Form FF-104-FY-21-191 ( FF-104-FY-21-191 ( Transportable Temporary Housing Unit Ready for Occupancy

DEPARTMENT OF HOMELAND SECURITY

Federal Emergency Management Agency
TRANSPORTABLE TEMPORARY HOUSING UNIT
READY FOR OCCUPANCY STATUS

OMB Control Number: 1660-0138
Expiration Date: MM/DD/YYYY

PAPERWORK BURDEN DISCLOSURE NOTICE

Public reporting burden for this form is estimated to average 20 minutes per response. The burden estimate includes the time for reviewing
instructions, searching existing data sources, gathering and maintaining the needed data, and completing, reviewing, and submitting the form.
This collection of information is mandatory. You are not required to respond to this collection of information unless a valid OMB control number
appears in the upper right corner of this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing
this burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency, 500 C
Street, SW, Washington, DC, 20472, Paperwork Reduction Project (1660-NEW). Please do not send your completed survey to the above
address.
PRIVACY ACT STATEMENT
AUTHORITY: The Robert T. Stafford Disaster Relief and Emergency Assistance Act as amended, 42 U.S.C. § 5174 and Title 44 C.F.R. Part
206.117.
PRINCIPAL PURPOSE(S): This information is being collected for the primary purpose of determining the ready for occupancy (RFO) status of
a Transportable Temporary Housing Unit (TTHU) prior to its use as a form of direct temporary housing assistance under a Presidentiallydeclared disaster.
ROUTINE USE(S): The information on this form may be disclosed as generally permitted under 5 U.S.C. § 552a(b) of the Privacy Act of 1974,
as amended. This includes using this information as necessary and authorized by the routine uses published in DHS/FEMA - 008 Disaster
Recovery Assistance Files System of Records, 78 Fed. Reg. 25282 (Apr. 30, 2013), and upon written request, by agreement, or as required by
law.
DISCLOSURE: The disclosure of information on this form is voluntary; however, failure to provide the information requested may delay or
prevent the applicant from receiving the requested disaster-related temporary housing assistance.
FEMA RFO Checklist
Contract #:

Task Order #:

Type of TTHU:

Date of Inspection:

Address:

City, State:

TTHU Barcode:

TTHU VIN:

Inspector Name:
FEMA Monitor Name:

YES

UFAS:

DRAFT
Inspector Signature:

Phone Number:

FEMA Monitor Signature:

Phone Number:

NO

Note: Descriptions in this document are for reference only. The requirements are found in the contract. Descriptions in this document do not
supersede any of the requirements in the contract.
EXTERIOR
ITEM

INITIALS
DESCRIPTION

YES

NO

N/A

CONTRACTOR
CERTIFICATION

FEMA MONITOR

PLACING/SECURING
BLOCKING

Is the TTHU blocked according to the
solicitation, state or local entity requirements,
and/or manufacturer specifications?

LEVEL

Is the TTHU level and elevated if required?

TIE DOWNS

Is the TTHU tied down safely and securely?

ANCHORING

Is the TTHU anchored safely and securely?

UTILITIES
WATER

Is the water piping connected and working
properly?

SEWER

Is the sewage system connected properly (check
slope, etc.) and in working condition?

ELECTRIC

Are all the electrical components working
properly?

FEMA FORM FF-104-FY-21-191 (formerly 009-0-129)
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TRANSPORTABLE TEMPORARY HOUSING UNIT READY FOR OCCUPANCY STATUS
ITEM

DESCRIPTION

STEP

Is the entry component installed and safe to use?

PLATFORM STAIR

Is the entry component installed and safe to use?

RAMP

Is the entry component installed and safe to use?

DOOR/LOCKS

Are the exterior locks and door functioning
properly?

YES

NO

N/A

CONTRACTOR
CERTIFICATION

FEMA MONITOR

ENTRY

EXTERIOR STRUCTURE
WINDOWS

Are all windows present and functional?

ROOF

Is the roof in good condition?

SIDING

Is the siding in good condition?

TANK AND PUMP SYSTEM (TPS)
Is the Tank and Pump System installed and ready to use?
INTERIOR
KITCHEN
FLOOR

Is the floor in good condition?

FLOOR COVERING

Is the floor covering in good condition?

WALLS

Are the walls in good condition?

CEILING

Is the ceiling in good condition?

LIGHTING

Are all lighting components functioning properly?

OUTLETS

Are all outlets functioning properly?

CABINETS

Are all cabinets in good condition?

SINK

Is the sink functioning properly?

EXTINGUISHER

Is the fire extinguisher present and in working
condition?

FURNISHINGS

Are all the furnishings in good condition?

BLINDS

Are all blinds present and in good condition?

DRAFT

APPLIANCES
RANGE

Is the range functioning properly?

REFRIGERATOR

Is the refrigerator functioning properly?

MICROWAVE

Is the microwave functioning properly?

RANGE HOOD

Is the range hood functioning properly?

WATER HEATER

Is the water heater functioning properly?

CLEAN AND MAKE
READY

Is the TTHU clean?

WEATHER RADIO

Is the Weather Radio functioning properly?

LIVING ROOM
FLOOR

Is the floor in good condition?

