Public Assistance Excess Funds Usage Request Form

Step 1 of 2

Information Needed To Complete This Form
Before starting this form, please ensure that you have the following information at hand:

- Project information (Grants Portal Project #, and EMMIE PW #, both of which are located in the excess funds email from your field rep).

- The federal share of the Category Z award that you are requesting to use as excess funds.

- Excess funds proposal letter (the information required for this was included in the excess funds email from your field representative). It is preferred that this proposal be on letterhead.
Contact Information
Sub-Recipient Name (Municipality/Entity Name)*
Primary Point of Contact (POC)*
First Last
Primary POC Email*
Enter Email Confirm Email
Primary POC Phone*
Project Information
Disaster (DR) Number*
Category Z Grants Portal Project Number*
Please enter a number from 0 to 999999.
Category Z EMMIE Project Number*
Please enter a number from 0 to 500.
Total Amount Being Requested for Use as Excess Funds*
This is 100% of the Excess Funds Proposal.
Federal Share Being Requested for Use as Excess Funds*
This is automatically calculated based on the amount entered above. Federal Share is 75% of eligible project costs.

Documentation Upload
Excess Funds Proposal Letter*
Please upload your excess funds proposal (preferably on letterhead). This should include the following information:

- List of specific training, activities, materials, etc. that you wish to use the excess funds for.

- Timeline in which you propose to complete the activities and spend the excess funds (this can be an estimate).

- Cost associated with each training, activity, material, etc.

- Justification for how these training(s), activities, materials, etc. will help reduce the risk of damage in future disasters
Max. file size: 1 GB.
Additional Supporting Documentation
Please provide any additional documentation for the request here (i.e. task based narrative).
Drop files here or

Max. file size: 1 GB.
Comments
Provide any additional comments or notes that you would like to share with HSEM regarding this request.
Certification and Submission
The person completing this excess funds request is the same as the Primary POC listed at the start of this form*
- Yes
- No
Name of Person Completing Request*
First Last
Email of Person Completing Request*
Enter Email Confirm Email
Phone Number of Person Completing Request*
By selecting the box below and entering my name, I agree and understand that providing any false information may result in the inability to distribute monies or benefits related to this project. I also understand that this request is not a guarantee of funding and that excess funds requests must be approved by FEMA.*
- I understand and agree
Name*
First Last
Email
This field is for validation purposes and should be left unchanged.

Public Assistance Excess Funds Usage Request Form

Public Assistance Excess Funds Usage Request Form

Step 1 of 2

Information Needed To Complete This Form

Contact Information

Project Information

Documentation Upload

Certification and Submission

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