Form FEMA Form FF-104-F FEMA Form FF-104-F Project Application for Building Code and Floodplain Man

D EPARTMENT OF HOMELAND SECURITY OMB Control Number FF-104-FY-22-243

Federal Emergency Management Agency Expires Month Date Year

PROJECT APPLICATION FOR BUILDING CODE AND FLOODPLAIN MANAGEMENT ADMINISTRATION AND ENFORCEMENT

Paperwork Burden Disclosure Notice

Public reporting burden for this data collection is estimated to average 14 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 this form. This collection of information is required to obtain or retain benefits. 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, Paperwork Reduction Project (1660-0017) NOTE: Do not send your completed form to this address.

Privacy Act Statement

The collection of this information is authorized by the Robert T. Stafford Disaster Relief and Emergency Assistance Act, §§ 402-403, 406-407, 417, 423, 427, 428, 502, and 705; 42 U.S.C. 5170a-b, 5172-73, 5184, 5189a, 5189e, 5189f, 5192, 5205; and 2 C.F.R. § 200. This information is collected to provide assistance to eligible jurisdictions and organizations to facilitate the response to and recovery from a Presidentially-declared disaster or emergency, or to provide assistance for hazard mitigation measures during the recovery process. The disclosure of information on this form is voluntary; however, failure to provide the requested information may delay or prevent the agency from receiving funds from FEMA’s Public Assistance program.

Purpose and Applicability

Building code and floodplain management administration and enforcement activities related to the repair, replacement or retrofit of disaster-damaged structures in the jurisdiction of the Applicant may be eligible for Public Assistance funding. This may include public and private structures. FEMA uses this form to collect information necessary to support the Applicant’s claim. For more information, please see Applying for Building Code Administration and Enforcement Reimbursement through FEMA’s Public Assistance Program flyer or FEMA Policy FP 204-079-01 Building Code and Floodplain Management Administration and Enforcement. To see all information and documentation that may be requested to substantiate work or costs or for more information, please see Chapter 8 Permanent Work Eligibility in the Public Assistance Program and Policy Guide and the Public Assistance Resource Library. Please contact the State, local, Tribal, or Territorial emergency management office for additional information.

Recipients and Applicants should use Public Assistance Grants Portal to submit all documentation and information to FEMA. Questions are displayed in an intuitive manner to show the information and documentation needed based on answers provided. All signatures are official and legally binding.

The following information is needed to complete this form:

• The specific activities [to be] conducted

• When, where, and by whom the activities were [will be] completed

• Estimated or actual cost information

Section I – Declaration & Applicant Information¹

Declaration # [system generated]

Legal name of Applicant [system generated]

FEMA PA ID [system generated]

Section II – Project Information

Project #² [system generated]

Applicant-Assigned Project #³ (optional)

Project Title:

Project Amendment #⁴ [system generated]

Period of Performance deadline:⁵ [system generated]

Work Type: Building Code and Floodplain Management Administration and Enforcement

Location:⁶ Throughout jurisdiction [system generated]

Do you want to make this impact a high priority? High priority means that FEMA will work with you to address this impact before any others you list^. Please update if changed. [system generated]

☐ No

☐ Yes

Section III – Small Project⁷

This section is completed for projects with total costs less than the large project threshold.

Description of Activities

Which of the following activities were [will be] performed?⁸ Please select all that apply.

☐ Building code administration. Please describe or select from the eligible activities below:      

☐ Collect fees.

☐ Contract for services (e.g., contract planning, initiation, solicitation, evaluation, and award).

☐ Coordinate building code administration and enforcement with floodplain management regulation administration and enforcement, as appropriate.

☐ Establish construction plan review and inspection processes, procedures, and instructions for permit holders.

☐ Hire, train, supervise, certify, and license staff, as required to conduct eligible activities.

☐ Monitor impacted areas for unpermitted construction activities.

☐ Process requests for building code variances.

☐ Provide training and information to staff, contractors, and the public on unique considerations for repair of disaster-damaged buildings 45 years or older.

☐ Provide training and outreach to the public on building code and building permit requirements applicable to the repair, replacement, or retrofit of disaster-damaged buildings.

☐ Review and process applications for building permits; certificates of occupancy; certificates of compliance; and the associated plans, specifications, and construction documents for compliance with federal, state, and municipal building, housing, and life-safety codes and standards applicable to disaster-related repair, replacement, or retrofit.

☐ Code enforcement. Please describe or select from the eligible activities below:      

☐ Conduct and process condemnation determinations.

☐ Identify and carry out corrective action in cases where construction, design, and occupancy does not comply with codes and ordinances.

☐ Inspect structures under construction for compliance with approved plans, specifications, and all requirements of applicable codes, laws, and ordinances.

