Form FEMA Form FF-206-F FEMA Form FF-206-F FEMA DTA Request Form

FEMA DTA Request Form Page

Subpage to DTA Webpage: https://www.fema.gov/grants/mitigation/building-resilient-infrastructure-communities/direct-technical-assistance

H1: BRIC Non-Financial Direct Technical Assistance Request Form

Paragraph: This form is for requesting non-financial Direct Technical Assistance (DTA) offered through the Building Resilient Infrastructure and Communities (BRIC) program provided by the Federal Emergency Management Agency (FEMA). Eligible communities request hazard mitigation assistance by completing this form. Each community or group of communities may only submit one request. A confirmation email will be sent to you within X business days. This form closes Friday, Jan 27, 2023 at 3:00 PM ET.

Iframe/Embed of Form:

COMMUNITY DETAILS AND CONTACT INFORMATION

• What community or communities do you represent in this DTA application?

[Input: Text Box]

• Point of Contact Name

[Input: Text Box]

• Community Phone Number

[Input: Text Box]

• Preferred Email Address

[Input: Text Box]

• Community Address

[Input: Text Box]

• City/Town

[Input: Text Box]

• State, territory, or tribal government

[Input: Drop Down (only one selection)]

• AL Alabama

• AL Alaska

• AS American Samoa

• AZ Arizona

• AR Arkansas

• CA California

• CO Colorado

• CT Connecticut

• DE Delaware

• DC District of Columbia

• FM Federal States of Micronesia

• FL Florida

• GA Georgia

• GU Guam

• HI Hawaii

• ID Idaho

• IL Illinois

• IN Indiana

• IA Iowa

• KS Kansas

• KY Kentucky

• LA Louisiana

• ME Maine

• MH Marshall Islands

• MD Maryland

• MA Massachusetts

• MI Michigan

• MN Minnesota

• MO Missouri

• MT Montana

• NE Nebraska

• NV Nevada

• NH New Hampshire

• NJ New Jersey

• NM New Mexico

• NY New York

• NC North Carolina

• ND North Dakota

• MP Norther Marina Islands

• OH Ohio

• OK Oklahoma

• OR Oregon

• PW Palau

• PA Pennsylvania

• PR Puerto Rico

• RI Rhode Island

• SC South Carolina

• SD South Dakota

• TN Tennessee

• TX Texas

• UT Utah

• VT Vermont

• VI Virgin Islands

• VA Virginia

• WA Washington

• WV West Virginia

• WI Wisconsin

• WY Wyoming

• Tribal government

• ZIP/Postal Code

[Input: Numeric 5 digits]

• Are you federally recognized Tribal Government(s)/entity?

[Input: Radio Button (only one selection)]

• Yes

• No

• Are you a non-federally recognized Tribal Government(s)/entity?

[Input: Radio Button (only one selection)]

• Yes

• No

• Does your community have or participate in a Hazard Mitigation Plan?

[Input: Radio Button (only one selection)]

• Yes

• No

• Unsure

• Name the Hazard Mitigation Plan in which your community or communities participates?

[Input: Text Box]

ELIGIBILITY

• To be eligible for DTA, you must represent one or more of the options below. Please check all that apply.

[Input: Checkbox list]

• City

• Township

• County/Parish

• Special District Government

• Federally recognized Tribal Nation Government(s)

• Non-Federally recognized Tribal Nation Government(s)

• Group of two or more communities that fit the above criteria

HAZARD IDENTIFICATION

• Please check the box that describes the nature of the hazard(s) your community is facing. Please check all that apply.

[Input: Checkbox list]

1. Avalanche

2. Dam Failure

3. Drought

4. Earthquake

5. Erosion

6. Expansive Soils

7. Extreme Cold

8. Extreme Heat

9. Flood

10. Hail

11. Hurricane Wind

12. Landslide

13. Lightning

14. Sea Level Rise

15. Severe Winter Weather

16. Storm Surge

17. Subsidence

18. Tornado

19. Tsunami

20. Wildfire

21. Pandemic

DTA SUPPORT

Through DTA, FEMA can provide support for hazard mitigation planning, mitigation project assistance, and Building Resilient Infrastructure and Communities (BRIC) application-specific needs.

• Please indicate a primary Direct Technical Assistance need.

[Input: Dropdown (only one selection)]

1. Hazard Mitigation Plan Development/Update

2. Mitigation of a Specific Hazard/Risk Assessment

3. Community Outreach & Partnerships

4. General Hazard Mitigation Capacity Building Workshops

5. Project Identification & Scoping

6. Potential Funding Sources Identification

7. Benefit Cost Analysis (BCA)

8. Grant Writing Workshop

9. Grants Management Workshop

10. BRIC Sub-Application Development

11. Other

1. If “other” is selected, provide text box to explain further

• Please briefly describe any disasters your community has experienced in the past seven years.

[Input: Text Box]

• Please provide a brief description of the community’s need for Direct Technical Assistance and any challenges you have faced.

[Input: Text Box]

• Please provide a brief description of proposed deliverables and timelines, including duration of technical assistance.

[Input: Text Box]

PREVIOUS FEMA ASSISTANCE

• Have you received a subaward (Project, Advance Assistance, Capability and Capacity Building) under BRIC, the Pre-Disaster Mitigation (PDM) grant program, the Flood Mitigation Assistance (FMA) grant program, or the Hazard Mitigation Grant Program (HMGP) within the past 5 years?

[Input: Radio Button (only one selection)]

1. Yes

2. No

3. I don’t know

DISADVANTAGED COMMUNITIES

Paragraph: Social Vulnerability refers to the potential negative effects on communities caused by external stresses on human health. Such stresses include natural or human-caused disasters, or disease outbreaks. More information and resources regarding the Social Vulnerability Index can be found here https://www.atsdr.cdc.gov/placeandhealth/svi/index.html.

• Please briefly describe the social vulnerability within your community is potentially facing or has recently faced below.

[Input: Text Box]

• Is your community 3,000 or fewer individuals?

[Input: Radio Button (only one selection)]

1. Yes

2. No

Paragraph: Justice40 is a whole-of-government effort to ensure that Federal agencies work with states and local communities to deliver at least 40 percent of the benefits from Federal investments in climate and clean energy to disadvantaged communities. More information on this initiative can be found here: https://www.whitehouse.gov/omb/briefing-room/2021/07/20/the-path-to-achieving-justice40/.

Paragraph: You can determine if your community falls under the Justice40 Initiative using the Climate and Economic Justice Screening Tool (CEJST) here: Explore the tool - Climate & Economic Justice Screening Tool (geoplatform.gov)

• Are you designated as a disadvantaged community as defined by Executive Order14008, including Tribal Nation Government(s)?

[Input: Radio Button (only one selection)]

1. Justice40

2. No

3. I don’t know

POINT OF CONTACT ACKNOWLEDGEMENT

[Check box] By checking this box I confirm that if selected the community or communities referenced in this form agree to a) sign a Memorandum of Understanding with FEMA before non-financial technical assistance can begin and b) actively participate in Direct Technical Assistance (DTA) according to a DTA Plan developed in conjunction with FEMA.

FEMA Form FF-206-FY-22-155