DEPARTMENT OF HOMELAND SECURITY O.M.B. No. 1660-0002
Federal Emergency Management Agency
   RESOURCE REQUEST FORM (RRF)
O.M.B. No. 1660-0002
 I. REQUESTING ASSISTANCE (Completed by Requestor)
 1. Requestor's Name
  {var fldI1}
 2. Title
 {var fldI2}
 3. Phone No.
 {var fldI3}

 4. Requestor's Organization
  {var fldI4}
 5. Fax No.
  {var fldI5}
 6. E-Mail Address
  {var fldI6}
 II. REQUESTING ASSISTANCE (Completed by Requestor)
 1. Description of Requested Assistance:
{var fldII1}
 2. Quantity {var fldII2}  3. Priority  {var fldII3}   4. Date and Time Needed  
 {var fldII4}
 5. Delivery Site Location
{var fldII5}
  6. Site Point of Contact (POC)
  {var fldII6}
  7. 24 Hour Phone No
  {var fldII7}
 8. Fax No.
  {var fldII8}
 9. State Approving Official Signature
 {var fldII9}
 10. Date and Time  
 {var fldII10}
III. SOURCING THE REQUEST - REVIEW/COORDINATION (Operations)
1.Reviews
 OPS Review by: {var fldIII1a}
 LOG Review by: {var fldIII1b}
 Other Coordination: {var fldIII1c}
 Other Coordination: {var fldIII1d}
 Other Coordination: {var fldIII1e}
2. Source:
Donations
Requisitions Procurement
Interagency Agreement
Mission Assignment
Other
{var fldIII2other}
3. Assigned to:
 ESF/OFA: {var fldIII3a}
 RSF/OFA: {var fldIII3b}
 Other: {var fldIII3c}
 Date/Time {var fldIII3d}

4. Immediate Action Required: {var fldIII4}
IV. STATEMENT OF WORK (Operations Only)
 1. OFA Action Officer
  {var fldIV1}

 2. 24 Hour Phone #
 {var fldIV2}

 3. Fax #
  {var fldIV3}
 4. FEMA Project Manager
  {var fldIV4}
 5. 24 Hour Phone #
  {var fldIV5}
 6. Fax #
  {var fldIV6}
 7. Statement of Work
{var fldIV7}
 8. Estimated Completion Date {var fldIV8}  9. Estimated Cost {var fldIV9}
V. ACTION TAKEN (Operations Only)
Accepted
Rejected
Requestor Notified
Reason / Disposition
{var fldVReason}
TRACKING INFORMATION (FEMA)
 ECAPS/NEMIS Task ID:
 {var ECAPS}
 Received by (Name)
  {var RecievedName}
 Resource Request #
  {var RRnumber}
 State {var State}
 Program Code/Event #

  {var EventCode}

Originated as verbal

                                           FEMA FORM 010-0-7
Ver 1.9 KE4WLT