☐ Investigate complaints and assist in preparation of materials for abating violations of building codes and related ordinances.

☐ Review and issue elevation certificates.

☐ Floodplain management ordinance administration and enforcement. Please describe or select from the eligible activities below:      

☐ Conduct inspections to ensure the removal of temporary fill and related materials used in flood fighting.

☐ Contract for services (e.g., contract planning, initiation, solicitation, evaluation, and award).

☐ Coordinate floodplain management ordinance administration and enforcement with building code administration and enforcement, as appropriate.

☐ Determine whether proposed disaster-related development activities are in areas regulated by the community’s floodplain management ordinance or building code.

☐ Enforce or administer standards for development according to community floodplain management regulations.

☐ Hire, train, supervise, certify, and license staff, as required to conduct eligible activities.

☐ Inspect all disaster-related development in the applicable jurisdiction.

☐ Monitor impacted areas for unpermitted construction activities.

☐ Process, maintain, and track temporary occupancy permits and inspect temporary occupancy buildings.

☐ Process permits for disaster-related development in the floodplain associated with the declared disaster.

☐ Process requests for floodplain management ordinance variances.

☐ Provide information on flood hazards, floodplain map data, advisory flood data, and compliance to residents and property owners.

☐ Provide training and information to staff, contractors, and the public on unique considerations for repair of disaster-damaged buildings 45 years or older.

☐ Provide training and outreach to the public on floodplain permit requirements applicable to the repair, replacement, or retrofit of disaster-damaged buildings.

☐ Review disaster-related development proposals to ensure compliance with the requirements of applicable floodplain management ordinances.

☐ Take corrective action necessary to ensure compliance with Federal, State, and Local floodplain regulations.

☐ Substantial damage determinations. Please describe or select from the eligible activities below:      

☐ Collect field data for damage assessments.

☐ Conduct damage inventory of structures.

☐ Conduct initial field surveys to determine extent of damage

☐ Determine if damaged structures have been designated as historic or that may be eligible for such designation.

☐ Determine whether proposed improvements are “substantial improvements” and trigger requirements for compliance, including a building permit.

☐ Enter damage inventory administrative data into the Substantial Damage Estimator or comparable data collection software.

☐ Establish damage trends to identify areas to focus building-specific assessment efforts.

☐ Hire, train, supervise, certify, and license staff, as required to conduct eligible activities.

☐ Inform property owners of damage determination and provide compliance requirements.

☐ Perform inspections to ensure compliance with repair and substantial damage construction requirements.

☐ Prepare cost information on repairs and pre-disaster market value estimates for substantial damage estimates.

☐ Review, adjudicate, and resolve Substantial Damage Determination appeals.

☐ Track cumulative substantial damage and repetitive loss for communities.

☐ Other.⁹ Please describe:      

General Cost and Work Status Information

Has the Applicant started any of the work activities claimed on this project application? [system generated]

☐ All work is complete. Please provide work start and end dates (MM/DD/YYYY) - (MM/DD/YYYY)

☐ Work has started and is approximately    % complete. Please provide the start date and a projected end date, if known: (MM/DD/YYYY) - (MM/DD/YYYY)

☐ Work has not started. Please provide a projected start date: (MM/DD/YYYY)

     

Has [Does] the Applicant received [anticipate receiving] funding from another source for this work?¹⁰ Please update if changed. [system generated]

☐ No

☐ Yes. Please check all that apply:

☐ Cash Donations. Please describe:       Amount $     

☐ Federal Grants.¹¹ Please describe:       Amount $      

☐ Non-Federal Grants. Please describe:       Amount $      

☐ Revenue. Please describe:       Amount $      

Cost Estimate

Please upload an itemized cost estimate for this project. Please include the number and type of resources necessary to complete the work.

What is the basis for the estimate?

☐ Actual costs

☐ Historical unit costs

☐ Average costs for similar work in the area

☐ Contractor or vendor quotes

☐ Other.¹² Please describe:      

What resources did [will] the Applicant use to complete the work? Please select all that apply.

☐ Contracted

Has the Applicant procured and selected a contractor?

☐ No

☐ Yes

How did the Applicant ensure the contract costs were reasonable?

☐ Competitive procurement process

☐ Cost or price analysis

☐ Compared to historical costs for similar projects in the area

☐ Other. Please describe:     

What is the total cost of contracted work?

Completed Cost	+	Future Cost	=	Total Cost
$		$		$ [system calculated]

☐ Labor

☐ Applicant’s own employees

What is the total cost of employee labor?

Completed Cost	+	Future Cost	=	Total Cost
$		$		$

☐ Mutual aid, prison labor, or national guard

What is the total cost of mutual aid, prison labor, or national guard?

