FEMA Form FF-104-F Impact List

D EPARTMENT OF HOMELAND SECURITY OMB Control Number FF-104-FY-22-236

Federal Emergency Management Agency Expires Month Day, Year

IMPACT LIST

Paperwork Burden Disclosure Notice Public reporting burden for this data collection is estimated to average 30 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 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 Applicants complete this form to report incident-related impacts and damage. The information collected will help catalog the damage and impacts to ensure all claims are submitted to FEMA for reimbursement. FEMA and the Recipient use this information to determine manage the event and identify resources required to assist the Applicant. FEMA does not use this information to determine the monetary assistance available for the Applicant. For more information, please see Chapter 5 Damage and Impact Information in the Public Assistance Program and Policy Guide or contact the State, local, Tribal, or Territorial emergency management office for additional information. Recipients and Applicants should use PA 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. In general, this form collects impact-level information, including: Impacted communities and sectors Priorities and immediate needs List and locations of all impacted sites Work status and approximate cost
Section I – Declaration & Applicant Information1
Declaration # [system generated]		Legal name of Applicant: [system generated]			FEMA PA ID: [system generated]
Section II –Impact Information Select activities associated with this project and provide additional information in the sections below based only on selected activities.
Which of the following incident-related activities is the Applicant claiming under FEMA’s Public Assistance program?2 [system generated] Please update if changed. ☐ Debris removal3 ☐ Emergency protective measures4 ☐ Infrastructure damage5 ☐ Building code and floodplain management administration and enforcement6 ☐ Administrative costs related to managing Public Assistance awards7
Debris Removal Information8
When was the debris deposited? (MM/DD/YYYY) Please select all debris activities the Applicant did [will] conduct on public property.9 See Impact List Addendum for selection options. Please describe how the debris removal activity meets the requirement of addressing an immediate threat to life, public health or safety:10       [Optional] Please upload documentation to support the immediate threat.11 Did [will] the Applicant conduct debris activities on private property? See Impact List Addendum for selection options. ☐ No ☐ Yes12 Is the Applicant legally responsible for performing the debris removal activity?13 ☐ No14 ☐ Yes. The Applicant is a government organization, and the State’s, Tribe’s. or Territory’s constitution or laws delegate jurisdictional powers to the Applicant. ☐ Yes. A statute, order, contract, articles of incorporation, charter, or other legal document provides the Applicant authority to conduct the activities. [optional] Please upload supporting documentation15 and describe:       Did [will] the Applicant authorize residents to place debris curbside? ☐ No ☐ Yes. Please provide timeframe: Start Date: (MM/DD/YYYY) End Date: (MM/DD/YYYY)
Emergency Protective Measures Information16
Please select all emergency protective measures the Applicant did [will] conduct on public property.17 See Impact List Addendum for selection options. Please describe the immediate threat to life, public health, or safety; or of significant additional damage to improved public or private property addressed by this activity:18       [Optional] Please upload documentation to support the immediate threat.19 Did [will] the Applicant conduct emergency protective measures on private property?20 ☐ No ☐ Yes. Please describe:       For emergency repairs to private roads, was this the only access route?21 ☐ No22 ☐ Yes. Describe how repairs to the access route economically eliminates the need for temporary housing      . [Optional] Upload documentation to substantiate eligibility. Is the Applicant legally responsible for conducting the emergency response activity/protective measure?23 ☐ No24 ☐ Yes. The Applicant is a government organization, and the State’s, Tribe’s, or Territory’s constitution or laws delegate jurisdictional powers to the Applicant. ☐ Yes. A statute, order, contract, articles of incorporation, charter, or other legal document provides the Applicant authority to conduct the activities. Please describe:      [Optional] Please upload supporting documentation25.
Infrastructure Damage and Facility Details26
Please select the type of facility damaged. See Impact List Addendum for selection options. (Optional) Please provide pre-incident photographs of the facility.27 (Beach) Was the beach engineered?28 ☐ No29 ☐ Yes.30 Please be prepared to upload the following documentation when completing the project application: Design studies, plans, construction documents, and as-builts for the original nourishment. Documentation and details of the maintenance plan, including how the need for renourishment is determined and funded. Renourishment history, design studies, and as-builts for every renourishment, including construction documents if applicable. (Bridge) [Optional] What is the bridge identification number?31       Please upload pre-and post-inspection reports. 