DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
   MISSION ASSIGNMENT (MA)
O.M.B. No. 1660-0002
I. TRACKING INFORMATION (FEMA Use Only)
  State
  		  Resource Request Number
 
  Program Code/Event Number
  		  Date/Time Received
 
 II. REQUESTING ASSISTANCE (To be completed by Requestor)                                   See Attached
  Assistance Requested
 
 Delivery Location
  		  Internal Control Number
  		  Date/Time Required
 

 Initiator/Requestor Name
  		  24 Hour Phone Number
  		  Email Address
  		  Date
 
 Site POC Name
  		  24 Hour Phone Number
  		  Email Address
  		  Date
 
III. INITIAL FEDERAL COORDINATION (Operations Section)
  Action to:   ESF/OFA:
  RSF/OFA:
  Other:  		  Date/Time
  		  Priority
    Lifesaving Life Sustaining
    High Normal
IV. DESCRIPTION (Assigned Agency Action Officer)
  Statement of Work
 
  Assigned Agency
 
  Projected Start Date
 

  Estimated Projected End Date
 
New or Amendment to MA #:
                            		  Total Cost Estimated
  		  Total Required this Obligation Cycle
 
  ESF/OFA/RSF Action Officer
  		  Phone Number
  		  Email
 
V. COORDINATION (FEMA Use Only)
  Type of MA:
  Direct Federal Assistance State Cost Share (0%, 10%, 25%)       Federal Operations State Share (0%)
  State Cost Share Percent %   State Cost Share Amount: $
  Fund Citation: 20 -06- -6- XXXX-250 -D   Appropriation code: 70X0702
  Mission Assignment Manager (Preparer)
 

  Date

  **FEMA Project Manager/Branch Director (Program Approval)
 

  Date

   **Comptroller/Funds Control (Funds Review)
  		  Date
VI. APPROVAL
  *State Approving Official (Required for DFA)   Date
  **Federal Approving Official (Required for all)   Date
VII. OBLIGATION (FEMA Use Only)
  Mission Assignment Number
  		  Amount This Action
  $ 		  Date/Time Obligated
 
  Amendment Number
  		  Cumulative Amount
  $ 		  Initials
 
                                      FEMA FORM 1660-0002
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