	Completed Cost	+	Future Cost	=	Total Cost
Mutual Aid	$		$		$
Prison Labor	$		$		$
National Guard	$		$		$

☐ Equipment

☐ Applicant’s own equipment

☐ Purchased or rented equipment

Has the Applicant completed the purchase or rental?

☐ No

☐ Yes

How did the Applicant ensure the costs were reasonable?

☐ Cost or price analysis

☐ Compared to historical costs for similar projects in the area

☐ Obtained multiple quotes

☐ Other. Please describe:

What is the total cost of equipment?

Completed Cost	+	Future Cost	=	Total Cost
$		$		$

☐ Materials

☐ From Stock

☐ Purchased

Has the Applicant completed the purchase?

☐ No

☐ Yes

How did the Applicant ensure the costs were reasonable?

☐ Cost or price analysis

☐ Compared to historical costs for similar projects in the area

☐ Obtained multiple quotes

☐ Other. Please describe:     

What is the total cost of materials?

Completed Cost	+	Future Cost	=	Total Cost
$		$		$

☐ Donated Resources

☐ Labor

☐ Equipment

☐ Materials

☐ Buildings or Land

☐ Permanent¹³

☐ Temporary¹⁴

☐ Space

☐ Logistical Support

What is the total value?

Completed Cost	+	Future Cost	=	Total Cost
$		$		$

☐ Additional Building Code and Floodplain management administration and enforcement cost

☐ Travel

☐ Miscellaneous. Please describe:     

☐ Other. Please describe:     .

What are the costs of Additional Building Code and Floodplain Management Administration and Enforcement costs?

Completed Cost	+	Future Cost	=	Total Cost
$		$		$

Total Cost Claim

$ [system calculated]

Section IX – Small Project Closeout Request¹⁵

Has the Applicant completed all the work associated with the project?

☐ No

☐ Yes. Work Completed date: (MM/DD/YYYY)¹⁶

Does the Applicant want to close this project or other small projects as well?

☐ Applicant wants to closeout this project only.¹⁷

☐ Applicant wants to closeout multiple small projects.¹⁸

☐ Applicant wants to closeout all small projects.¹⁹

The Applicant may request additional funding if its combined actual cost of all its Small Projects exceeded the combined cost FEMA approved for all its Small Projects. Does the Applicant wish to claim any costs that exceeded the total amount obligated?²⁰ [system generated for the small project with the latest period of performance]

☐ No

☐ Yes. Amount $      Please upload all documentation to support work and costs for all small projects.

Total approved amount [system generated]

Federal share obligated [system generated]

Date obligated [system generated]

Section V – Large Project²¹

Description of Activities

Which of the following activities were [will be] performed?

☐ Building code administration

☐ Collect fees.

☐ Contract for services (e.g., contract planning, initiation, solicitation, evaluation, and award).

☐ Coordinate building code administration and enforcement with floodplain management regulation administration and enforcement, as appropriate.

☐ Establish construction plan review and inspection processes, procedures, and instructions for permit holders.

☐ Hire, train, supervise, certify, and license staff, as required to conduct eligible activities.

☐ Monitor impacted areas for unpermitted construction activities.

☐ Process requests for building code variances.

☐ Provide training and information to staff, contractors, and the public on unique considerations for repair of disaster-damaged buildings 45 years or older.

☐ Provide training and outreach to the public on building code and building permit requirements applicable to the repair, replacement, or retrofit of disaster-damaged buildings.

☐ Review and process applications for building permits; certificates of occupancy; certificates of compliance; and the associated plans, specifications, and construction documents for compliance with federal, state, and municipal building, housing, and life-safety codes and standards applicable to disaster-related repair, replacement, or retrofit.

☐ Code enforcement

☐ Conduct and process condemnation determinations.

☐ Identify and carry out corrective action in cases where construction, design, and occupancy does not comply with codes and ordinances.

☐ Inspect structures under construction for compliance with approved plans, specifications, and all requirements of applicable codes, laws, and ordinances.

☐ Investigate complaints and assist in preparation of materials for abating violations of building codes and related ordinances.

☐ Review and issue elevation certificates.

☐ Floodplain management ordinance administration and enforcement

☐ Conduct inspections to ensure the removal of temporary fill and related materials used in flood fighting.

☐ Contract for services (e.g., contract planning, initiation, solicitation, evaluation, and award).

☐ Coordinate floodplain management ordinance administration and enforcement with building code administration and enforcement, as appropriate.

☐ Determine whether proposed disaster-related development activities are in areas regulated by the community’s floodplain management ordinance or building code.

☐ Enforce or administer standards for development according to community floodplain management regulations.

☐ Hire, train, supervise, certify, and license staff, as required to conduct eligible activities.

☐ Inspect all disaster-related development in the applicable jurisdiction.

☐ Monitor impacted areas for unpermitted construction activities.