32 (Building) Is this building constructed with a welded steel moment frame?33 ☐ No ☐ Yes34 (Canal, drainage channel, aqueduct, debris/stormwater/retention/detention basin, reservoir)35 Was the facility built for flood control purposes? ☐ No. Please describe the purpose:      . ☐ Yes Does the Applicant have documentation to support the pre-incident carrying or storage capacity? ☐ No36 ☐ Yes. [Optional] Please upload the following documentation. ☐ Reports or survey data, either recent or covers a multi-year period, to substantiate the pre-incident capacity and amount of new material reasonably attributable to the incident. ☐ Written maintenance plan/activity logs documenting regular intervals of activity.37 ☐ Other. Please Describe:      . (Power generation, transmission, or distribution)38 Does the damage include electrical conductors? ☐ No ☐ Yes. Please upload the following documentation:39 ☐ A signed, dated, and stamped letter from a licensed professional engineer who has direct experience with the damaged electrical transmission or distribution system certifying the pre-disaster capacity and condition of the conductor along with records providing satisfactory evidence of the pre-disaster capacity and condition of the conductor. Records may include, but are not limited to, maintenance records, contract documents, work orders, inspection logs, or a description of past inspection and maintenance activities certified by a licensed professional engineer. ☐ Copies of construction work plans demonstrating the utility's past practices and current and future projects, if applicable. ☐ Corrective action plans for Rural Utility Service borrowers through the U.S. Department of Agriculture, if applicable. ☐ Staking sheets (Road)40 Is the damage a result of inundated or submerged road?41 ☐ No ☐ Yes.42 Is the surface material gravel? ☐ No ☐ Yes Is there traffic-induced surface damage from reopening prematurely?43 Please select all that apply. ☐ No ☐ Yes, by emergency vehicles performing eligible emergency work. ☐ Yes, by normal road traffic.44 (Water/ Wastewater)45 Is the Applicant legally responsible for repairing the facility?46 ☐ No47 ☐ Yes, the Applicant owns and uses the facility. [Optional] Please upload proof of ownership.48 Was the facility under construction at the time of the incident? ☐ No ☐ Yes. [Optional] Please upload a copy of the contract.49 ☐ Yes, the Applicant leases the facility to another entity. [Optional] Please upload lease or other proof of legal responsibility to repair incident-related damage.50 ☐ Yes, the Applicant leases the facility from another owner. [Optional] Please upload lease or other proof of legal responsibility to repair incident-related damage.51 Is the facility scheduled for replacement using Federal funds within the next 12 months? ☐ No ☐ Yes Was the facility scheduled for improvements prior to the incident? ☐ No ☐ Yes52 Was the facility in active use at the start of the incident period?53 ☐ No.54 Was the facility inactive for repairs or remodeling? ☐ No ☐ Yes. Please upload a copy of the contract.55 Is there an approved budget for future use of the facility? ☐ No ☐ Yes. Does the Applicant have a documented date to begin using the facility? ☐ No ☐ Yes. Please provide:     . 56 ☐ Yes
Building Code and Floodplain Management Administration and Enforcement Information
Has your community been suspended from or sanctioned for not participating in the National Flood Insurance Program?57 ☐ No ☐ Yes58
Section III - Impact-specific Information59 Please answer the following questions for each impact identified.
Impact Line Item #60 [List generated]		(Optional) Please provide the facility name, if applicable.61      			(Optional) Please provide the site or campus name.62      
Does the facility serve historically underserved communities?63 ☐ No ☐ Yes. Please describe how:      			Where is the location of the facility or activity?64 ☐ Throughout jurisdiction ☐ Specific area (e.g., neighborhood or quadrant).65 Please describe:       ☐ Specific address or GPS coordinates:      
(Temporary facilities only) Please describe the selection process for the location(s):66       Did [will] the location of the temporary facility affect historically underserved communities? ☐ No ☐ Yes. Please describe how:      
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.67 ☐ No ☐ Yes	Which of the following best describes the sector(s) impacted?68 Please select all that apply.
	☐ Communications ☐ Education ☐ Emergency Services ☐ Energy ☐ Health and Social Services			☐ Housing ☐ Natural and Cultural Resources ☐ Transportation ☐ Water/Wastewater ☐ Other. Please describe:      
What is the status of the work?69 ☐ All work is complete.70 Please provide work start and end dates (MM/DD/YYYY) - (MM/DD/YYYY). ☐ Work has started and is approximately       % complete [hauled].71 Please provide the start date and a projected end date, if known: (MM/DD/YYYY) - (MM/DD/YYYY) ☐ Work has not started.72 Please provide a projected start date: (MM/DD/YYYY) Did the damage occur on a facility identified in a climate adaptation plan?73 ☐ No ☐ Yes. Please briefly describe:      74 Please describe any considerations related to climate adaptation for the repair or reconstruction of this facility:       What is the Applicant’s plan for restoring this facility? Please select all that apply. ☐ Site investigations, surveys, or preliminary design services needed to determine appropriate restoration method.75 ☐ Repair the facility with: ☐ No changes76 ☐ Changes required by codes and standards ☐ General improvements77 ☐ Interior configuration ☐ Change in materials ☐ Change the size or capacity ☐ Change the function ☐ Replace the facility78 Is it feasible to repair the facility? ☐ No. Please describe why it is not feasible to repair the facility (e.g., apparent based on visual observation that the incident completely destroyed the facility): ☐ Applicant plans to relocate the facility79 ☐ Yes80 ☐ Abandon the facility81 ☐ Unsure82 Does the Applicant have insurance for the facility?83 Please upload insurance documentation. ☐ No, the facilities and work were not insured.84 ☐ Yes, the Applicant anticipates receiving $      . ☐ Yes, the Applicant received $      . ☐ Yes, but the Applicant is uncertain of the amount it will receive. ☐ Yes, but the cost from damage or impacts does not exceed the deductible.85 Has [Does] the Applicant received [anticipate receiving] funding from another source for this impact?86 ☐ No ☐ Yes. Please check all that apply: ☐ Cash Donations. Please describe:       Amount $      ☐ Federal Grants. Please describe:       Amount $       ☐ Non-Federal Grants. Please describe:       Amount $       ☐ Revenue. Please describe:       Amount $       ☐ Third-Party Liability. Please describe:       Amount $       ☐ Unsure87
What was [is] the total [approximate] cost to perform the work? $      88 Insurance Reduction -$     89 Other Reductions -$     90 Total anticipated amount for FEMA claim: $      91
