DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
MISSION ASSIGNMENT (MA) |
O.M.B. No. 1660-0002 |
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I. TRACKING INFORMATION (FEMA) |
State
{var fldI1} |
Resource Request Number
{var fldI2} |
Program Code/Event Number
{var fldI3} |
Date/Time Received
{var fldI4} |
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II. REQUESTING ASSISTANCE (Completed by Requestor)
See Attached
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Assistance Requested
{var fldIIb}
Delivery Location
{var fldIIc} |
Internal Control Number
{var fldIId} |
Date/Time Required
{var fldIIe} |
Initiator/Requestor Name
{var fldIIf} |
24 Hour Phone Number
{var fldIIg} |
Email Address
{var fldIIh} |
Date
{var fldIIi} |
Site POC Name
{var fldIIj} |
24 Hour Phone Number
{var fldIIk} |
Email Address
{var fldIIl} |
Date
{var fldIIm} |
III. INITIAL FEDERAL COORDINATION (Operations Section) |
Action to: |
ESF/OFA: {var fldIII3a}
RSF/OFA:
{var fldIII3b}
Other:
{var fldIII3c}
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Date/Time
{var fldIII3d} |
Priority
{var fldIII3e} |
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IV. DESCRIPTION (Assigned Agency Action Officer) |
Statement of Work
{var fldIVa} |
Assigned Agency
{var fldIVb} |
Projected Start Date
{var fldIVc} |
Estimated Projected End Date
{var fldIVd} |
{var fldIVe}
MA #:
{var fldIVf}
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Total Cost Estimated
{var fldIVg}
|
Total Required this Obligation Cycle
{var fldIVh} |
ESF/OFA/RSF Action Officer
{var fldIVi} |
Phone Number
{var fldIVj} |
Email
{var fldIVk} |
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V. COORDINATION (FEMA) |
Type of MA: {var fldVa}
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State Cost Share Percent
{var fldVb}
% |
State Cost Share Amount: $ {var fldVc}
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Fund Citation: 20 -06-
{var fldVd} -6-{var fldVe} XXXX-250
{var fldVf} -D |
Appropriation code: 70X0702
{var fldVg}} |
Mission Assignment Manager (Preparer)
{var fldVh}
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Date
{var fldVi}
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**FEMA Project Manager/Branch Director (Program Approval)
{var fldVj}
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Date
{var fldVk}
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**Comptroller/Funds Control (Funds Review)
` {var fldVl}
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Date
{var fldVm}
|
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VI. APPROVAL |
*State Approving Official (Required for DFA) {var fldVIa} |
Date
{var fldVIa} |
**Federal Approving Official (Required for all)
{var fldVIc} |
Date
{var fldVId} |
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VII. OBLIGATION (FEMA) |
Mission Assignment Number
{var fldVIia} |
Amount This Action
$
{var fldVIib}
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Date/Time Obligated
{var fldVIic} |
Amendment Number
{var fldVIid} |
Cumulative Amount
$ {var fldVIie} |
Initials
{var fldVIif} |
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FEMA FORM 1660-0002
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Ver 1.5.1 KE4LWT
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