FEMA Form FF-119-F Surplus Federal Real Property Application for Public Ben

DEPARTMENT OF HOMELAND SECURITY

Federal Emergency Management Agency

OMB Control No. 1660-0080
Expiration Date: 07/31/2023

SURPLUS FEDERAL REAL PROPERTY PUBLIC BENEFIT CONVEYANCE
PROGRAM APPLICATION AND GUIDANCE FOR FEDERAL EMERGENCY
MANAGEMENT RESPONSE AND FIRE AND RESCUE USE
ELIGIBILITY
The fifty States, the District of Columbia, the Commonwealth of Puerto Rico, Guam, American Samoa, the Virgin Islands, the
Federated States of Micronesia, the Marshall Islands, Palau, and the Northern Mariana Islands.

DEADLINE
The completed application is due within 60 days of the announcement date on the NOTICE OF SURPLUS DETERMINATION (or
within 30 days of the expiration date of the NOTICE OF SURPLUS DETERMINATION).

CONTACT INFORMATION
PBC Coordinator
Federal Emergency Management Agency
Installations & Infrastructure - Real Property
Suite 100, 400 C Street, SW, Washington, DC 20472
202-212-3631 (office)
[email protected]

DRAFT

SURPLUS FEDERAL REAL PROPERTY PUBLIC BENEFIT CONVEYANCE (PBC)
AND BASE REALIGNMENT AND CLOSURE (BRAC) PROGRAMS

BACKGROUND

Excess Federal Real property is defined as property that is no longer mission critical to the needs of the Federal government. The
conveyance and disposal of excess real property is governed by the Federal Property and Administrative Services Act of 1949
(Property Act) as amended, 40 U.S.C. 541, et. seq., and applicable regulations (Title 40 U.S.C. 553 and 41 C.F.R. parts 102-75.750
through 102-75.815). Under the sponsorship of Federal Emergency Management Agency (FEMA), the Act gives the Administrator of
the General Services Administration (GSA) authority to convey Federal real and related personal property (without monetary
consideration) to units of State and local government for emergency management response purposes, including fire and rescue
services.
PBC - GSA and other Federal and local government land holding agencies are tasked with regularly surveying governmentowned properties to determine if properties are being fully utilized, under utilized, or not put to best use. GSA reviews the
resulting reports and makes a determination as to the availability of these properties. If available, GSA categorizes them as
excess and the properties are offered to other Federal government agencies for acquisition*. If no other Federal agency
expresses an interest in the excess properties, the properties are then deemed surplus and are offered to State and local
government agencies for acquisition via negotiated sale or through the vehicle known as public benefit conveyance (PBC). GSA
will determine the appropriate program for which the properties are best suited and will inform the proper sponsoring agency of
availabilities. GSA is responsible for enforcing compliance with the terms and conditions of disposals of property to be used for
emergency management response purposes.
BRAC - Under the Department of Defense Base Realignment And Closure (BRAC) Act of 1990, PBC sponsoring agencies,
such as FEMA, work under the auspices of the Office of Economic Adjustment (OEA) and in conjunction with Local
Redevelopment Authorities (LRA) to efficiently utilize military base locations that have been approved for public use*. The LRA
is responsible for developing a reuse plan that appropriately balances the needs of the various communities affected by these
modifications. OEA manages and directs the Defense Economic Adjustment Program and coordinates the involvement of other
federal agencies and Local Redevelopment Authorities in assisting communities that may be adversely impacted by such
program changes. While GSA assumes primary administration responsibilities for BRAC properties, final disposition rests solely
with DoD.

FEMA
FEMA reviews all applications to make recommendations to the GSA Administrator or the Secretary for Defense, as to whether: (1)
the use proposed by the state or unit of local government meets the requirements of the statute; and/or (2) the environmental impact
of the proposed transfer has been properly assessed under the National Environmental Policy Act (NEPA).
FEMA is also responsible for providing interested parties with an application kit, which requests relevant information so that FEMA
can determine if the proposed use is appropriate and in compliance with applicable Federal laws.
*In 1987, Congress enacted the Stewart B. McKinney Homeless Assistance Act. Title V of this Act made serving the homeless the first priority for use
of all surplus Federal properties, including military installations. The Department of Housing and Urban Development (HUD) reviews all LRA plans to
determine compliance with the statue.