Do any of the following apply to the work? 92 ☐ Disposal of demolition debris or other materials or disposal of construction debris ☐ Fill or borrow material ☐ Ground disturbance93 ☐ Handling of hazardous materials94 ☐ In an invasive species quarantine area95 ☐ Hazardous materials at or adjacent to the work site96 ☐ In a Special Flood Hazard Area97 ☐ (Optional) In or near a Brownfield or Superfund site98 ☐ (Optional) In or near a Conservation Area or Wildlife Refuge99 ☐ (Optional) In or near a Non-Attainment Area100 ☐ In or within 200 feet of a waterway, body of water, floodway, or wetland101 ☐ Near threatened or endangered species or designated critical habitat102 ☐ On a beach or coastal facility103 ☐ On or adjacent to a facility constructed 45 or more years ago104 ☐ On or adjacent to a facility listed on a local, state, tribal, or national register105 ☐ On or adjacent to a facility locally registered as a landmark106 ☐ On or near undeveloped or undisturbed area107 ☐ Temporary access road construction ☐ Temporary staging of equipment or materials108 ☐ Unsure109 ☐ None of the above
Coordination with a Federal, State, Tribal, or Territorial regulatory agency may be required to restore the facility. Has the Applicant coordinated with a regulatory agency?110 ☐ No ☐ Yes. Please provide name of Regulatory Agency:      111
Section IV – Impacts List Addendum
Debris Removal Activities (A) ☐ Debris clearance ☐ Debris removal ☐ From the grounds of a facility or complex. Check if the activities occurred on private property ☐ ☐ From roads or rights-of-way ☐ From a waterway ☐ Navigable ☐ Non-navigable ☐ Hazardous stumps, trees, limbs, or branches. Check if the activities occurred on private property ☐ ☐ Vehicles or vessels ☐ Other debris removal from public property: Please describe:      ☐ Other debris removal from private property: Please describe:      Emergency Protective Measures (B) ☐ Animal carcass removal ☐ Animal control services ☐ Animal replacement ☐ Childcare Services ☐ Debris clearance for emergency access. Check if the activities occurred on private property ☐ ☐ Demolition. Check if the activities occurred on private property ☐ ☐ Commercial structures ☐ Residential structures ☐ Dissemination of information ☐ Distribution of commodities for the general public ☐ Electrical meter repair. Check if the activities occurred on private property ☐ ☐ Emergency Operations Center activities ☐ Evacuation and Sheltering. Please select all that apply: ☐ Evacuation ☐ Congregate sheltering ☐ Non-congregate sheltering ☐ Host-State, Tribe, or Territory sheltering ☐ Congregate ☐ Non-congregate ☐ Firefighting ☐ Flood fighting. Please select all that apply: ☐ De-watering behind a levee ☐ Emergency stormwater/wastewater pumping ☐ Increasing the height of a levee ☐ Sandbagging ☐ Other flood fighting activity. Please describe:      ☐ Hazardous material removal ☐ Human remains ☐ Search and recovery of human remains ☐ Storage and interment of unidentified human remains or mass mortuary services ☐ Other activities associated with human remains. Please describe:      ☐ Increased cost of operating a facility or providing a service ☐ Fuel ☐ Generators (fixed or temporary) ☐ Water testing or treatment ☐ Other increased cost. Please describe:      ☐ Medical care associated with a destroyed, severely compromised, or overwhelmed emergency medical delivery system ☐ Mosquito abatement ☐ Pre-positioning or movement of supplies, equipment, or other resources ☐ Pumping of basements, septic tanks, or wells Check if the activities occurred on private property ☐ ☐ Safety inspections ☐ Search and rescue of survivors, household pets, or service animals ☐ Security, law enforcement, barricading, or patrolling ☐ Snow-related activities ☐ Temporary relocation of essential services ☐ Emergency protective measures that involve facility construction or repairs ☐ Buttressing, shoring, or bracing facilities to stabilize them or prevent collapse ☐ Emergency berms or temporary levees to provide protection from floodwaters or landslides ☐ Emergency repairs to an access route ☐ Emergency repairs to prevent further damage to infrastructure ☐ Emergency slope stabilization ☐ Extracting water and clearing mud, silt, or other accumulated debris from eligible facilities ☐ Mold remediation ☐ Removal or storage of contents from eligible facilities ☐ Other protective measures that involve facility construction or repair. Please describe:      ☐ Other activities to protect public health and safety. Please describe:      Infrastructure Damage ☐ Government administration (e.g., administrative building or courthouse) ☐ Beaches ☐ Communication facility ☐ Educational Facility ☐ Emergency Services ☐ House of worship ☐ Housing ☐ Medical or Healthcare ☐ Parks or recreational facilities ☐ Roads or bridges ☐ Transportation facilities ☐ Utilities, including buildings and system components ☐ Water control facilities Infrastructure Damage - Ancillary facilities Select all that apply. ☐ Administrative ☐ Airport hangar ☐ Airport runway/taxiway ☐ Airport terminal ☐ Aqueduct ☐ Assisted living ☐ Athletic court ☐ Athletic field ☐ Beach ☐ Bench or bleacher ☐ Boardwalk ☐ Bridge ☐ Building ☐ Concession stand ☐ Community/recreation center ☐ Gymnasium ☐ Stadium/Arena ☐ Canal ☐ Cemetery ☐ Communication tower ☐ Contents ☐ Courthouse ☐ Culvert ☐ Dam ☐ Detention basin ☐ Ditch ☐ Dock ☐ Drainage channel ☐ Emergency Operations Center ☐ Equipment ☐ Fence/gate ☐ Fire ☐ Fish hatchery ☐ Flood protection ☐ Berm ☐ Dune ☐ Levee ☐ Sand revetment ☐ Seawall ☐ Golf course ☐ Library ☐ Lift station ☐ Low water crossing ☐ Maintenance ☐ Museum ☐ Natural gas transmission and distribution system ☐ Parking ☐ Rehabilitation facility ☐ Reservoir ☐ Pavilion or covered shelter ☐ Picnic table ☐ Pier ☐ Playground ☐ Police ☐ Port or harbor ☐ Power Plant ☐ Power transmission and distribution system ☐ Prison or Correctional ☐ Public or affordable housing ☐ Pumping station ☐ Railway ☐ Road ☐ Sediment or debris basin ☐ Sidewalk ☐ Signage ☐ Storage ☐ Stormwater retention ☐ Substation ☐ Supplies ☐ Swimming pool ☐ Trail ☐ Tribal housing ☐ Tunnel ☐ Vehicle ☐ Wastewater collection system ☐ Wastewater treatment plant ☐ Water distribution system ☐ Water treatment plant ☐ Wind turbine ☐ Zoo ☐ Other damaged infrastructure not listed above. Please describe:      

