FEMA Form FF-104-F Risk Reduction Proposal

DEPARTMENT OF HOMELAND SECURITY

OMB Control No. 1660-0159
Expiration Date: 11/30/2026

Federal Emergency Management Agency
Hermit's Peak/Calf Canyon Claims Office

RISK REDUCTION PROPOSAL
CLAIMANT CONTACT INFORMATION
Claim Number:

Name:

Current Address:

City, State, Zip, and County:

Contact Phone Number:

Email (optional):

Property Address of Proposed Risk Reduction:

City, State, Zip, and County:

WHAT KIND OF PAYMENT ARE YOU SEEKING?

DRAFT
Advanced payments for work not yet started

Reimbursements for completed work

Please include an explanation of the risk or hazard to be mitigated and how this risk is connected to the Hermit's Peak/Calf Canyon
fire and flood event.
Statement:

SELECT PROJECT TYPE(S) (Select all applicable boxes)
Defensible Space Measures

Install Multi-paned/Tempered Glass

Replace Exterior Doors and Cladding
Install/Replace Exterior Wall Coverings
FIRE

Install Non-Combustible Gutters
Decks

Install/Replace Shutters

Other (Include description below):

Temporary Flood Control Measures

Elevate of Flood-Proof Utilities

Flood Protection Measures for Sewer Utility Systems
Install Flood Vents
FLOOD

Install/Replace Ember Resistance Vents

Lot Grading Improvement

Use of Flood Resistant Building Materials

Anchor Fuel Tanks

Flood-Proofed Basements

Reduce Impervious Surfaces

Culverts

Other (Include description below):

FEMA Form FF-104-FY-24-121 (4/24)

Page 1 of 3

DESCRIPTION OF WORK PERFORMED AND/OR TO BE PERFORMED
Provide your response below. Describe the heightened risk(s) to your property that the proposed project addresses. Please note that
all proposed work must be performed in accordance with local and state building codes and standards, which need to be included in
the project description.
If additional space is required for your response, you may attach additional pages. Please keep all original documents and retain a
copy of this Risk Reduction Proposal form for your records.

DRAFT
DATE THAT WORK WILL BE COMPLETED BY AND PROJECT DURATION
(For reimbursement of already completed projects,
please indicate the timeframe which the project was conducted)

ESTIMATE OF WORK

Please complete the table below or, if working with a licensed contractor, attach your invoice with an itemized list of project costs to
this form. For reimbursements, please include proof of payment provided to contractor or itemized list of project costs including labor
and materials.
QUANTITY

MATERIAL AND/OR DESCRIPTION

COST
$
$
$
$
$
$
$
$
TOTAL COST

Name of Contractor Company:

Phone Number of Contractor Company:

Contractor License Number:

Contractor Address:

FEMA Form FF-104-FY-24-121 (4/24)

$

Page 2 of 3

PERMITS AND CODE ENFORCEMENT
Claimants are responsible for obtaining all applicable federal, state, and local permits and other authorizations and adhering to
permit conditions for project implementation prior to construction. For project reimbursements, please include any applicable building
permits or zoning approvals as well as any state and federal approvals and permits that have been acquired.
Please list the obtained permits and authorizations for your project:

AGREEMENT
I, the undersigned, certify that the information provided in this form is accurate to the best of my knowledge. Your signature
authorizes the Claims Office to visually inspect your property to verify that the risk reduction project is complete.
Claimant Signature:

Date:

Claims Reviewer and/or Claims Office Technical Assistance Staff:

Date:

DRAFT

FEMA Form FF-104-FY-24-121 (4/24)

Page 3 of 3