☐ Process, maintain, and track temporary occupancy permits and inspect temporary occupancy buildings.

☐ Process permits for disaster-related development in the floodplain associated with the declared disaster.

☐ Process requests for floodplain management ordinance variances.

☐ Provide information on flood hazards, floodplain map data, advisory flood data, and compliance to residents and property owners.

☐ Provide training and information to staff, contractors, and the public on unique considerations for repair of disaster-damaged buildings 45 years or older.

☐ Provide training and outreach to the public on floodplain permit requirements applicable to the repair, replacement, or retrofit of disaster-damaged buildings.

☐ Review disaster-related development proposals to ensure compliance with the requirements of applicable floodplain management ordinances.

☐ Take corrective action necessary to ensure compliance with Federal, State, and Local floodplain regulations.

☐ Substantial damage determinations

☐ Collect field data for damage assessments.

☐ Conduct damage inventory of structures.

☐ Conduct initial field surveys to determine extent of damage

☐ Determine if damaged structures have been designated as historic or that may be eligible for such designation.

☐ Determine whether proposed improvements are “substantial improvements” and trigger requirements for compliance, including a building permit.

☐ Enter damage inventory administrative data into the Substantial Damage Estimator²² or comparable data collection software.

☐ Establish damage trends to identify areas to focus building-specific assessment efforts.

☐ Hire, train, supervise, certify, and license staff, as required to conduct eligible activities.

☐ Inform property owners of damage determination and provide compliance requirements.

☐ Perform inspections to ensure compliance with repair and substantial damage construction requirements.

☐ Prepare cost information on repairs and pre-disaster market value estimates for substantial damage estimates.

☐ Review, adjudicate, and resolve Substantial Damage Determination appeals.

☐ Track cumulative substantial damage and repetitive loss for communities.

☐ Other. Please describe:      

Please provide documentation to substantiate the activities related to building code ordinance administration and enforcement for disaster-damaged properties as applicable:

• List of addresses²³ where enforcement activities took place.

• Evidence that these addresses were damaged as a result of the incident.

• Evidence that the activities being claimed are related only to incident-related damage (e.g., activity logs to show that employees were assigned to inspect disaster-damaged addresses).

• Activity logs and sign-in sheets to document training and outreach activities.

Please describe the scope of work for any activity selected above or upload documentation with at least the same level of information:      ²⁴ Please upload any design drawings, sketches, technical surveys, or reports.

General Cost and Work Status Information

Has the Applicant started any of the work activities claimed on this project application? [system generated]

☐ All work is complete. Please provide work start and end dates (MM/DD/YYYY) - (MM/DD/YYYY)

☐ Work has started and is approximately    % complete. Please provide the start date and a projected end date, if known: (MM/DD/YYYY) - (MM/DD/YYYY)

☐ Work has not started. Please provide a projected start date: (MM/DD/YYYY)      

Please indicate what type of cost was used for this project: Please select all that apply:

☐ Actual cost. Please complete actual cost table below.

☐ Estimate for future cost.

☐ Estimated contracted cost: $     

☐ Estimated labor cost: $     

☐ Estimated equipment cost: $     

☐ Estimated materials cost: $     

☐ Estimated other costs: $     

Has [Does] the Applicant received [anticipate receiving] funding from another source for this work?²⁵ Please update if changed. [system generated]

☐ No

☐ Yes. Please check all that apply:

☐ Cash Donations. Please describe:       Amount $     

☐ Federal Grants.²⁶ Please describe:       Amount $      

☐ Non-Federal Grants. Please describe:       Amount $      

☐ Revenue. Please describe:       Amount $      

Actual Cost Information

What resources did the Applicant use to complete the work? Please select all that apply.

☐ Contracted

☐ Labor

☐ Equipment

☐ Materials

☐ Additional Building Code and Floodplain Management Administration and Enforcement costs

Contracted Costs

Please complete the Contract Information form for all contracts that have an estimated value of more than $1,000,000.²⁷

Has the Applicant procured and selected a contractor?²⁸

☐ No

☐ Yes.²⁹ How did the Applicant ensure the contract costs were reasonable? Please upload a copy of the awarded contract, bid package, any change orders, and invoices.

☐ Cost or price analysis

☐ Compared to historical costs for similar projects in the area

☐ Obtained multiple quotes

☐ Other.³⁰ Please describe:      

Labor and Equipment

Name of Individual     ³¹

☐ Donated labor³²

☐ Applicant employee

☐ Mutual aid³³

☐ Emergency Management Assistance Compact (EMAC). Please upload the following documents:

• EMAC Resource Support Agreement.

