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PROJECT WORKSHEET SAMPLE <br />DEPARTMENT OF HOMELAND SECURITY <br />FEDERAL EMERGENCY MANAGEMENT AGENCY <br />PROJECT WORKSHEET <br />FEMA Form 009-0-0-7 APRIL 2013 REPLACES PREVIOUS EDITION Form 90-91 <br />Attachment 3 <br />o.M.B. NO. 1660-0017 <br />Expires April 30,2013 <br />PAPERWORK BURDEN DISCLOSURE NOTICE <br />Public reporting burden for this form is estimated to average 90 minutes per response. Burden means the iime, effort and financial resources expended by <br />persons to generate, maintain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the <br />collection, including suggestions for reducing the burden to: lnformation Collections Management, Department of Homeland Security, Federal Emergency <br />ManagementAgency,500 C Street, SW, Washington, DC20472, Paperwork Reduction Project(OMB Control Number 1660-0017). You are not required <br />to respond to this collection of information unless it displays a valid OMB number. NOTE: Do not send your completed questionnaire to this address. <br />DISASTER <br />FEMA.-DR- <br />PROJECT NO.PA ID NO.DATE CATEGORY <br />DAMAGED FACILITY WORK COMPLETE AS OF <br />% <br />APPLICANT COUNTY <br />LOCATION LATITUDE LONGITUDE <br />DAI\4AGE DESCRIPTION AND DIMENSIONS <br />SCOPE OF WORK <br />Does the Scope of Work change the pre-disaster conditions at the site? <br />Special Considerations issues included? l-* VES f* ruO <br />ls there insurance coverage on this facility? l- VgS f- ruO <br />f- ves [- ruo <br />Hazard Mitigation proposal included? f- yeS f- ruO <br />PROJECT COST <br />ITEM CODE NARRATIVE QUANTITYiUNIT UNIT PRICE cosT <br />TOTAL COST <br />PREPARED BY TITLE SIGNATURE <br />APPLICANT REP TITLE SIGNATURE <br />FFY18 Fire Management Assistance Grant Agreement Page 21 of 22 Kittitas, County of, D19-1004