FEMA Form FF-119-FY-22-133 (formerly 119-0-1) (10/22)

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DISCLAIMER
Please note under 40 U.S.C. 553, the GSA Administrator and/or the Secretary for Defense has final approval authority with respect
to any and all surplus property conveyances.

ELIGIBILITY
The fifty states, the District of Columbia, the Commonwealth of Puerto Rico, Guam, American Samoa, the Virgin Islands, the
Federated States of Micronesia, the Marshall Islands, Palau, and the Northern Mariana Islands, or any political subdivision or
instrumentality thereof, may authorize applications for conveyance of surplus real property for correctional facility, law enforcement
or emergency management response purposes.

STIPULATIONS AND COMPLIANCE
The deed of conveyance for each and every Program surplus property, stipulates that all of the subject property must always be
used and maintained for the purpose(s) set forth in the Program application. Periodic inspections of properties will be made by GSA
and FEMA to ensure continuing compliance with the terms and conditions of the conveyance. Recipients can suffer hardship and
financial loss when properties revert back to Federal ownership for noncompliance. For example, if a facility is constructed on
property conveyed for Federal emergency management response use, and is later found, instead, as being used for mental health
facility purposes, the recipient would be deemed in non-compliance and the property would be subject to reversion to the Federal
Government. Recipients must coordinate any proposed deviation, however minor, with FEMA and GSA. Recipients must also file an
annual self-certification with their respective regional GSA representatives stating that their current program of use is consistent with
those identified in the application.

NON-DISCRIMINATION CLAUSE

DRAFT

Section 102-75.360: The Grantee covenants for itself, its heirs, successors, and assigns and every successor in interest to the
property hereby conveyed, or any part thereof, that the said Grantee and such heirs, successors, and assigns shall not discriminate
upon the basis of race, creed, color, religion, sex, disability, age, or national origin in the use, occupancy, sale, or lease of the
property, or in their employment practices conducted thereon.

INTERGOVERNMENTAL REVIEW OF FEDERAL PROGRAMS

To foster intergovernmental partnerships between the States and their local governments, your intent to apply for excess Federal
property must be communicated to your State's Single Point of Contact (SPOC) for review as per Executive Order 12372:
https://www.fws.gov/policy/library/rgeo12372.pdf.

APPLICATION

Please complete and sign the attached application and submit with required attachments via e-mail to: [email protected]
Mail: Suite 100, 400 C Street, SW, Washington, DC 20472

PAPERWORK BURDEN DISCLOSURE NOTICE
Public reporting burden for this form is estimated to average 4.5 hours per response. The burden estimate includes the time for
reviewing instructions and searching existing data sources, gathering and maintaining the data needed and completing and
submitting the form. You are not required to respond to this collection of information unless a valid OMB control number appears in
the upper right corner 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 (1660-0080). NOTE: Send completed form to Federal
Emergency Management Agency, Installations & Infrastructure Division - Real Property, 400 C Street SW, Suite 100, Washington
DC 20472.

PRIVACY NOTICE
AUTHORITY: FEMA collects, uses, maintains, retrieves, and disseminates the records in this system under the authority of the
Federal Property and Administrative Services Act of 1949 (Property Act) as amended, and 40 U.S.C. §§ 541,553, and 41 C.F.R.
102-75.750-102-75.815.
PRINCIPAL PURPOSES: This information is being collected for the primary purpose of processing applications for Public Benefit
Conveyance (PBC) and Base Realignment and Closure (BRAC) programs whereby state, local or tribal governments may acquire
federal surplus property for emergency management purposes at no cost.
USES: The information on this form will be used by FEMA for the purpose described above and will be shared with the General
Services Administration (GSA) and the applicant. FEMA will retain these records for 3 years, but longer retention is authorized if
required for business use; pursuant to the General Records Schedule 5-4, item 40.
CONSEQUENCES OF FAILURE TO PROVIDE INFORMATION: The disclosure of information on this form is voluntary; however,
failure to provide the information requested may result in the inability to process applications for excess real property.
FEMA Form FF-119-FY-22-133 (formerly 119-0-1) (10/22)

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SECTION I - APPLICANT INFORMATION
1. STATE, LOCAL, OR TRIBAL GOVERNMENT NAME