• R-1 form

• R-2 form

• Signed Proof of Payment

☐ Other:      

Rate type³⁴ [optional if claiming equipment]

☐ Straight time $     

☐ Overtime $     

☐ Premium $     

☐ Hazard $     

Date(s)³⁵

     

Hours

     

Total hours:      ³⁶

Labor hours:      

Equipment hours:      

Total hours:      

[system calculated]

Total Cost³⁷

Labor cost $     

Equipment cost $     

Donated value $     

Total cost $     

[system calculated]

Equipment Description and source      ³⁸

☐ Applicant owned

☐ Purchased

☐ Rented³⁹

☐ Donated      

Is the Applicant claiming mileage or hourly rate?⁴⁰

☐ Mileage      

☐ Equipment $     

How did the Applicant ensure the costs were reasonable?⁴¹

☐ Cost or price analysis

☐ Compared to historical costs for similar projects in the area

☐ Obtained multiple quotes

☐ Other.⁴² Please describe:      

Materials⁴³

Material description

     

How was the material obtained?⁴⁴

☐ Donated      ⁴⁵

☐ Purchased

☐ From Stock⁴⁶

Purchased Date (MM/DD/YYYY)      

Used Date (MM/DD/YYYY)      

Quantity Purchased

     

Unit Price

     

Quantity Used

     

Fair Market Value⁴⁷

     

Total Cost⁴⁸

Donated value $     

Total cost $     

[system calculated]

How did the Applicant ensure the costs were reasonable?⁴⁹

☐ Cost or price analysis

☐ Compared to historical costs for similar projects in the area

☐ Obtained multiple quotes

☐ Other. Please describe:      

Additional Building Code and Floodplain Management Administration and Enforcement costs⁵⁰

Description

☐ Travel

☐ Meals

☐Miscellaneous Please describe:      

Vendor

     

Purchased date

     

Used Date

     

Quantity Purchased

     

Fair Market Value

     

Total Cost⁵¹

     

[system calculated]

Section VI – Scope of Work and Cost Summary

Work Summary

Scope of Work:       [system generated]

Closeout Project Scope of Work:       [system generated]

Cost Breakdown⁵²

Estimated Costs

Closeout Final Costs

[system calculated below]

Contract:      

Labor

☐ Applicant’s own employees:      

☐ Mutual Aid:      

Equipment:

☐ Applicant’s own equipment:      

☐ Purchased equipment:      

☐ Rented equipment:      

Materials:

☐ Stock materials:      

☐ Purchased materials:      

Additional Building Code and Floodplain Management Administration and Enforcement costs

☐ Travel:      

☐ Meals:      

☐ Miscellaneous:      

Deductions:

☐ Other sources:      

[system calculated below]

Contract:      

Labor

☐ Applicant’s own employees:      

☐ Mutual Aid:      

Equipment:

☐ Applicant’s own equipment:      

☐ Purchased equipment:      

☐ Rented equipment:      

Materials:

☐ Stock materials:      

☐ Purchased materials:      

Additional Building Code and Floodplain Management Administration and Enforcement costs

☐ Travel:      

☐ Meals:      

☐ Miscellaneous:      

Deductions:

☐ Other sources:      

Donated Resources:

☐ Labor:      

☐ Equipment:     

☐ Material:     

☐ Buildings or Land:      

☐ Space:      

☐ Logistical Support:      

☐ Total value:      

Donated Resources:

☐ Labor:      

☐ Equipment:     

☐ Material:     

☐ Buildings or Land:      

☐ Space:      

☐ Logistical Support:      

☐ Total value:      

Grand Total:      

Grand Total:      

Section VII – Additional Information and Comments [optional]

If you have any additional information and supporting documentation not previously provided, use this section to help support your claim. Please ensure personally identifiable information is redacted on any documentation submitted.⁵³

Please provide any additional information, comments, or a brief description of the uploaded documentation, if applicable:      

