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Home My WebLink AboutMEMO FOR RECORD - EXIT INTERVIEW FEDERAL EMERGENCY MANAGEMENT AGENCY MEMORANDUM FOR RECORD SUBJECT: EXIT INTERVIEW APPLICANT NAME: 0 KICKOFF MEETING DATE: 01/00/00 FIPS# 0 Note the number of small and large Project Worksheets written for each category and the total number of PW's by Category. If there is no damage in a category, mark "N/A." This document is to be signed by the Public Assistance Coordinator, State Applicant Liaison, and the Applicant's Authorized Representative as shown on the RPA. Give a copy to the applicant and turn in the original to the data entry section. # Small # Large Completed Categories Projects Projects Total # of PW's Estimated Cost Category A: Debris Clearance 0 Category B: Protective Measures 0 • Category C: Road Systems 0 Category D: Water Control Facilities 0 Category E: Building& Contents 0 Category F: Public Utility System 0 Category G: Other(Recreational) 0 Total # of Project Worksheets 0 0 0 $0 At this time, damage surveys in all categories of work are completed and all Project Worksheets are written. Exceptions are listed in the comment section below. Examples of exceptions are sites under water or Category A or B records being compiled for completed work. If additional damage is found,the applicant must notify FEMA in writing within 60 days of kickoff meeting: 02/29/00 Public Assistance Coordinator: 0 Date: State Applicant Liaison: Date: I hereby certify that to the best of my knowledge and belief all work claimed is eligible in accordance with the grant conditions. All work will comply with the provisions of the Clean Water Act, Clean Air Act, Fish and Wildlife Coordination Act, Endangered Species Act,National Historic Preservation Act, related Federal Statutes, associated State, Tribal and Local Laws, Codes, Ordinances, and Other Statutes. Complete records and cost documents for all approved work will be maintained for at least three (3)years from the date the last project was completed or on receipt of final payment, whichever is later. Applicants have the right to appeal a decision. The appeal must be submitted within 60 days from receipt of the determination by FEMA or the State. All decisions should be addressed to the State Emergency Management Office. Applicant Representative: Date: Comments: FEDERAL EMERGENCY MANAGEMENT AGENCY APPLICANT INFORMATION SHEET APPLICANT FIPS# DISASTER# FEMA DR PROJECT LOCATION/SITE REFERENCE# COUNTY CATEGORY DESCRIPTION OF WORK PERFORMED/PROJECT TITLE PERIOD COVERING KICKOFF MEETING DATE PROJECT OFFICER PUBLIC ASSISTANCE COORDINATOR FEMA - 0 DR - 0 PROJECT WORKSHEET TRANSMITTAL RECORD APPLICANT: 0 FIPS: 0 COUNTY: DATE: 01/00/00 CATEGORY A B C D E F G PAC: 0 PARTIAL: X PO: FINAL: OFFICIAL OFFICE USE ONLY I PAO REVIEW: Name: Date: PW TO: PAC DATA ENTRY EXCEL Applicant Staus Report Updated: Name: Date: NEMIS Team Status Report Updated: Name: Date: CM FILE Updated: Name: Date: Federal Emergency Management Agency Project Worksheet Declaration No. Project No. FIPS No. Date Category FEMA- 0 DR- 0 0 0 0 Damaged Facility: Work Completed as of: Date: Per Cent: 0 Applicant: County: 0 Location: Latitude: Longitude: 0 Damage Description&Dimensions: Scope of Work: Does the Scope of Work change the pre-disaster conditions at the site? Li YES U NO Special Considerations issues included? ❑YES ❑NO Is there insurance coverage on this facility?Ty• ❑YES ❑NO Hazard Mitigation proposal included? ❑YES ❑NO Project Costs Item Code Narrative Quant. Unit Unit Price Cost 0 0 0 0 0 0 0 0 0 0 0 Total Cost $0 PREPARED BY: TITLE: Project Officer APPLICANT: DATE:I PHONE: STATE OF IOWA PUBLIC ASSISTANCE PROGRAM"APPLICATION DOCUMENTS" GUIDANCE Please find included here the two documents that comprise the Public Assistance Program"Application Documents". These documents include: 1. State of Iowa Application for Federal/State Assistance 2. Applicant's Assurances and Certifications (2 pages) Each Applicant approved for Public Assistance Grant funding must submit to Iowa Homeland Security and Emergency Management Division both of these forms-completed, and signed by the individual designated as the Authorized Representive for their jurisdiction. It is recommended that each applicant designate an authorized representative as soon as possible. In accordance with the State of Iowa Public Assistance Administrative Plan and the FEMA-State Agreement: PAYMENTS OF APPROVED GRANT FUNDING CANNOT BE MADE TO AN APPLICANT UNTIL BOTH OF THESE COMPLETED AND SIGNED FORMS ARE ON FILE WITH IOWA HOMELAND SECURITY AND EMERGENCY MANAGEMENT DIVISION. Completed and signed forms should be copied for the Applicant's files, and the original document mailed to: State Public Assistance Officer Iowa Homeland Security and Emergency Management Division 7105 NW 70th Avenue Camp Dodge, Building W-4 Johnston, Iowa 50131 Please keep in mind the following information when completing these forms: State of Iowa Application for Federal/State Assistance: All required information needs to be entered, including the Federal Employer Identification#and the applicant's Fiscal year start date. The applicant's physical address is required in this section; formal correspondence will be directed to the address of the Designated Authorized Representative. The Employer Identification Number, also referred to a Federal Tax I.D. Number, is required by Federal law for financial transactions. The State accounting system will not process a payment without this number on record. The Fiscal Year Start Date required refers to the established fiscal year of the Applicant. This information will relate to the various audit requirements that result from the receipt of Federal and/or State funding. Each applicant may specify whether they prefer to receive their share of grant funding by check, or by electronic fund transfer. If Electronic Fund Transfer is selected by an applicant that has not had previous electronic trans- actions with the State of Iowa, it may be necessary for them to complete and submit the"Electronic Funds Transfer Authorization Form",which is available on the Iowa Departement of Administrative Services (DAS)website, or a hard copy can be obtained from Iowa Homeland Security and Emergency Management Division upon request. If no"preferred payment method" is designated on the application form, payments will be made by check. Each applicant must designate an "Authorized Representative"and a "Chief Finance Officer". The applicant may designate anyone of their choosing for these respective functions, but only one person may be designated to a function at a time (i.e. one Authorized Representative and one Chief Finance Officer). It is recommended not to designate the same person to both functions, but the applicant does have the prerogative of doing so. Each functional designee must sign and date the application form in the section of their designation. The signatures of the individual(s) named shall be recognized as certification that,to the best of their knowledge and belief,the information on the application is complete and accurate, and that their respective designation to sign and file documents on behalf of the applicant cited on the form is authorized by official resolution, code, or statute, recognized by the governing body of the applicant as legally binding. Each applicant may designate a replacement Authorized Representative or Chief Finance Officer at any time during the grant. A change to either designation will require submittal of a new, signed application form. Applicant's Assurances and Certifications: This form must be signed and dated by the Designated Authorized Representative. This signature, on behalf of the applicant, signifies agreement and adherance to all of the terms and conditions set forth therein. Any questions about these forms may be directed to Pat Hall or Michael Powell, at(515) 725-3231.