1 Functionality: Generate Declaration # from the Incident Information. Generate Legal Name of Applicant, and FEMA PA ID from the Organization Profile.

2 (Help text) Applicants may not add or change activities post 60-days from the Applicant’s Recovery Scoping Meeting/Video unless FEMA approves a time extension. Applicants may delete items to withdraw them from the claim after this date but may not add them back later. Functionality: Generate response from Applicant Impact Survey.

3 (Help text) Debris includes, but is not limited to, vegetative debris, construction and demolition debris, sand, mud, silt, gravel, rocks, boulders, white goods, and vehicle and vessel wreckage.

4 (Help text) Emergency protective measures are activities conducted before, during, or after an incident to eliminate or lessen immediate threats to lives, public health, or safety; or eliminate or lessen immediate threats of significant additional damage to improved public or private property in a cost-effective manner.

5 (Help text) Infrastructure includes built or manufactured buildings, systems, or equipment; or improved and maintained natural features.

6 (Help text) State, local, Territorial and Tribal governments must be in compliance with the National Flood Insurance Program (NFIP), as FEMA will not fund activities under this policy in a community that is suspended from or has been sanctioned for not participating in the NFIP, FEMA Policy 204-079-01 Building Code and Floodplain Management Administration and Enforcement. Confirm NFIP status in the Community Status Book | FEMA.gov.

7 (Help text) See FEMA Recovery Policy FP 104-11-2 Public Assistance Management Costs (Interim). Functionality: Do not allow a yes selection post 60-days from the Applicant’s Recovery Scoping Meeting/Video unless FEMA approves a time extension. Applicants may change the response to no after this date. Functionality: Allow Recipients to complete the Management Cost Project Application. Do not allow a subrecipient to complete a Management Cost Project Application until it has a project obligated.

8 Functionality: Trigger if Debris removal is selected as an activity.

9 (Help text) See Impact List Addendum for selection options. Functionality: Each activity generates a separate impact line item. When impacts span across a large geographical area, they may be listed separately based on geographical areas (e.g., Applicants may select debris removal multiple times with different information provided in Section III for each location).

10 Functionality: Only ask for each of the following impacts when selected in the Impact List Addendum: Debris removal from non-navigable waterway and Removal of hazardous stumps, trees, limbs, or branches.

11 (Help text) Documentation to support the presence of an immediate threat may include technical reports, safety inspector reports, or photographs.

12 (Help text) See Impact List Addendum for selection options. Each activity generates a separate impact line item. When impacts span across a large geographical area, they may be listed separately based on geographical areas (e.g., Applicants may select debris removal multiple times with different information provided in Section IV for each location).

13 (Help text) To determine legal responsibility, FEMA evaluates whether the Applicant requesting the assistance either had jurisdiction over the area in which work was performed or the legal authority to conduct the activities. See the Debris Removal section in the PAPPG for more information. Functionality: If the Applicant claimed funding for activities at this facility in a previous incident, pre-populate with previous information and allow Applicant to update if changed.

14 (Help text) Per Title 44 Code of Federal Regulations § 206.223(a)(3), work must be the legal responsibility of the Applicant requesting assistance. The Applicant should contact FEMA or the Recipient for more information. Please remove this item from the Impact List. Functionality: Activity is not eligible.

15 Functionality: Documentation required prior to submitting project application.

16 Functionality: Trigger if Emergency Protective Measures is selected as an activity.

17 (Help text) See Impact List Addendum for selection options. Functionality: Each activity generates a separate impact line item. When impacts span across a large geographical area, they may be listed separately based on geographical areas (e.g., Applicants may select emergency protective measures multiple times with different information provided in Section III for each location).

18 (Help text) See the Emergency Work Eligibility section in the Public Assistance Program and Policy Guide for more information Functionality: Only ask for each of the following impacts when selected on the Impact List: Animal Carcass Removal; Animal Control Services; Childcare Services; Demolition on private property, Flood fighting; security, law enforcement, barricading, or patrolling; and Other activities to protect public health and safety.

19 (Help text) Documentation to support the presence of an immediate threat may include technical reports, safety inspector reports, or photographs.

20 (Help text) See the Emergency Protective Measures on Private Property section in the PAPPG for more information. Functionality: Question only triggered if the activity on the Impact List is listed within “Activities Conducted on Private Property”.

21 (Help Text) See the Emergency Access section in the PAPPG for more information. Functionality: Only trigger if “Emergency repairs to an access route” was selected under “Private Property” on the Impact List.

22 (Help text) Emergency repairs to a privately-owned road are only eligible if there is no other access point. See the Emergency Access section of the PAPPG for more information. The Applicant should remove this item from its Impact List. Functionality: Applicants may not proceed with claiming this impact.

23 (Help text) To determine legal responsibility, FEMA evaluates whether the Applicant requesting the assistance either had jurisdiction over the area in which work was performed or the legal authority to conduct the activities. Functionality: If the Applicant claimed funding for activities at this facility in a previous incident, pre-populate with previous information and allow Applicant to update if changed.