Section VIII – Project Acknowledgements and Certifications
I acknowledge and certify that I have reviewed and understand the following information regarding overarching requirements to receive Public Assistance. Please initial next to each statement.       The State, local, Tribe, or Territory represented has not been suspended or sanctioned and are in good standing with the National Flood Insurance Program (NFIP).       This project application does not claim any activities conducted through the Substantial Damage Data Collection Contract.       The requirement to comply with applicable Federal, State, local, Tribal, and Territorial laws, regulations, and executive orders. Non-compliance may result in denial or de-obligation of funding. This includes but is not limited to laws prohibiting discrimination; complying with the most restrictive of its own documented policies and procedures used for procurements with non-Federal funds; Federal procurement and contracting laws in accordance with 2 C.F.R. §§ 200, compliance with the Environmental Protection Agency guidelines for procurement of recovered materials; environmental and historic preservation laws; and inclusion of required provisions as applicable.       Applicants must maintain all source documentation for each Project for 3 years after the date of transmission of the Closeout Form as certified by the Recipient. Recipients must keep all financial and program documentation for 3 years after the date it submits the final SF-425, in accordance with Title 2 C.F.R. §200.334-337. Longer retention periods may apply to real property and equipment disposition, audits, and litigation. Additionally, State, local, Tribal, or Territorial government laws may require longer retention periods.       The requirement to inform FEMA of all purchased equipment with a fair market value over $5,000 after it is no longer needed for federally funded programs or projects in accordance with 2 C.F.R. § 200.313. FEMA reduces eligible funding by this amount.       The requirement to inform FEMA if the aggregate fair market value of unused supplies purchased for FEMA projects is over $5,000 after they are no longer needed for federally funded programs or projects in accordance with 2 C.F.R. § 200.314. FEMA reduces eligible funding by this amount.       All activities on private property must have completed all necessary legal processes and obtained rights-of-entry and agreements to indemnify and hold harmless the Federal Government.
      As required by Title VI of the Civil Rights Act of 1964, Sections 308 and 309 of the Stafford Act, and applicable provisions of laws and authorities prohibiting discrimination, all work claimed was [will be] delivered in an impartial and equitable manner.       As required by 44 C.F.R. § 206.228 and 2 C.F.R. Part 200.404, the costs claimed were of a type generally recognized as ordinary and necessary for the type of facility and work.       As required by Stafford Act § 312, I certify that I am not claiming any work or costs that are covered by another source such as revenue, non-federal grants, cash donations, another Federal agency, or another FEMA Program (e.g., Individual Assistance programs or Hazard Mitigation Grant Program). If I receive funding for any work or costs in this project application, I will notify the Recipient and FEMA, and funding will be reconciled to eliminate duplication.       All information provided regarding the project application is true and correct to the best of my knowledge. Upon submittal this project application becomes a legal document. The Recipient or FEMA may use external sources to verify the accuracy of the information entered. It is a violation of Federal law to intentionally make false statements or hide information when applying for Public Assistance. The False Claims Act (31 U.S.C. §§3729-3733) prohibits the submission of false or fraudulent claims for payment to the federal government. Suspicion of fraudulent activities should be reported to the FEMA Disaster Fraud Hotline, the Department of Homeland Security's Office of the Inspector General, or the Department of Justice Fraud Hotline. I understand that, if I intentionally make false statements or conceal any information in an attempt to obtain Public Assistance, it is a violation of Federal laws, which carry severe criminal and civil penalties including a fine of up to $250,000, imprisonment, or both. (18 U.S.C. §§ 287, 1001, 1040, and 3571).
Applicant Signature
Applicant Authorized Representative [system generated]	Title		Signature		Date submitted [system automated]
Section IX – Recipient Recommendation54
Does all work in this project meet the criteria to be eligible for Public Assistance funding? ☐ No. Please describe why:       ☐ Yes
Recipient Authorized Representative [system generated]	Title		Signature		Date submitted55 [system automated]
Section X – Large Project Closeout Request56
Has the Applicant completed all the work associated with the project? ☐ No ☐ Yes. Proceed to the General Cost and Work Status Information section to provide the final costs and upload supporting documentation.
Work Completed date: (MM/DD/YYYY)57 Please update if changed. [system generated]
Total approved amount [system generated]		Federal share obligated [system generated]		Date obligated [system generated]

Section XI – Applicant Closeout Acknowledgments and Certifications
I acknowledge and certify that I have reviewed and understand the following information regarding overarching requirements to receive Public Assistance. Please initial next to each statement.       Projects were completed in accordance with 44 C.F.R. § 206.205 and the FEMA approved scopes of work, all necessary documents have been received, and any appeal for project overruns have been reconciled.       The Stafford Act Section 705 imposes a 3-year limit on FEMA’s authority to recover payments made to SLTT government Recipients and Applicants unless there is evidence of fraud. Section 705 does not apply to Private Non-profit organizations. I have read and understand FEMA issued Recovery Policy (FP 205-081-2), Stafford Act Section 705, Disaster Grant Closeout Procedures, which describes the limitations and requirements in detail.
Applicant Authorized Representative [system generated]	Title [system generated]	Signature [system generated]	Date submitted58 [system automated]
Section XII – Recipient Closeout Certifications and Signature
I certify that I have reviewed and understand the following information regarding overarching requirements to receive Public Assistance. Please initial next to each statement.       I certify that all costs were incurred in the performance of eligible work, that the projects were completed in accordance with the FEMA approved scopes of work, and that the project is in compliance with the provisions of the FEMA-State/Tribe/Territory Agreement, in accordance with 44 C.F.R. § 206.205.       I certify that the Recipient paid its applicable contribution to the non-Federal share, in accordance with the FEMA-State/Tribe/Territory Agreement.
Recipient Authorized Representative [system generated]	Title [system generated]	Signature [system generated]	Date submitted59 [system automated]

1 Functionality: Generate Declaration # from the Request for Public Assistance. Generate Declaration date, Recipient, and Region from the Incident Information.