2. ORGANIZATION

3. ADDRESS

5. CITY

4. COUNTY

6. STATE

7. ZIP CODE

8. CONGRESSIONAL DISTRICT(S)

9. NAME OF PRINCIPAL POINT OF CONTACT

10. TELEPHONE NUMBER

11. EMAIL ADDRESS

SECTION II - ACQUISITION AUTHORITY
1. IDENTIFY THE STATE AND LOCAL GOVERNMENT AGENCY THAT IS AUTHORIZED BY LAW TO ENTER INTO
CONTRACTS WITH THE FEDERAL GOVERNMENT FOR THE CONVEYANCE OF REAL PROPERTY. (Please provide a copy
of the State enabling legislation and cite the actual paragraph or portion of the legislation that establishes that authority)

2. IF THE ABOVE-AUTHORIZED AGENCY IS NOT THE APPLICANT AGENCY, PROVIDE WRITTEN DELEGATION FROM THE
AUTHORIZED AGENCY TO PROCURE THE REQUESTED PROPERTY.

DRAFT

3. ACQUISITION AUTHORITY: Name, title, address, telephone number, and email address of official with legal authority to enter
into contracts with the federal government.
3a. NAME/TITLE
3b. ADDRESS (Include city, state, and zip code)

3c. TELEPHONE NUMBER

3d. EMAIL ADDRESS

SECTION III - PROPERTY INFORMATION
1. PROPERTY IDENTIFCATION* (Name, city, county, and state)

2. GSA NUMBER (if applicable) OR BASE REALIGNMENT ID
NO.

3a. DATE APPLICANT NOTIFIED GSA OR LOCAL
REDEVELOPMENT AUTHORITY (LRA) OF INTEREST
(Please attach notice)

3b. DATE APPLICANT
NOTIFIED FEMA (Please
attach notice)

3c. DATE PROPERTY WILL
BE AVILABLE FOR
CONVEYANCE

4. DESCRIPTION OF PROPERTY (Attach separate sheet, as necessary)
a. Provide a legal description of the subject property and identify all buildings, structures, and current use. Attach metes and
bounds survey with aerial photos. Mark property area to be conveyed.
b. Identify the property's current zoning classification.
c. Attach or itemize all inventories (personal property) to be conveyed as described in Notice of Availability.

*Attach copy of Determination of Surplus Announcement or BRAC announcement.

FEMA Form FF-119-FY-22-133 (formerly 119-0-1) (10/22)

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SECTION III - PROPERTY INFORMATION (continued)
5. ASSIGNED FEDERAL GSA OR OEA PROPERTY SPECIALIST
5a. NAME
5b. REGIONAL OFFICE LOCATION
5d. EMAIL ADDRESS

5c. TELEPHONE NUMBER

If you are seeking a determination for property under the Base Realignment and Closure (BRAC) program,
please complete items #6 and #7.
6. BRAC ONLY: APPLICANT'S LOCAL REDEVELOPMENT AUTHORITY (Recognized LRA name, address, telephone, & contact
person; please attach copy of final LRA Plan)

7. BRAC ONLY: DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT (HUD) DETERMINATION (Please attach letter)

SECTION IV - PROJECT INFORMATION
1. PROJECT TITLE

DRAFT

2. PROPOSAL: PROVIDE A DETAILED DESCRIPTION OF THE APPLICANT'S PROJECT AND INCLUDE THE FOLLOWING
INFORMATION
a. Describe the applicant's mission, problems to be addressed, and how it will benefit from the proposed PBC.
b. Describe the activities to be conducted (e.g., training), the population the PBC will serve, and the anticipated benefits to that
population
c. Federal Emergency Management Response and Fire and Rescue Renovation: Describe the State, local or national authority
standards or guidelines that will be met in designing, renovating, and operating an emergency management facility and the
process and procedural requirements that must be met to assure compliance. Provide detailed description of design, type,
and size of structure and interior floor plans.
d. Provide a schedule for accomplishing renovation/construction and implementing activities after conveyance.

SECTION V - BUDGET
a. Provide an estimate of the total funds needed to renovate, furnish, and/or remodel requested property or to construct on
requested property and the projected cost to maintain it. (Include monthly upkeep, maintenance, utilities, landscaping,
telephone, Internet, etc.)
b. Give source of funds, process to obtain the funds, and projected date of availability of funds.
c. Provide a timetable for acquiring funds and maintaining funding to sustain requested property.

