Privacy Act Notice

Disaster Case Management (DCM) Application, Appeal, and Modification Forms
Privacy Notice

GENERAL: This information is being collected for the primary purpose of communication with the point
of contact (POC) for states, tribes, and territories (STTs) or qualified private organizations applying for
grants to provide Disaster Case Management (DCM) services following a Presidentially declared disaster.
AUTHORITY: Section 426 of the Robert T. Stafford Disaster Relief and Emergency Assistance Act, as
amended (42 U.S.C. § 5189d).
USES AND SHARING: FEMA may share the information collected from POCs, including personally
identifiable information, with Department of Homeland Security (DHS) Office of the Chief Financial
Officer-Risk Management and Compliance Division and DHS Office of Inspector General (DHS-OIG).
Further information regarding FEMA’s use and sharing of information can be found within the
DHS/FEMA/PIA-049 Individual Assistance Program, DHS/FEMA/PIA-013 Grant Management Program,
DHS/FEMA/PIA-052 Grant Management Modernization, and DHS/FEMA/PIA - 056 Administered Disaster
Case Management Program Privacy Impact Assessments. The Department’s list of Privacy Impact
Assessments can be found on the Department’s website at https://www.dhs.gov/privacy-impactassessments.
EFFECTS OF NONDISCLOSURE: The disclosure of information on this form is voluntary; however, failure
to provide the information requested may delay or prevent FEMA from providing the requested funding.