2 Functionality: Assign a Project number.

3 (Help text) The Applicant may assign a unique title and number for each project application. This title and number may help the Applicant connect this project application to their accounting or other systems. Functionality: Optional, not required.

4 Functionality: Assign a Project Amendment number.

5 Functionality: Automate based on standard period of performance deadlines by category and any approved time extensions.

6 Functionality: Generate default location as “Throughout jurisdiction” and allow Applicant to update if needed.

7 (Help text) The simple approach is the fastest way to request FEMA funding and requires the least documentation. Under the simple approach, once an Applicant's Request for Public Assistance is approved, the Applicant will have 21 days to review information about eligibility for Public Assistance and an additional 60 days to submit all claims to FEMA. Once submitted, simplified claims typically take 30-60 days to process. This option is only available for projects totaling up to $1,000,000. Functionality: Generate Environmental and Historic Preservation (EHP) Addendum if any EHP triggers were identified in the Impact List.

8 Functionality: Generate activities selected in the Impact List.

9 Functionality: Notify FEMA and the Recipient for review of activities.

10 (Help text) FEMA is legally prohibited from duplicating benefits from other sources. If the Applicant receives funding from another source for the same work that FEMA funded, FEMA reduces the eligible cost or de-obligates funding to prevent a duplication of benefits. See Section 312 of the Robert T. Stafford Disaster Relief and Emergency Assistance Act for more information.

11 (Help text) See the Non-Federal Grants and Cash Donations section in the PAPPG for more information.

12 Functionality: Flag for Recipient and FEMA review of estimating methodology.

13 (Help text) For buildings or land donated permanently (i.e., with a transfer of ownership), offset is based on the fair market value at the time of donation as established by an independent appraisal and certified by the Applicant.

14 (Help text) For building or land space donated for temporary use, the offset is based on the fair rental value of comparable privately-owned space in the same locality as established by an independent appraisal.

15 Functionality: Only show this section if the work is 100% complete.

16 (Help text) 2 CFR § 200.344(a). The recipient must submit, no later than 120 calendar days after the end date of the period of performance, all financial, performance, and other reports as required by the terms and conditions of the Federal award. An Applicant must submit to the pass-through entity, no later than 90 calendar days (or an earlier date as agreed upon by the Recipient (pass-through entity) and Applicant) after the end date of the period of performance, all financial, performance, and other reports as required by the terms and conditions of the Federal award. The Federal awarding agency or pass-through entity may approve extensions when requested and justified by the Recipient (non-Federal entity), as applicable. Functionality: Generate date from General Cost and Work Status Information section if work is shown as complete.

17 Functionality: Generate Applicant and Recipient Closeout Acknowledgements and Certifications sections.

18 Functionality: Generate list of available small projects and allow the Applicant to select multiple small projects.

19 Functionality: Auto-select all small projects.

20 (Help text) Applicants may request additional funding within 60 days of the work completion on its last small project. Functionality: Generate this question if Applicant wants to close all small projects was selected.

21 (Help text) The simple approach is the fastest way to request FEMA funding and requires the least documentation. Under the simple approach, once an Applicant's Request for Public Assistance is approved, the Applicant will have 21 days to review information about eligibility for Public Assistance and an additional 60 days to submit all claims to FEMA. Once submitted, simplified claims typically take 30-60 days to process. This option is only available for projects totaling up to $1,000,000. Functionality: Generate EHP Addendum if any EHP triggers were identified in the Impact List.

22 (Help text) The FEMA-developed Substantial Damage Estimator tool assists State, local, Territorial and Tribal governments in estimating Substantial Damage for residential and non-residential structures in accordance with the requirements of the National Flood Insurance Program as adopted by the communities. For additional information, please see the Substantial Damage Estimator User Manual and Field Workbook.

23 (Help text) Please include addresses only. Do not include any Personally Identifiable Information (PII) such as names, phone numbers, etc.

24 (Help text) You may upload documentation with at least the same level of information. Functionality: Requested, not required.

25 (Help text) FEMA is legally prohibited from duplicating benefits from other sources. If the Applicant receives funding from another source for the same work that FEMA funded, FEMA reduces the eligible cost or de-obligates funding to prevent a duplication of benefits. See Section 312 of the Robert T. Stafford Disaster Relief and Emergency Assistance Act for more information.

26 (Help text) See the Non-Federal Grants and Cash Donations section in the PAPPG for more information.