SECTION VI - INTERGOVERNMENTAL REVIEW
a. Applicable. Attach a copy of the cover letter addressed to the applicant's State Single Point of Contact (SPOC) for review.
b. State Single Point of Contact. Attach response from SPOC to above notification.
c. Not Applicable. Applicant's State does not require an Intergovernmental Review.

SECTION VII - ENVIRONMENTAL IMPACT
NATIONAL ENVIRONMENTAL POLICY ACT: All applicants for surplus property for corrections facility, emergency management, or
law enforcement purposes or use must complete the attached environmental questionnaire to comply with Title 41 C.F.R. part
102-75.785(d) which states in part: "Any determination that DOJ or FEMA submits to the disposal agency must provide complete
information concerning the correctional facility, law enforcement, or emergency management response use, including:... (d) The
environmental impact of the proposed correctional facility, law enforcement, or emergency management response use." Please
complete the attached Environmental Questionnaire. GSA will consult with the State Historic Preservation Officer, if required.

FEMA Form FF-119-FY-22-133 (formerly 119-0-1) (10/22)

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SECTION VIII - CERTIFICATIONS
1. Equal Employment Opportunity: Applicant agrees that for receiving federal surplus real property, it will not discriminate upon
the basis of race, color, national origin, sex, age, disability, or religion in the use, occupancy, or lease of the property for the period
during which the real property is used for the purpose under which the federal financial assistance is extended.
2. Perpetual Use: Applicant understands that the property transfer is pursuant to 40 U.S.C. 553, and agrees that the property will be
used and maintained for Federal emergency management response purposes in perpetuity and that in the event the property
ceases to be used or maintained for the purposes for which the property was conveyed, all or any portion of the property shall in
its then existing condition at the option of the grantor, revert to the grantor.
3. Application Certification: I certify that to the best of my knowledge, the information provided in this application is true and correct
and the application has been duly authorized by the governing body of the applicant.
TITLE

PRINTED NAME

CERTIFYING REPRESENTATIVE SIGNATURE

DATE

DRAFT

FEMA Form FF-119-FY-22-133 (formerly 119-0-1) (10/22)

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APPLICATION FOR FEDERAL SURPLUS PROPERTY PUBLIC BENEFIT CONVEYANCE (PBC)
SECTION VII - ENVIRONMENTAL QUESTIONNAIRE
PROPERTY:
ADDRESS:
CITY, STATE, AND ZIP CODE:
Provide a narrative explanation of the probable environmental effects of the proposed program of use on the particular
property and its surrounding community, both in the short and long term, based on the following criteria. Attach separate
sheet, as necessary.
1. Please describe the specific property that will be directly affected in terms of its current use and proposed use. If the land is in a
natural state, please provide a brief description with respect to plant and animal life.

2. Describe the surrounding area. Is it primarily residential, industrial, agricultural, etc.? Is the property in a rural, urban, or suburban
area? Has the area been formally zoned for specific uses? Please provide a map of the immediate area covering approximately
one square mile.

3. Broadly and briefly discuss the geography of the area, wildlife, water and air quality, area population, and potential users of the
service to be provided, the economy of the area, any current environmental concerns, and historic and cultural resources.

DRAFT

4. If the proposed action is in a floodplain or affects a floodplain, please list all pertinent restrictions (with citations) on land use under
Federal, State, and local laws and regulations, and any actions the Applicant proposes to mitigate foreseeable adverse effects.

5. Will the proposed action directly or indirectly affect a wetland? Please list any pertinent Federal, State, and local wetland
regulations and any actions the Applicant proposes to mitigate foreseeable adverse effects.

6. Will the proposed action have a direct or indirect effect on any Federally-listed or State-listed endangered species? If so, please
describe any impacts as well as any actions the Applicant proposes in order to mitigate foreseeable adverse effects.

7. Is it reasonably foreseeable that the proposed activity will have a direct or indirect effect on natural resources, land uses, or water
uses in the coastal zone? If so, describe how the Applicant will comply with the State’s enforceable and mandatory coastal zone
policies. Please describe any impacts as well as any actions the Applicant proposes in order to mitigate foreseeable adverse effects.

