FEMA Form FF-104-F Time Extension

DEPARTMENT OF HOMELAND SECURITY OMB Control Number FF-104-FY-22-248

Federal Emergency Management Agency Expires Month Day, Year

TIME EXTENSION REQUEST

Paperwork Burden Disclosure Notice Public reporting burden for this data collection is estimated to average 24 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; Title 44 Code of Federal Regulations (C.F.R.) § 206 Subpart G; and 2 C.F.R. § 200. This information is being 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 Time extensions are changes to the original grant agreements. This form shows all information and documentation that is needed for FEMA to process the request. Questions are displayed in a cascading manner to show the information and documentation needed based on answers provided. Please contact the State, local, Tribal, or Territorial emergency management office for additional information. All signatures are official and legally binding. In general, this form will collect certain time extension information including: Declaration-level, Project-level, Impact level, and/or Applicant-level information Work completion or Change request status Justification for extension Time extension details and justification Proposed deadline
Section I – Applicant Information
Declaration #	Legal Name of Applicant: [system generated]		FEMA PA ID: [system generated]		Project Application #: (Optional)
Section II – Time Extension Request Recipients and Applicants complete a time extension request for each type of time extension.
Time Extension Type
Please select the time extension type: 1 ☐ Project Period of Performance2 ☐ Non-Congregate Sheltering3 ☐ Fixed Cost Offer4 ☐ Request for Public Assistance5 ☐ First Large Project Quarterly Progress Report6 ☐ Impact List7 ☐ Medical Care8 ☐ Closeout Submittal9 ☐ Prime Award Period of Performance10
Project Period of Performance11 The project period of performance is the time during which the Applicant or Recipient may conduct activities to carry out the work authorized under the Federal award. Debris clearance and emergency work activities are limited to 6 months and permanent work activities are limited to 18 months. The Recipient may extend the deadlines for an additional 6 months for debris clearance and emergency work and an additional 30 months, on a project-by-project basis, for permanent work. FEMA may extend the project period of performance deadline beyond the Recipient’s authority when a request is submitted with justification for the delay.
Project period of performance deadline [system generated]			Approved by [system generated]
Number of previous extensions [system generated]		Previous project period of performance deadline(s) [system generated]		Approved by [system generated]
What is the current status of the project?12 Please update if changed. ☐ Pre-design, architectural, or engineering service phase13 ☐ Procurement phase ☐ Work has started and is approximately       % complete. Please provide a projected end date, if known: (MM/DD/YYYY) and the construction timeline/project schedule (MM/DD/YYYY). Please describe what work is remaining on the project.14 ☐ All work was completed on (MM/DD/YYYY). Your current deadline is:       [system generated] How much additional time is requested?       days, until (MM/DD/YYYY)15 [system generated] Please provide the justification for the extension:       Please upload any supporting documentation. 16 [optional]
Non-congregate Sheltering17 Applicants must request and receive approval from FEMA for a time extension for non-congregate sheltering activities when congregate shelters are not available, after the initial FEMA- approved 30 days. Applicants should include a detailed justification for the need of a time extension and a revised analysis of options, including the costs for each option.
Your current deadline is:       [system generated] How many individuals/households are anticipated to be sheltered during this extension:       Please explain and/or upload supporting documentation that demonstrates the continuing necessity of non-congregate sheltering:      18 Are there other recovery resources available to transition disaster survivors out of non-congregate sheltering? Please update if changed. ☐ No. Please describe the reason other recovery resources are not sufficient to transition disaster survivors due to known and documented disaster-caused housing challenges:       ☐ Yes.19 Please describe plan to transition disaster survivors out of non-congregate sheltering:       How much additional time is requested?       days, until (MM/DD/YYYY)20 [system generated] Please provide the justification for the extension:       Please upload any supporting documentation. 21 [optional]
Fixed Cost Offer22 Applicants receive a fixed cost offer from FEMA for all large permanent work projects. Applicants have up to 18 months from the disaster declaration date to accept the fixed cost offer for each project. Additionally, each time FEMA transmits a fixed cost offer, the Recipient and Applicant have a combined total of 30 calendar days from the date of FEMA’s transmittal to accept the offer (not to exceed the 18-month deadline). Time extensions to accept fixed-cost offers must be approved by FEMA’s Assistant Administrator for Recovery.
What is the time extension request for? ☐ A specific project. Please select project: 23 [system generate list of projects] 24 ☐ Multiple projects. Please select all projects for which this extension is requested: 25 [system generate list of projects]
Project #       [system generated]		Project title       [system generated]		Category of Work       [system generated]
Fixed Cost Offer Transmittal Date:       [system generated]			Fixed Cost Offer Deadline:      26 [system generated]
Your current deadline is:       [system generated] How much additional time is requested:       days, or until (MM/DD/YYYY)27 [system automated] Please provide the justification for the extension:       Please upload any supporting documentation. 28
Request for Public Assistance29 Government organizations and private nonprofit organizations apply for FEMA’s Public Assistance program by completing a Request for Public Assistance (RPA) form within 30 days of the disaster declaration or the date the respective area was designated. FEMA may extend the deadline for submitting an RPA if the Recipient submits a request with justification based on extenuating circumstances beyond the Applicant’s or Recipient’s control.
What is the time extension request for? ☐ A specific Applicant. Please select Applicant:      30 [system generate list of Applicants] ☐ Multiple designated areas. Please select all designated areas for which this extension is requested: 31 [system generate list of designated areas]