27 (Help text) Section 1224(e) of the Disaster Recovery Reform Act requires FEMA to collect and store information, prior to the project closeout phase on any contract entered into by a Public Assistance Recipient or Applicant that throughout the base award, available options, or any subsequent modification has an estimated value of more than $1,000,000.

28 Functionality: Only ask if FEMA is preparing the estimate.

29 Functionality: Applicant’s cost estimate should be derived based on the bid or contract amount. Requested, not required.

30 Functionality: Flag for Recipient and FEMA review of method used to determine costs to be reasonable.

31 Functionality: Allow Applicants to select an employee previously provided on the Staff, Equipment, and Facility Inventory form or allow the Applicant to update the form. Optional field if only claiming equipment cost.

32 Functionality: Donated labor sign in sheet required if donated was listed as a resource type.

33 Functionality: Mutual aid agreement required if mutual aid was listed as a resource type.

34 (Help Text) Select appropriate rate type. If multiple rates are paid to this employee on this project, populate hours separately by rate type. For Permanent Work and Debris Removal, both straight-time and overtime labor costs are eligible for both budgeted and unbudgeted employee hours. For Emergency Protective Measures, only overtime labor is eligible for budgeted employee hours. For unbudgeted employees both straight-time and overtime labor are eligible. See the Labor section of the PAPPG. Functionality: For Applicant Employees, auto-calculate based on employee’s rate plus fringe benefit from Grants Portal Registration. Optional field if only claiming equipment cost.

35 Functionality: Allow the applicant to provide all dates and hours related to this project.

36 Functionality: Only show if Applicant selected “Equipment Rate”.

37 Functionality: Calculate based on rates and hours.

38 (Help text) Include year, make model, size, and capacity. For more information, please see the Applicant-Owned and Purchased Equipment section of the PAPPG. Functionality: Generate from Equipment Information list in the Organization Profile. If Applicant entered, populate information in the Equipment Information list.

39 (Help text) Please upload rental agreement. Include the cost for fuel if applicable and upload fuel receipt. Functionality: If “Rented” is selected, do no request hourly rate and the number of hours. Documentation required prior to reconciliation.

40 (Help text) Please provide the total number of miles claimed. Functionality: If mileage is selected, use GSA rate. If Equipment Rate is selected, generate based on either FEMA or SLTT rate. If the rate is local or FEMA, use the lower of the two. If the rate is a state, territorial, or tribal rate, use the rate provided it does not exceed $75. If there is no rate for the equipment listed, notify the PAGS.

41 Functionality: Populate question only if Applicants selects Purchased Equipment.

42 Functionality: Flag for Recipient and FEMA review of method used to determine costs to be reasonable.

43 Functionality: Request invoices/receipts for select material items.

44 (Help text) Applicants select least cost alternative when the claimed cost is less than the cost to repair the facility to pre-disaster design and function. The cost of materials and supplies is eligible if (1) the materials or supplies were purchased and justifiably needed to effectively address the described threats or (2) the materials or supplies were taken from an Applicant's stock and used to address threats caused by the specified hazard or threat. The Applicant needs to track items taken from stock with inventory withdrawal and usage records. FEMA will also consider escalation of costs (such as due to shortages) or exigent circumstances in evaluating cost reasonableness.

45 (Help text) Please provide donor name. Functionality: Applicants submitting donated resources must provide donor name.

46 (Help text) Applicants using materials from their stock do not need to provide Vendor Name.

47 (Help text) When equipment or supplies (including materials) purchased with PA funding are no longer needed for response to or recovery from the incident, the Applicant may use the items for other federally funded programs or projects, provided the Applicant informs FEMA. Tribal and local governments and PNPs must calculate the current fair market value of each individual item of equipment. Fair market value is either the selling price or the advertised price for a similar item in a competitive market. The Applicant must provide the current fair market for any items that have a current fair market value of $5,000 or more. FEMA reduces eligible funding by this amount.

48 Functionality: Calculate based on quantity x unit price.

49 Functionality: Populate question only if Applicants selects Purchased.

50 (Help text) Include other costs not covered in the previous categories. Not all costs incurred as a result of the incident are eligible. See the Public Assistance Program and Policy Guide for detailed requirements on Ineligible Costs.

51 Functionality: Calculate total cost.

52 Functionality: Generate costs from the General Cost and Work Status Information section.

53 Functionality: Optional not required.

54 Functionality: The Recipient completes this section prior to submission to FEMA.

55 Functionality: Automated based on date submitted.

56 Functionality: Only show this section if the work is 100% complete.

57 Functionality: Generate Work Completed date from the Large Project QPR. If certificate is created or submitted after the deadline prompt a Closeout Extension Request.

58 Functionality: Automate based on date submitted.

59 Functionality: Automate based on date submitted.

FEMA Form FF-104-FY-22-243 5