, who resides with you and who is a citizen, naturalized
citizen or qualified alien of the United States.
In
addition, you certify the following:
You
understand that,
if you intentionally make false statements or conceal any
information in an attempt to obtain disaster aid, it is a
violation of federal and State laws, which carry severe criminal
and civil penalties, including a fine up to $250,000,
imprisonment, or both. FEMA may use external parties to verify the
accuracy of representation made in the application process.
You
understand that
the information provided regarding your application for FEMA
disaster assistance may be subject to sharing within the
Department of Homeland Security (DHS) including, but not limited
to, the Bureau of Immigration and Customs Enforcement.
You
authorize
FEMA to verify all information given by you about your
property/place of residence, income, employment and dependents in
order to determine your eligibility for disaster assistance;
and
You
authorize
all custodians of records of your insurance, employer, any public
or private entity, bank financial or credit data service to
release information to FEMA and/or the State upon request.
Do
you understand and agree to these statements?
(If
the applicant disagrees, delete the registration, if they agree,
continue)
Service
Rep:
May
I have your Social Security Number?
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Service
Rep:
Please
read the following statement to each Delta Call applicant, as they
will not have heard it from the phone recorded message.
FEMA
is required to provide you with the following statement:
The
Privacy Act of 1974 protects your rights as to how FEMA uses and
shares your information with entities such as other Federal
agencies, including Department of Homeland Security, States,
tribal or local governments, voluntary organizations, and other
organizations providing disaster assistance in accordance with the
law. FEMA may share your information with these partners to make
sure you receive all disaster assistance available to you, prevent
duplicating benefits, or to prevent future disaster losses.
The
Stafford Act, Privacy Act and other laws allow FEMA to collect
information to determine eligibility and provide assistance as a
result of a Presidentially declared disaster.
FEMA
may record phone calls for internal quality assurance purposes.
Providing your Social Security Number and other requested
information is voluntary, however, refusing to provide this
information may delay or prevent you from receiving assistance.
To
be eligible for FEMA Assistance, you must hereby declare under
penalty of perjury, that you are a citizen, non-citizen national,
a qualified alien of the United States, or a parent or legal
custodian of a minor child, who lives with you and who is a
citizen, non-citizen national or qualified alien of the United
States.
You
must understand that
if you intentionally lie or hide any information in an attempt to
obtain disaster assistance, it is a violation of federal and State
laws, which carry severe fines and or imprisonment.
You
must understand that
if
you received FEMA Assistance and have insurance that covers the
same loss or receive other assistance for the same loss, you may
be required to return some or all of the FEMA Assistance provided
to you.
You
must authorize
FEMA to verify all information given by you about your primary
residence, income, identity, and dependents in order to determine
your eligibility for disaster assistance.
You
must authorize
FEMA and/or the State to request your personal information from
entities such as your insurance company, or financial institution.
To
continue your registration, you must acknowledge you understand
and that you agree with the information I have just read to you.
Do you understand and agree to these statements?
(If
the applicant disagrees, delete the registration, if they agree,
continue)
Service
Rep:
May
I have your Social Security Number?
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Condensing
per leadership request
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Damaged Dwelling Address
Screen – Help Text
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Enter
the Street Address, City, State and Zip Code without any
abbreviations (use 23 Back Mountain St instead of 23 Bk Mtn St).
Do
not enter a P.O. Box or General Delivery address for the damaged
dwelling address. You can use Rural Route, Rural Road, Farm Road,
FM, etc. but not a PO Box address.
Do
not enter a "#" symbol. (this is incorrect and should
be removed)
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Enter
the Street Address, City, State and Zip Code without any
abbreviations (use 23 Back Mountain St instead of 23 Bk Mtn St).
Do
not enter a P.O. Box or General Delivery address for the damaged
dwelling address. You can use Rural Route, Rural Road, Farm Road,
FM, etc. but not a PO Box address.
Only
one special character (#, -, /) is permitted.
Do
not enter extra spaces.
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Clarification
added regarding system formatting requirements for entering a
street address
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