DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
   MISSION ASSIGNMENT (MA)
O.M.B. No. 1660-0002
I. TRACKING INFORMATION (FEMA)
  State
  {var fldI1}
  Resource Request Number
  {var fldI2}
  Program Code/Event Number
  {var fldI3}
  Date/Time Received
  {var fldI4}
 II. REQUESTING ASSISTANCE (Completed by Requestor)                                   See Attached
  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}

  Date/Time
  {var fldIII3d}
  Priority {var fldIII3e}
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}

  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}
V. COORDINATION (FEMA)
  Type of MA: {var fldVa}
  State Cost Share Percent {var fldVb} %   State Cost Share Amount: $ {var fldVc}
  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}
  Date
  {var fldVi}
 
  **FEMA Project Manager/Branch Director (Program Approval)
  {var fldVj}
  Date
  {var fldVk}
 
  **Comptroller/Funds Control (Funds Review)
  ` {var fldVl}
  Date
  {var fldVm}
VI. APPROVAL
  *State Approving Official (Required for DFA) {var fldVIa}   Date {var fldVIa}
  **Federal Approving Official (Required for all) {var fldVIc}   Date {var fldVId}
VII. OBLIGATION (FEMA)
  Mission Assignment Number
  {var fldVIia}
  Amount This Action
  $ {var fldVIib}
  Date/Time Obligated
  {var fldVIic}
  Amendment Number
  {var fldVIid}
  Cumulative Amount
  $ {var fldVIie}
  Initials
  {var fldVIif}
                                FEMA FORM 1660-0002
Ver 1.5.1 KE4LWT