24 (Help text) Per Title 44 Code of Federal Regulations § 206.223(a)(3), work must be the legal responsibility of the Applicant requesting assistance. The Applicant should contact FEMA or the Recipient for more information. Please remove this item from the Impact List. Functionality: This activity is not eligible.

25 Functionality: Documentation required prior to submitting this survey.

26 Functionality: Only trigger if Infrastructure Damage is selected as an activity.

27 (Help Text) Although PA does not require photographs be submitted on all small projects, FEMA requires documentation to confirm compliance with EHP laws, regulations and executive orders, and such documentation may include photographs. Provision of photographs for EHP compliance helps speed project processing provides a quicker path to reimbursement and recovery; and, avoids delays associated with subsequent requests for information or EHP site visits in cases where necessary information could be obtained from photographic images. Therefore, if photographs are available, FEMA encourages  applicants to submit them with the project application.

28 (Help Text) An engineered beach includes man-made beaches that are designed and have engineered plans. An engineered beach does not include natural beaches. Functionality: Only ask if Beaches was selected on the Impact List Addendum.

29 (Help Text) This beach is not eligible per the Beaches section in the Public Assistance Program and Policy Guide. The Applicant should remove this item from its Impact List. Functionality: Applicants may not proceed with this impact.

30 Functionality: Documentation required prior to proceeding. If Applicant provided documentation for this beach in a previous incident, link to that documentation and request the Applicant upload any updated documentation.

31 Functionality: Response is requested but not required. Only ask if Roads or bridges was selected on the Impact List Addendum.

32 Functionality: Documentation is requested not required.

33 (Help text) For buildings and building systems, distinguishing between damage caused by the incident and pre-existing damage may be difficult. Before making an eligibility determination, FEMA considers evidence of regular maintenance, evidence of pre-disaster condition, such as interior water stains from a leaky roof (in such cases, FEMA evaluates whether the roof was repaired prior to the incident), severity and impacts of the incident; and whether the Applicant took prudent actions to prevent additional damage. To reduce delays, documentation to substantiate the cause of damage is recommended. See the Maintenance section of the PAPPG for more information (Help text) and Functionality: Documentation is not required if the applicant is able to clearly demonstrate in the description how the damage is a direct result of the disaster and not impacted by lack of maintenance. Only ask for Building impacts.

34 (More Info) FEMA has specific eligibility criteria for evaluating and repairing earthquake damage to buildings with welded steel moment frames. See Recommended Post Earthquake Evaluation and Repair Criteria for Welded Steel Moment Frame Buildings (FEMA 352). Please submit a request for Approval Welded Steel Frame. Functionality: Only ask for buildings on earthquake declarations. This facility should not be combined with other facilities.

35 Functionality: Only ask for Drainage Channel or Aqueduct, Sediment/Debris Basin, Stormwater Retention/Detention Basin, and Reservoir.

36 (Help text) Restoring the facility to its pre-disaster capacity is not eligible if the Applicant cannot provide documentation to establish the pre-disaster capacity. See the Restoring the Capacity of Channels, Basins, and Reservoirs section of the PAPPG for more information. The Applicant should remove this item from its Impact List. Functionality: Applicants may not proceed with claiming this impact.

37 (Help text) Applicant logs documenting clearance of blockages in response to resident complaints are not sufficient to substantiate a regular maintenance schedule. See the Restoring the capacity of channels, basins, and reservoirs in the PAPPG for more information. Functionality: Documentation is required prior to submitting the form.

38 Functionality: Only ask for Power Generation and Power Transmission and Distribution impacts.

39 (Help text) If the Applicant provides the requested information, FEMA does not require further documentation to establish pre-disaster condition. The Applicant is not precluded from substantiating the pre-disaster condition with other documentation if it is unable to provide the documentation. See the Power: Transmission and Distribution System Conductor Replacement section in the PAPPG for more information. Functionality: Required prior to submitting a Project Application.

40 Functionality: Only triggered for roads. If GIS shows facility is a major collector or urban minor collector, flag for PDMG or PD TFL review and provide the following (Help text for non-Tribal Government) This facility is not eligible for Public Assistance. See the Eligibility Considerations by Facility section in the PAPPG for more information. Please contact the Federal Highway Administration (FHWA) to determine if they may provide assistance under the Emergency Relief Program. For more information: https://www.fhwa.dot.gov/programadmin/erelief.cfm. (Help Text for Tribal Governments) The Bureau of Indian Affairs (BIA) or the Federal Highway Administration (FHWA) may have authority to provide funding for permanent restoration of the public Tribal roads. If the Tribal Government does not receive funding from BIA or FHWA, the roads may be eligible for FEMA PA funding. Please only proceed if funding will not be requested or was not approved by the BIA or FHWA.

41 (Help text) See the Public Assistance Guidance on Inundated and Submerged Roads (FEMA Policy FP 104-009-13) for specific eligibility criteria prior to proceeding.

42 (Help text) The road is identified as located in a closed basin. Restoration work for roads located in closed basins that have experienced inundation by floodwaters is not eligible per Public Assistance Guidance on Inundated and Submerged Roads (FEMA Policy FP 104-009-13). If the Applicant does not concur with the determination please contact the Recipient or Program Delivery Manager, if assigned, otherwise the Applicant should remove this item from its Impact List. Functionality: Show help text if the facility is identified as located in a closed basin; impact is not eligible. Flag for PDMG or PDTFL review.