FLOOR COVERING

Is the floor covering in good condition?

WALLS

Are the walls in good condition?

FEMA FORM FF-104-FY-21-191 (formerly 009-0-129)
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TRANSPORTABLE TEMPORARY HOUSING UNIT READY FOR OCCUPANCY STATUS
ITEM

DESCRIPTION

CEILING

Is the ceiling in good condition?

LIGHTING

Are all lighting components functioning properly?

OUTLETS

Are all outlets functioning properly?

FURNISHINGS

Are all furnishings in good condition?

BLINDS

Are all blinds present and in good condition?

SMOKE/STROBES

Is the smoke alarm functioning properly?

CLEAN AND MAKE
READY

Is the TTHU clean?

YES

NO

N/A

CONTRACTOR
CERTIFICATION

FEMA MONITOR

BATHROOM 1
FLOOR

Is the floor in good condition?

FLOOR COVERING

Is the floor covering in good condition?

WALLS

Are the walls in good condition?

CEILING

Is the ceiling in good condition?

LIGHTING

Are all lighting components functioning properly

OUTLETS

Are all outlets functioning properly?

FIXTURES

Are all fixtures present and functioning properly?

SINK

Is the sink in good condition and functioning
properly?

TUB/SHOWER

Is the tub/shower present and functioning
properly?

COMMODE

Is the commode functioning properly?

CLEAN AND MAKE
READY

Is the TTHU clean?

BATHROOM 2

DRAFT

FLOOR

Is the floor in good condition?

FLOOR COVERING

Is the floor covering in good condition?

WALLS

Are the walls in good condition?

CEILING

Is the ceiling in good condition?

VENT FAN

Is the vent fan functioning properly?

DOOR

Is the door in good condition?

LIGHTING

Are all lighting components functioning properly?

OUTLETS

Are all outlets functioning properly?

CABINETS

Are all cabinets in good condition?

FIXTURES

Are all fixtures present and functioning properly?

TUB/SHOWER

Is the tub/shower in good condition and
functioning properly?

COMMODE

Is the commode functioning properly?

SINK

Is the sink in good condition and functioning
properly?

CLEAN AND MAKE
READY

Is the TTHU clean?

FEMA FORM FF-104-FY-21-191 (formerly 009-0-129)
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TRANSPORTABLE TEMPORARY HOUSING UNIT READY FOR OCCUPANCY STATUS
ITEM

DESCRIPTION

YES

NO

N/A

CONTRACTOR
CERTIFICATION

FEMA MONITOR

BEDROOM 1
FLOOR

Is the floor in good condition?

FLOOR COVERING

Is the floor covering in good condition?

WALLS

Are the walls in good condition?

CEILING

Is the ceiling in good condition?

DOOR

Is the door in good condition?

LIGHTING

Are all lighting components functioning properly?

OUTLETS

Are all outlets functioning properly?

FURNISHINGS

Are all furnishings in good condition? Are the
mattresses new?

BLINDS

Are all blinds present and in good condition?

SMOKE/STROBES

Is the smoke alarm functioning properly?

CLEAN AND MAKE
READY

Is the TTHU clean?

BEDROOM 2
FLOOR

Is the floor in good condition?

FLOOR COVERING

Is the floor covering in good condition?

WALLS

Are the walls in good condition?

CEILING

Is the ceiling in good condition?

DOOR

Is the door in good condition?

LIGHTING

Are all lighting components functioning properly?

OUTLETS

Are all outlets functioning properly?

FURNISHINGS

Are all furnishings in good condition?

BLINDS

Are all blinds present and in good condition?

SMOKE/STROBES

Is the smoke alarm functioning properly?

CLEAN AND MAKE
READY

Is the TTHU clean?

DRAFT

BEDROOM 3
FLOOR

Is the floor in good condition?

FLOOR COVERING

Is the floor covering in good condition?

WALLS

Are the walls in good condition?

CEILING

Is the ceiling in good condition?

DOOR

Is the door in good condition?

LIGHTING

Are all lighting components functioning properly?

OUTLETS

Are all outlets functioning properly?

FURNISHINGS

Are all furnishings in good condition?

BLINDS

Are all blinds present and in good condition?

SMOKE/STROBES

Is the smoke alarm functioning properly?

CLEAN AND MAKE
READY

Is the TTHU clean?

FEMA FORM FF-104-FY-21-191 (formerly 009-0-129)
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TRANSPORTABLE TEMPORARY HOUSING UNIT READY FOR OCCUPANCY STATUS
ITEM

DESCRIPTION

YES

NO

N/A

CONTRACTOR
CERTIFICATION

FEMA MONITOR

HALLWAY
FLOOR

Is the floor in good condition?

WALLS

Are the walls in good condition?

CEILING

Is the ceiling in good condition?

HVAC

Is the HVAC in good condition?

SMOKE/STROBES

Is the smoke alarm functioning properly?

DRYER VENT
INSTALLED

Is the dryer vent functioning properly?

CLEAN AND MAKE
READY

is the TTHU clean?

ADDITIONAL COMMENTS

DRAFT

FEMA FORM FF-104-FY-21-191 (formerly 009-0-129)
(12/21)

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