Privacy Act Statement (used for both FEMA forms)

Privacy Act Statement
Authority: The Robert T. Stafford Disaster Relief and Emergency Assistance Act as amended,
42 U.S.C. § 5121–5207 and Reorganization Plan No. 3 of 1978; 4 U.S.C. §§ 2904 and 2906; 4
C.F.R. § 206.2(a) (27); the Personal Responsibility and Work Opportunity Reconciliation Act of
1996 (Pub. L. 104-193) and Executive Order 13411. DHS asks for your SSN pursuant to the
Debt Collection Improvement Act of 1996, 31 U.S.C. §§ 3325(d) and 7701(c) (1).
Purpose: This information is being collected for the primary purpose of determining eligibility
and administering financial assistance under a Presidentially-declared disaster. Additionally,
information may be reviewed internally within FEMA for quality control purposes.
Routine Uses: The information on this form may be disclosed as generally permitted under 5
U.S.C. § 552a(b) of the Privacy Act of 1974, as amended. This includes using this information
as necessary and authorized by the routine uses published in DHS/FEMA – 008 Disaster
Recovery Assistance Files System of Records September 24, 2009, 74 FR 48763 and upon
written request, by agreement, or as required by law.
Disclosure: Furnishing this information is voluntary; however, failure to furnish the requested
may delay or prevent the individual from receiving disaster assistance.