43 Functionality: Only ask if “Road” was selected on the Impact List. (More info) To help avoid damage to roads that have been inundated, Applicants should allow time for saturated soil to dry out prior to reopening roads to normal traffic to prevent surface damage caused by reopening roads prematurely. Such damage is traffic-induced, not disaster-related, and should be expected on a saturated roadbed. In addition to not being a result of the declared disaster, surface damage from reopening roads to normal traffic prematurely may constitute negligence and, therefore, may not be eligible for repair assistance from PA. See Public Assistance Guidance on Inundated and Submerged Roads (FEMA Policy FP 104-009-13) for more information.

44 (Help text) Restoration work for roads that have experienced inundation by floodwaters with damage caused by reopening to normal traffic prematurely is not eligible per Public Assistance Guidance on Inundated and Submerged Roads (FEMA Policy FP 104-009-13). The Applicant should remove this item from its Impact List. Functionality: Impact is not eligible.

45 Functionality: Only ask for Water and Wastewater impacts.

46 (Help Text) See the Legal Responsibility section in the PAPPG for more information. Functionality: If the Applicant claimed funding for this facility in a previous incident, pre-populate with previous information and allow Applicant to update if changed.

47 (Help text) Per Title 44 Code of Federal Regulations § 206.223(a)(3), work must be the legal responsibility of the Applicant requesting assistance. Please remove this facility from the Impact List. Functionality: This activity is not eligible.

48 (Help text) Documentation may include deeds, title, or tax records. Functionality: Optional, not required.

49 Functionality: Required prior to proceeding.

50 Functionality: Required prior to proceeding.

51 Functionality: Required prior to proceeding.

52 (Help text) The Applicant may wish to make improvements to a damaged facility that are not required by eligible codes or standards. A project that restores the pre-disaster function of a facility and incorporates improvements or changes to the pre-disaster design is an Improved Project. The Applicant must obtain approval from the Recipient. See the Capped Projects section in the Public Assistance Program and Policy Guide (PAPPG) for more information. Functionality: Trigger the Request for Approval Form.

53 Functionality: Automate the incident period dates.

54 (Help text) To be eligible, a facility must have been in active use at the start of the incident period. Inactive facilities are ineligible, unless one of the following conditions is met: The facility was only temporarily inactive for repairs or remodeling and the contractor was not legally responsible for repair of disaster-related damage; the Applicant established future active use in an approved budget; or the Applicant clearly demonstrates its intent to begin use within a reasonable amount of time. These criteria also apply to facilities that are partially inactive at the start of the incident period. Inactive portions are ineligible unless one of the exceptions noted above applies. See the Inactive or Partially Inactive Facility section in the Public Assistance Program and Policy Guide for more information. Functionality: If the Applicant answers “No” to all 3 questions below, the work is ineligible.

55 Functionality: Please upload documentation of the ongoing repair or remodeling, such as a development plan, building records, or contracts Required prior to proceeding.

56 Functionality: Required prior to proceeding.

57 Functionality: Automate system check against the National Flood Insurance Program database.

58 Functionality: This activity may not be eligible. Please notify FEMA and the Recipient for review.

59 Functionality: Each question in Section IV is asked for each impact line item unless otherwise noted.

60 Functionality: Assign a number to each line item entered beginning with number 1 for each Applicant.

61 (Help text) For activities in waterways, please list the body of water name. For facilities, please list the facility name. For contents, equipment, and supplies, please include the facility name for which the items are associated. Applicants should use titles that can be used in future incidents for the same facility. Functionality: Allow applicants to select facility names previously entered for this incident or previous incidents. Auto-select all impacts at the same facility on the same Project Application.

62 (Help text) Applicants should use titles that can be used in future incidents for the same site. For items listed based on geographic district or area, please include the district or area. Functionality: Allow applicants to select names previously entered for this incident or previous incidents. Auto-select all impacts at the same site or campus on the same Project Application.

63 Functionality: Populate only for Infrastructure Damage.

64 (Help text) For systems that span geographical districts or areas, list the district or area and upload a map of locations. Functionality: 1) Require specific address or GPS location for protective measures that involve facility construction or repairs; emergency repairs to an access route (require start and end), private property demolition; temporary generators; temporary relocation of services; emergency pumping; congregate sheltering; non-congregate sheltering; sandbagging; host-State or host-Tribe sheltering; storage of human remains; mass mortuary services; and all permanent line items. 2) Pre-populate information from previous incidents for the Applicant to re-select for this incident. 3) Do not allow locations outside of the declared area except for sheltering, evacuation, or Emergency Operation Center activities.

65 Functionality: Allow the map to recognize 3 or more defined points as an area.

66 (Help text) Consider how the location of each site - relative to other locations – best advances a focus on supporting underserved communities. Functionality: Only generate for the following activities on the Impact List: use of a Temporary Debris Staging and Reduction Site, Final Disposal Site; Childcare Services, Dissemination of information, Distribution of commodities, Evacuation, Congregate sheltering, Non-congregate sheltering, Host-State, Tribe, or Territory sheltering, Temporary relocation of essential services, and Relocation of a damaged facility.

67 (Help text) The Applicant should consider its recovery priorities and identify associated impacts that need Recipient and FEMA prioritization. These priorities are specific to each Applicant, not the overall incident.

68 Functionality: Generate from the Impact List Addendum and allow Applicant to select the sector for any that are not identified on the addendum.

69 Functionality: The Applicant may update this section any time prior to submitting a project completion certification.

70 Functionality: Do not allow this activity to be combined with activities that do not have this box checked.

71 (Help text) FEMA conducts inspections at sites with work to be completed. The purpose of the inspection is

to validate, quantify, and document the cause, location, and details of the reported damage and

debris impacts. Functionality: Use hauled instead of complete for Debris Removal line items. Generate Damage Information Form.