8. Approximately how many vehicles will be introduced into the area on a daily basis as a result of the operation of the facility? Will
there be any identifiable increased traffic in the surrounding area as a result of the proposed use of the property?

9. How much water will the Applicant use on the property in a normal day? What system will provide the water (name and address of
system)? Will the sewage be handled by a sewage treatment facility? If so, please provide the name and address of the system.

10. Will the proposed use of the property likely result in the use, storage, release and/or disposal of toxic, hazardous, or radioactive
materials, or in the exposure of people to those materials? If so, please describe these proposed activities and under what
authority they will be regulated.

11. Will the proposed use of the property affect historic, cultural, or archaeological resources that exist either on the property or in
the vicinity of the property? Please describe any actions the Applicant proposes to mitigate any adverse effects on, or access to,
historic, cultural, or archaeological resources resulting from the proposed use. Please describe any plans for preservation or
mitigation of foreseeable adverse effects the Applicant proposes for such resources existing on the subject property.

FEMA Form FF-119-FY-22-133 (formerly 119-0-1) (10/22)

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12. Will the proposed use of the property require a variance from any Federal, Tribal, State, or local laws pertaining to any of the
following: land, air, or water pollution; the visual environment; odors; public health; or noise? If so, please specify, and describe
any impacts as well as any actions the Applicant proposes in order to mitigate foreseeable adverse effects.

Name of Preparer:

Preparer's Contact Information (including mailing address,
telephone number, fax, and email address):

Qualifications of Preparer:

Signature of Certifying Official:

Date:

Title:

Agency:

DRAFT

FEMA Form FF-119-FY-22-133 (formerly 119-0-1) (10/22)

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APPLICATION INSTRUCTIONS AND REQUIRED ATTACHMENTS
Please mark any field on the application that is not applicable as "N/A" or "Not Applicable"
SECTION I - APPLICANT INFORMATION
1. Provide state, local, or tribal government name.
2. For Organization, this is usually the agency, department, or office that will occupy the property if granted (e.g., Office of
Emergency Management)
SECTION II - ACQUISITION AUTHORITY
Provide a copy of the governing legislation enabling applicant to receive or act on behalf of applicant for the purpose of
receiving Federal property. Attach copy and cite.
SECTION III - PROPERTY INFORMATION
3a. Applicant's Notice of Interest: Attach Notice of Interest to the General Services Administration or Department of Defense.
3b. Applicant's Notice of Interest: Attach Notice of Interest to FEMA.
4. Property's Legal Description: Attach the legal description of subject property and identification of all buildings and structures
and current use(s). Attach list of personal inventory to be conveyed with the property as found in the Notice of Availability.

DRAFT

*NOTE: Attach copy of Determination of Surplus Announcement or DoD (BRAC) announcement.
6. BRAC Only: Attach applicant's Local Redevelopment Authority (LRA) Plan.

7. BRAC Only: Department of Housing and Urban Development's determination in compliance with the Stewart B. McKinney
Homeless Assistance Act. This can be received from your LRA or:
Base Realignment and Closure Coordinator
Department of Housing and Urban Development
Office of Special Need Assistance Programs
451 Seventh Street, SW., Room 7266
Washington, D.C. 20410
202-402-2595 (Office) / 202-401-0053 (Fax)
SECTION IV - PROJECT/PROPOSAL INFORMATION
Please submit as an attachment.
SECTION V - BUDGET
Please submit as an attachment. Applicant must show ability to maintain requested property.
SECTION VI - INTERGOVERNMENTAL REVIEW
Does your State require an Intergovernmental Review? www.OMB.gov and search Intergovernmental Review - State Point
of Contact (SPOC). If your state is listed, submit your application to your SPOC for review, obtain the SPOC's response, and
attach to this application when submitted to FEMA. If your state is not listed, please check "C" for not applicable.
SECTION VII - ENVIRONMENTAL IMPACT/ NATIONAL ENVIRONMENTAL POLICY ACT
Read and complete the attached Environmental Questionnaire. Sign and attach supporting documentation as needed.
SECTION VIII - CERTIFICATIONS
Confirm you have read and agree to the terms of #1, #2, #3 before you sign this PBC Program Application by checking the
box below.

I agree with the terms of this application.
FEMA Form FF-119-FY-22-133 (formerly 119-0-1) (10/22)

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