Designation Date:      [system generated]		Designated Area(s):       [system generated]		Request for Public Assistance deadline:      32 [system automated]
Your current deadline is:       [system generated] How much additional time is requested:       days, or until (MM/DD/YYYY)33 [system generated] Please provide the justification for the extension:       Please upload any supporting documentation. 34 [optional]
Section III – Applicant 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.       All information provided regarding this form is true and correct to the best of my knowledge. Upon submittal this form 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).
Non-Congregate Sheltering
      The Applicant acknowledges that if there is a multi-state event that is impacting the Recipient or Applicant’s ability to manage sheltering in some other manner that FEMA may consider a one-time extension under an emergency declaration.       The Applicant certifies that all individuals/households being sheltered meet each of the five following work eligibility criteria: Each household is in an IA designated county/parish/jurisdiction; Each household has registered with FEMA IA program for disaster assistance; Each household has not requested to withdraw its FEMA registration The Applicant has determined that the home (primary residence) is not habitable (see FEMA Policy 104-009-18, Appendix A for more information); and The Applicant has determined the household is able to document status as an owner or renter of the home (primary residence) pre-incident       The Applicant acknowledges that FEMA expects Applicants to develop a data management component that captures specific information regarding individuals/households when conducting non-congregate sheltering operations to ensure eligible work criteria is met and prevent duplication of benefits. Although FEMA does not require regular reporting of the information, the data could be requested by FEMA. The information collected should contain the following data points: FEMA Registration ID (if available) Head of Household: First Name Head of Household: Last Name Head of Household: Mobile or other phone number Number of individuals in the Household Damaged Dwelling: Street Address Damaged Dwelling: City Damaged Dwelling: State Damaged Dwelling: Zip Code Primary-residence habitability status       The Applicant acknowledges that FEMA expects aggregate data reporting the first week of NCS operations and weekly thereafter until the NCS operations have concluded. This reporting should include the following data elements: Number of rooms / non-congregate shelter units occupied by disaster survivors by county or parish Number of disaster survivor households and individuals sheltered in non-congregate shelter by county or parish The counties/parishes in which non-congregate shelter is being conducted       The Applicant acknowledges that FEMA may fund costs associated with necessary non-congregate sheltering activities which were incurred up to six days (applicable only for potential, pre-landfall hurricane events) before the incident period begins and for up to 30 days after the onset of the incident period.       The Applicant acknowledges for non-congregate sheltering activity conducted after the initial 30 days, the Applicant must submit a request through the Recipient to the appropriate FEMA Regional Administrator, which can be accomplished by using this form. Time extensions are granted in 30-day increments. The time extension request should be submitted not less than seven days before the expiration date of currently approved period of performance.       The Applicant acknowledges for all time extensions the Applicant must justify the ongoing need for non-congregate sheltering. For non-congregate sheltering activity associated with either an emergency declaration or a major disaster declaration that does not include Individual Assistance programs, the applicant may be limited to one-time extension for an additional 30-days.       The Applicant acknowledges FEMA will determine whether maintaining disaster survivors in non-congregate shelters during time extensions is eligible work based on the information provided and the criteria listed in FEMA Policy 104-009-18, Section 3. Work Eligibility and the Public Assistance Program and Policy Guide.       The Applicant acknowledges for non-congregate sheltering conducted for more than 30 days, Recipients and Applicants will be required to collect and use data regarding the individuals and households sheltered to effectively manage the non-congregate sheltering operations. This will ensure that only individuals and households with a demonstrated need for continued emergency sheltering remain in non-congregate sheltering facilities. The applicant should collect and compile sufficient information from disaster survivors sheltered in non-congregate sheltering facilities to enable proper management of the project and support disaster survivor transition to longer‐term housing solutions or out of NCS. Applicants should inform individuals and households that information collected may be shared with FEMA.
Applicant Authorized Representative [system generated]	Title [system generated]		Signature [system generated]		Date submitted35 [system automated]
Section IV – Recipient Recommendation36
Does the Recipient recommend approval of this time extension? ☐ No. Please provide the basis for the denial, including the provisions of law, regulation, or policy that support the determination and a complete list of all documents reviewed:       ☐ Partially. Please provide the basis for the portion denied, including the provisions of law, regulation, or policy that support the determination and a complete list of all documents reviewed and approved extension:       and (MM/DD/YYYY)37 [system generated] ☐ Yes. The Recipient recommends approval of extension: (MM/DD/YYYY)38 [system generated] Please provide any additional comments or information regarding the project period of performance time extension request:      
Recipient Authorized Representative [system generated]	Title [system generated]		Signature [system generated]		Date submitted39 [system automated]
Section V – FEMA Review and Determination40
Does FEMA approve the request? ☐ No.41 ☐ Partially.42 ☐ Yes. FEMA approves the request.
FEMA Authorized Representative [system generated]	Title [system generated]		Signature [system generated]		Date submitted43 [system generated]