72 (Help text) FEMA conducts inspections at sites with work to be completed. The purpose of the inspection is

to validate, quantify, and document the cause, location, and details of the reported damage and

debris impacts. Functionality: Generate Damage Information Form.

73 Functionality: Only ask if the Applicant selected yes to the climate adaptation question in the Applicant Impact Survey.

74 Functionality: Notify the Recipient and the FEMA Public Assistance and Hazard Mitigation Group Supervisors that the Applicant requests support to develop plans for climate adaptation.

75 (Help text) If the Applicant would like technical assistance to identify mitigation opportunities, please let the Recipient and/or the PDMG know so that a Mitigation Specialist can be assigned to assist. Functionality: This should not be combined with other line items in the Project Application.

76 (Help text) FEMA recognizes that after a disaster, the best time to protect a facility from future, damage is during the recovery period. Mitigation projects done during recovery reduces overall cost and construction efforts associated with retrofitting a repaired facility. During the recovery process, FEMA will assist you with assessing damage, developing a Hazard Mitigation Proposal, and evaluating the cost-effectiveness of mitigation projects. If the Applicant is interested in working with a Mitigation Specialist, please contact the Recipient or PDMG.

77 (Help text) The Applicant may wish to make improvements to a damaged facility that are not required by State, Tribe, Territory, local, or consensus-based codes or standards. A project that restores the pre-disaster function of a facility and incorporates improvements or changes to the pre-disaster design may be considered an Improved Project. This type of change requires pre-approval and will require the Applicant to complete the Pre-Approval for an Improved Project. Changes to materials, configuration, or size could be considered mitigation. Please work with the Recipient and/or the PDMG to ensure all necessary information is provided to prevent delays in funding.

78(Help Text) See the Repair vs. Replacement section in the PAPPG for more information. Functionality: This should not be combined with other line items in the Project Application.

79 Functionality: Trigger the Replacement Project section of the Request for Approval. Notify the PDTFL, PDMG, and Mitigation TFL.

80 (Help text) The cost to repair the disaster-related damage must exceed 50 percent of the cost to replace the facility based on its pre-disaster size, capacity, and function. See Repair vs. Replacement section of the PAPPG for more information. Functionality: Trigger Request for Approval Form.

81 Functionality: Do not allow selection of any other option. Should not be combined with other line items in the Project Application. Trigger the Alternate Project section of the Request for Approval.

82 (Help text) If the Applicant is not assigned a Program Delivery Manager, the Recipient or FEMA may assign one to assist with recovery. Functionality: Notify the Recipient and FEMA.

83 (Help text) Applicants are required to take reasonable efforts to recover insurance proceeds that it is entitled to receive from its insurers. FEMA will consider final insurance settlements that may be less than the insurance policy limits when an applicant demonstrates that it has taken reasonable efforts to recover insurance proceeds that it is entitled on a case-by-case basis. See Recovery Policy FP 206-086-1, Public Assistance Policy on Insurance for more information.

84 (Help text) If an applicant received Public Assistance funding on a previous event and was required to obtain and maintain insurance for a specific amount, failure to do so could jeopardize funding for the current event. Functionality: If "No, the facilities and work were not insured" is selected, notify PDMG and Insurance Specialist for review.

85 (Help text) FEMA may reduce the total estimated project cost by an estimated amount of insurance proceeds based on a review of the Applicant’s insurance policy.

86 (Help text) FEMA is legally prohibited from duplicating benefits from other sources. The approximate cost listed must be reduced by any other funding the Applicant may receive for this work including insurance, non-Federal grants, cash donations, and other Federal funding. Functionality: This Applicant may update this section until submittal of its project completion certification.

87 Functionality: Notify FEMA and the Recipient for review.

88 (Help text) Please enter the total approximate cost estimated to address this impact. The Applicant may adjust this amount upon submittal of its Project Application for this impact.

89 Functionality: Calculate based on amounts listed under insurance.

90 Functionality: Calculate based on amounts listed under funding from another source.

91 Functionality: Calculate based on the total approximate amount minus insurance and other reductions.

92 (Help text) Please review the following list and identify any options that apply to the work. If none of the options apply, please select “None of the above”. Functionality: Applicant must select an option prior to proceeding. If none of the options apply to the work, Applicants must select “None of the above”.

93 (Help text) Ground disturbance includes any work that results in disturbance of the earth such as digging, scraping, excavating, and activities that could cause soil compaction. This includes but is not limited to removal of stumps, trees, and vegetation. Projects involving any ground disturbance may require archaeological review prior to conducting work. See the Environmental and Historic Preservation Considerations section in the Public Assistance Program and Policy Guide for more information.

94 (Help text) See the Hazardous Materials section in the Public Assistance Program and Policy Guide for more information.

95 (Help text) See the Environmental and Historic Preservation Compliance section in the Public Assistance Program and Policy Guide for more information. Functionality: Generate response through system automation based on GIS technology and notify EHP for early engagement.

96 (Help text) See the Hazardous Materials section in the Public Assistance Program and Policy Guide for more information. Functionality: Generate response through system automation based on GIS technology and notify EHP for early engagement.

97 (Help text) Work may trigger environmental or historic preservation requirements or consultation with a regulatory agency. It is critical for the Applicant to coordinate with the respective state, tribal, or territorial environmental agency prior to conducting work. See the Floodplain Management and Wetland Protection section in the Public Assistance Program and Policy Guide for more information. Functionality: Generate response through system automation based on GIS technology and notify EHP for early engagement.

