FEMA Form FF-USFA- National Fire Department Registry - Paper Version

DEPARTMENT OF HOMELAND SECURITY

Federal Emergency Management Agency

OMB Control Number: 1660-0070
Expires: 06/30/2022

NATIONAL FIRE DEPARTMENT REGISTRY
PAPERWORK BURDEN DISCLOSURE NOTICE
Public reporting burden for this data collection is estimated to average 25 minutes 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 survey. You are not required to
respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of 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 (1660-0070) NOTE: Do
not send your completed form to this address.

Fire Department Name

Fire Department Identification Number (FDID)

The FDID is a unique identifier assigned by the state for fire incident reporting
purposes. If FDID is unknown, leave blank.

DRAFT

Fire Department Headquarters Address (physical location of the fire department)
Address Line 1
Address Line 2
City

State

County

Zip Code

Fire Department Mailing Address (if different than headquarters address)
Address Line 1
Address Line 2
Post Office Box Number

Number of Stations:

City

State

Zip Code

Please indicate the total number of fire stations within your department.

Note: If your fire department is comprised of two or more independently incorporated fire companies; please list the names and
addresses of those companies on the enclosed supplemental address sheet. An example of this would include a county fire
department that is comprised of two or more independently incorporated fire companies.
Fire Department Headquarters
Fire Department
Fire Department E-mail Address: Please complete only if this is a
Telephone Number
Headquarters Fax Number
department e-mail address. Do not use personal e-mail address.
(
)
(
)
Fire Department Web Address: If your fire department maintains a web site, please provide the web address URL.
Organization Type - Select the choice that best describes your fire department
Local (includes career, combination, volunteer fire departments and fire districts)
Tribal Government (includes Native American and Alaska Native tribal fire departments)
State Government (includes state forest fire agencies and state institution fire departments)
Regional/metropolitan transportation authority or airport fire department
Federal Government - Executive branch agency fire department
Federal Government - Department of Defense fire department
Private or industrial fire brigade
Contract fire department
Other (please explain)

FEMA Form FF-USFA-FY-21-100 (formerly 070-0-0-1)
(2/21)

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Emergency Management
Emergency Management (EM): integration and coordination of all-hazards mitigation, prevention, preparedness, response, and recovery
activities within a community for all (or most) agencies such as fire, EMS, public information, volunteer service, etc.
Is your fire department the primary agency responsible for emergency management in your community?

Yes

No

If no, then what agency is the primary agency responsible for emergency management in your community?
Population Protected
U.S. Census
Area Protected

Provide the total permanent resident population protected by your department and the source for the
information provided.
Estimate

Other (please explain)

Provide an estimate of the total primary response area in square miles protected by your department.

DRAFT

Number of active firefighting personnel Counting all stations, how many active career, volunteer, and paid per call firefighting personnel
does your department have? (Please indicate the number next to the category.)
Career
Indicate total number of full-time paid fire officers and firefighters within your department.
Volunteer
Indicate the total number of active firefighting volunteers within your department. A volunteer is defined as a member who
receives no compensation for his or her services.
Paid per call
Indicate the total number of firefighters in the department who are not full-time paid firefighters but receive compensation for
their participation.
Number of non-firefighting support personnel.
Non-firefighting volunteers

Civilian full-time and part-time employees

Specialized Services Provided
Some departments provide specialized services. As you read through the lists below, please check each of the specialized services your
department provides.
Wildfire/Urban-Wildland Interface
Airport/Aviation
Fireboat
EMS Ambulance Transport
EMS Non-Transport Response
Basic Life Support (BLS, First Responder/EMTBasic Level of Care)
Advanced Life Support (ALS, EMT-Paramedic/
EMT-Intermediate Level of Care)
HAZMAT Team (Technician Level)

Technical/Specialized Rescue, (Confined Space Rescue, Rope
Rescue, Swiftwater Rescue, Dive Rescue, Building Collapse
Rescue/Urban Search and Rescue, etc.)
Fire Inspection/Code Enforcement
Fire/Injury Prevention/Public Education
Departmental (in-house) Training Academy
Fire Investigation/Fire Cause Determination
Sworn (Investigators have power to arrest)
Non-Sworn
Juvenile Firesetter Intervention Program

Vehicle Extrication

FEMA Form FF-USFA-FY-21-100 (formerly 070-0-0-1)
(2/21)

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United States Fire Administration Programs
Is your fire department familiar with United States Fire Administration programs and publications?

Yes

No

If yes, how? (check all that apply)
Web site http://www.usfa.fema.gov
Publications
National Fire Academy Courses
National Fire Incident Reporting System (NFIRS)
Public Fire Education Programs
Other (please explain)

DRAFT

Survey Completed by: (Please provide contact information for the person completing this survey)
Name (Please print)
Telephone Number
(
)

Fax Number
(
)

E-mail Address:

Supplemental Address Sheet
(Please make additional copies if necessary.)

Fire Company Name
Address Line 1
Address Line 2
City

State

Zip Code

State

Zip Code

State

Zip Code

Fire Company Name
Address Line 1
Address Line 2
City
Fire Company Name
Address Line 1
Address Line 2
City

PRIVACY ACT NOTICE
The collection of this information is authorized by the Federal Fire Prevention and Control Act of 1974, as amended, 15 U.S.C. § 2201.
This information is being collected for the primary purpose of disseminating fire safety and prevention information to fire departments across
the United States. The United States Fire Administration (USFA) will share this information on its website, excluding individual names,
telephone numbers, fax numbers, and email addresses.
The disclosure of information on this form is voluntary; however, a failure to provide this information may result in your fire department not
receiving critical fire safety and prevention information.

FEMA Form FF-USFA-FY-21-100 (formerly 070-0-0-1)
(2/21)

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