1 (Help text) Recipients and Applicants complete a time extension request for each type of time extension. Functionality: Generate a time extension request form for each type of time extension requested.

2 (Help text) The project period of performance is the time during which the Applicant or Recipient may conduct activities to carry out the work authorized under the Federal award. Debris clearance and emergency work activities are limited to 6 months and infrastructure restoration work activities are limited to 18 months. The Recipient may extend the deadlines for an additional 6 months for debris clearance and emergency work and an additional 30 months, on a project-by-project basis, for infrastructure restoration work. FEMA may extend the project period of performance deadline beyond the Recipient’s authority when a request is submitted with justification for the delay.

3 (Help text) Applicants must request and receive approval from FEMA for a time extension for non-congregate sheltering activities when congregate shelters are not available, after the initial non-congregate FEMA approval.

4 (Help text) Applicants receive a fixed cost offer from FEMA for all large infrastructure restoration projects. Applicants have up to 18 months from the disaster declaration date to accept the fixed cost offer for each project. Additionally, each time FEMA transmits a fixed cost offer, the Recipient and Applicant have a combined total of 30 calendar days from the date of FEMA’s transmittal to accept the offer (not to exceed the 18-month deadline). Time extensions to accept fixed-cost offers must be approved by FEMA’s Assistant Administrator for Recovery.

5 (Help text) Government organizations and private nonprofit organizations apply for FEMA’s Public Assistance program by completing a Request for Public Assistance (RPA) form within 30 days of the declaration or the date the respective area was designated in the declaration. FEMA may extend the deadline for submitting an RPA if the Recipient submits a request with justification based on extenuating circumstances beyond the Applicant’s or Recipient’s control.

6 (Help text) Applicants and Recipients must request and receive approval from FEMA for a time extension on the submittal of the first Quarterly Progress Report.

7 (Help Text) Applicants must identify and report all incident-related impacts to FEMA within 90 days the Request for Public Assistance approval. FEMA may extend the deadline to identify and report incident-related impacts if the Applicant submits a request with justification based on extenuating circumstances beyond the Recipient’s or Applicant’s control. Applicants complete this form once for each impact in Grants Portal to identify and report incident-related impacts.

8 (Help text) When the emergency medical delivery system within a declared area is destroyed, severely compromised, or overwhelmed, FEMA may fund extraordinary costs associated with operating emergency rooms and with providing temporary facilities for emergency medical care of survivors. Costs are eligible up to 30 days from the declaration date unless extended by FEMA as described in the Medical Care section of the Public Assistance Program and Policy Guide.