98 (Help text) Work may trigger environmental or historic preservation requirements or consultation with a regulatory agency. It is critical for the Applicant to coordinate with the respective state, tribal, or territorial environmental agency prior to conducting work. See the Environmental and Historic Preservation Compliance section in the Public Assistance Program and Policy Guide for more information. Functionality: Generate response through system automation based on GIS technology and notify EHP for early engagement.

99 (Help text) Work may trigger environmental or historic preservation requirements or consultation with a regulatory agency. It is critical for the Applicant to coordinate with the respective state, tribal, or territorial environmental agency prior to conducting work. See the Environmental and Historic Preservation Compliance section in the Public Assistance Program and Policy Guide for more information. Functionality: Generate response through system automation based on GIS technology and notify EHP for early engagement.

100 (Help text) Work may trigger environmental or historic preservation requirements or consultation with a regulatory agency. It is critical for the Applicant to coordinate with the respective state, tribal, or territorial environmental agency prior to conducting work. Functionality: Generate response through system automation based on GIS technology and notify EHP for early engagement.

101 (Help text) Many activities in and around waterways and wetlands require permits, including dredging and filling. For projects involving work in a waterway, a new or modified permit from the U.S. Army Corps of Engineers may be required. See the Waterways section in the Public Assistance Program and Policy Guide for more information. Functionality: Generate response through system automation based on GIS technology and notify EHP for early engagement.

102 (Help text) Under Section 7 of the Endangered Species Act, FEMA must consult with the US Fish and Wildlife Service when FEMA-funded activities have the potential to affect federally listed threatened species, endangered species, or designated critical habitat. These activities include tree removal, work in water, or in or near water. Consultation must occur before work starts. See the Environmental and Historic Preservation Considerations section in the Public Assistance Program and Policy Guide for more information. Functionality: Generate response through system automation based on GIS technology and notify EHP for early engagement.

103 (Help text) Work on a beach or coastal facility may require coordination with U.S. Army Corps of Engineers, U.S. Fish and Wildlife, or other Regulatory agencies. See the Environmental and Historic Preservation Compliance section in the Public Assistance Program and Policy Guide for more information. Functionality: Generate response through system automation based on GIS technology and notify EHP for early engagement.

104 (Help text) Section 106 of the National Historic Preservation Act (NHPA) requires FEMA to consider the effects an undertaking will have on historic properties and provide the Advisory Council on Historic Preservation the opportunity to comment on the effects of the undertaking (see 16 U.S.C. § 470f.) Historic properties include buildings or groups of buildings (districts), structures, objects, landscapes, archaeological sites, and traditional cultural properties included in, or eligible for inclusion in, the National Register of Historic Places See the Environmental and Historic Preservation Compliance section in the Public Assistance Program and Policy Guide for more information. Functionality: Generate response through system automation based on GIS technology and notify EHP for early engagement.

105 (Help text) Section 106 of the National Historic Preservation Act (NHPA) requires FEMA to consider the effects an undertaking will have on historic properties and provide the Advisory Council on Historic Preservation the opportunity to comment on the effects of the undertaking (see 16 U.S.C. § 470f.) Historic properties include buildings or groups of buildings (districts), structures, objects, landscapes, archaeological sites, and traditional cultural properties included in, or eligible for inclusion in, the National Register of Historic Places (see www.nps.gov/subjects/nationalregister/index.htm). See the Environmental and Historic Preservation Compliance section in the Public Assistance Program and Policy Guide for more information. Functionality: Generate response through system automation based on GIS technology and notify EHP for early engagement.

106 (Help text) Section 106 of the National Historic Preservation Act (NHPA) requires FEMA to consider the effects an undertaking will have on historic properties and provide the Advisory Council on Historic Preservation the opportunity to comment on the effects of the undertaking (see 16 U.S.C. § 470f.) Historic properties include buildings or groups of buildings (districts), structures, objects, landscapes, archaeological sites, and traditional cultural properties included in, or eligible for inclusion in, the National Register of Historic Places (see www.nps.gov/subjects/nationalregister/index.htm). Functionality: Generate response through system automation based on GIS technology and notify EHP for early engagement.

107 (Help text) See the Environmental and Historic Preservation Compliance section in the Public Assistance Program and Policy Guide for more information. Functionality: Generate response through system automation based on GIS technology and notify EHP for early engagement.

108 (Help text) See the Temporary Staging Sites section in the Public Assistance Program and Policy Guide for more information.

109 (Help text) If unsure, please contact the State, local, Tribal, or Territorial emergency management office to determine prior to submitting the Project Application. The Applicant may update this information any time prior to submitting a project application for this impact. Functionality: If Unsure is selected for any of the items, send a notification to the Recipient and FEMA to inform there are items pending follow-up with the Applicant. Do not allow Applicant to submit the project application until it is updated to anything other than Unsure. Allow multiple GPS location entries. Notify the Recipient and FEMA EHP when an Applicant selects yes. Impacts with one or more of these activities should not be combined with any other impacts on the Project Application.

110 Functionality: Based on the answer to the question “Do any of the following apply to the work?” if any known coordination is required, implement system functionality to notify Applicant of required coordination.

111 Functionality: Insert drop down menu of applicable regulatory agencies [(National Marine Fisheries Service), (State, Local, Tribal, or Territorial agency), (State, Tribal, or Territorial Historic Preservation Office), (U.S. Army Corps of Engineers), (U.S. Coast Guard), (U.S. Department of Agriculture – Natural Resource Conservation Service), U.S. Department of Health and Human Service), (U.S. Department of Interior), (U.S. Environmental Protection Agency), (U.S. Fish and Wildlife Service), (Other). Based on the answer to the question “Do any of the following apply to the work?” if any known coordination is required, implement system functionality to notify Applicant of required coordination.

FEMA Form FF-104-FY-22-236