9 (Help text) The Recipient must submit its certification of the Applicant’s completion of projects with the final claim for Public Assistance funding and supporting documentation to FEMA within 180 days of the work completion date or the project deadlines, whichever occurs first. The Recipient must submit its certification for each of its own projects within 90 days of the work completion date or the project deadlines, whichever occurs first.

10 (Help Text) Recipients complete this form to capture a time extension request of a declaration’s Public Assistance award (referred to as the prime award) period of performance. The prime award period of performance begins on the first day of the incident period and initially extends four years from the declaration date.

11 Functionality: Only show if Project Period of Performance is selected.

12 Functionality: Response is generated from the last Large Project Quarterly Progress Report.

13 Functionality: This question is displayed only for permanent work.

14 Functionality: Trigger only for projects with more than 89% work complete for more than 90 days.

15 Functionality: Generate date based on the number of days entered.

16 Functionality: Documentation is optional.

17 Functionality: Only show if Non-congregate Sheltering is selected.

18 (Help text) In limited circumstances, such as when congregate shelters are not available or sufficient, FEMA may reimburse costs related to emergency sheltering provided in non-congregate environments. See the Non-congregate Sheltering section of the Public Assistance Program and Policy Guide (PAPPG) for more information. Functionality: Allow for document upload.

19 Functionality: Activity is not eligible.

20 Functionality: Generate date based on the number of days.

21 Functionality: Documentation is optional.

22 Functionality: Only show for Fixed Cost Offer is selected. Generate responses for Fixed Cost Offer Transmittal date and Fixed Cost Offer Deadline from Project Application for Infrastructure Restoration.

23 Functionality: Generate list of projects and populate the Project #, Project title, and Category of Work based on the specific project.

24 Functionality: Generate list of projects and populate the Project #, Project title, and Category of Work based on the specific project.

25 Functionality: Generate list of projects and populate Project #, Project title, and Category of Work for each project.

26 (Help text) The Applicant has up to 18 months from the disaster declaration date to accept a fixed-cost offer for each project (also subject to 30-day deadline from receipt). Each time FEMA transmits a fixed-cost offer, the Recipient and Applicant have a combined total of 30 calendar days from the date of FEMA's transmittal of the fixed-cost offer to accept the offer (not to exceed the 18-month deadline). Time extensions to accept fixed-cost offers must be approved by FEMA's Assistant Administrator for Recovery.

27 Functionality: Calculate based on Fixed Cost Offer Deadline plus the additional number of days requested.

28 Functionality: Documentation is optional.

29 Functionality: Only show if Request for Public Assistance is selected.

30 Functionality: Generate list of government organizations and private non-profits from the Organization Profile. (Help text) Applicants must have completed the Organization Profile to appear on list.

31 Functionality: Generate list of Designated Area(s) from Incident Information and populate Designation date, Designated Areas, and Request for Public Assistance Deadline for each area.

32 Functionality: Calculate date [30 days + disaster declaration or designation date].

33 Functionality: Calculate based on RPA Deadline in Section I plus the additional number of days requested.

34 Functionality: Documentation is optional.

35 Functionality: Automate based on date submitted.

36 Functionality: If the project is being submitted by the Recipient as the applicant, the system will not include Recipient Recommendation. This section is completed prior to submission to FEMA. If the project period of performance deadline in this section VIII exceeds the prime award period of performance in Section I, generate a Time Extension -Prime Award Period of Performance form and provide the following help text: (Help text) Project extensions cannot exceed the Recipient’s prime award period of performance. Therefore, the Recipient must request FEMA approval for an extension to the prime award period of performance. See the Work Completion Deadlines section in the Public Assistance Program and Policy Guide (PAPPG) for more information.

37 Functionality: Input date requested by Applicant.

38 Functionality: Input date requested by Applicant.

39 Functionality: Automate based on date submitted.

40 Functionality: If the recommended project period of performance deadline in this section VIII exceeds the prime award period of performance in Section I, do not allow FEMA to approve an extension unless and until FEMA approves a time extension to the Recipient’s prime award period of performance.

41 Functionality: Require the FEMA Ineligibility Determination Form.

42 Functionality: Require the FEMA Ineligibility Determination Form.

43 Functionality: Automate based on date submitted.

FEMA Form FF-104-FY-22-248 3