Form FEMA Form 080-0-4b FEMA Form 080-0-4b Staffing for Adequate Fire and Emergency Response Recrui

OMB No.: 1660-NW78 Expiration Date:

BURDEN DISCLOSURE NOTICE

FEMA Form 080-0-4b

Public reporting burden for this form is estimated to average 7.5 hours per response. The burden estimate includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and submitting the form. This collection of information is required to obtain or retain benefits. You are not required to respond to this collection of information unless it displays a valid OMB control number.  Send comments regarding the accuracy of the burden estimate and any suggestions for reducing the burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency, 500 C Street, SW, Washington, DC 20472, Paperwork Reduction Project (1660-NEW) NOTE: Do not send your completed form to this address.

Recruitment and Retention of Volunteer Firefighters Activity - for Fire Departments

Please provide the following additional information regarding your fire department. You must answer all of the project specific questions and specify at least one budget item. If your organization is a National/State/Local Volunteer Firefighter Interest Organization, please answer the Recruitment and Retention questions on page 10, not these Fire Department R+R questions.

As a reminder, the purpose of these grants is to assist fire departments with the recruitment and retention of volunteer firefighters who are involved with, or trained in, the operations of firefighting and emergency response. The grants are intended to create a net increase in the number of trained, certified, and competent firefighters capable of safely responding to emergencies within the grantee’s geographic response area.

Career fire departments are not eligible for this activity. If you are not applying for a Recruitment and Retention of Firefighters Activity, please go directly to page 17.

Note: Fields marked with an * are required.

* Is there a grant-writing fee associated with the preparation of this request? (if yes, you must add the cost as a budget item in order to be reimbursed with grant funds)

○ Yes ○ No

Recruitment and Retention of Volunteer Firefighters – Fire Departments
* 1. What is the ideal number of active volunteer firefighters needed by your department to adequately comply with NFPA 1710 (Section 5.2.4.2 - Initial Full Alarm Assignment Capability) or NFPA 1720 (Section 4.3 - Staffing and Deployment)? (Whole Numbers only) Note: This number must correspond to the information provided within the narrative section relating to the number of volunteer firefighters being recruited and/or retained with this grant application.
* 2. What is the total number of current active volunteer firefighters in your department? (Include only operational volunteer firefighters; administrative or EMS only members should not be included) (Whole Numbers only) Note: This number must correspond to the information provided within the narrative section relating to the number of volunteer firefighters being recruited and/or retained with this grant application.
* 3. What is your current total number of volunteer members in your? (This should include both administrative and operational members.) (Whole Numbers only)
* 4. How many active volunteer firefighters joined your department over the last three years? (Whole Numbers only)
* 5. How many active volunteer firefighters left your department over the last three years? (Whole Numbers only)
* 6. Will your department periodically evaluate your proposed program’s impact?		○ Yes ○ No
If Yes, please provide an explanation of how the evaluation will be conducted. Use an additional sheet if necessary.

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*7. Do you currently have a recruitment and/or retention volunteer coordinator’s position?		○ Yes ○ No, but will appoint one outside of the grant ○ Included in this request ○ No
* 8. Do you currently have a marketing plan as part of your recruitment and/or retention program?		○ Yes ○ No, but will be developing one as part of this grant ○ No
*9. Does your department currently offer worker’s compensation/accidental death and dismemberment (AD&D) insurance for active volunteer firefighters?		○ Yes ○ Included in this request ○ No
*10. Will your program have a regional impact?	○ Yes, the activities requested will be shared directly other departments ○ Yes, other departments will benefit indirectly from the recruitment or retention activities ○ No, other departments will not benefit ○ N/A (Requesting assistance to retain current members only)
If Yes, please provide a list of those departments and describe how they will benefit from this application. Note: If awarded, you may be required to provide documentation of the fire departments consent to participate in the application. If additional space is needed for your response, please include it in the Project Description portion within the Narrative section of your application.

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*11. Do you currently provide entry-level physicals in accordance with NFPA 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments 2003 Edition, Chapter 6?	○ Yes, NFPA 1582 compliant ○ No, but will provide other physicals not to NFPA 1582 specifications ○ Included in this request (for new recruits only) ○ No
*12. Do you currently provide annual medical/physical exams in accordance with NFPA 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments 2003 Edition, Chapter 6?	○ Yes, NFPA 1582 compliant ○ No, but will provide other physicals not to NFPA 1582 specifications ○ No
*13a. What is the minimum level of training and certification standard required by your locality/state?	○ None ○ First responder ○ FF I ○ FF I/EMT ○ FF II ○ FF II/EMT
*13b. Will the personnel recruited meet the minimum local or State fire and EMS training and certification requirements for firefighters within 24 months of appointment?	○ Yes ○ No ○ N/A – (Requesting assistance to retain current members only)
* 14a. Do you assure that your organization will, to the extent practicable, seek, recruit, and hire members of racial and ethnic minority groups and women to increase their ranks within your department?	○ Yes ○ No
* 14b. If so, explain what efforts your organization has instituted and how successful those efforts have been. If not, explain what policies and procedures you will implement to assure that, to the extent possible, you will seek, recruit, and hire minorities and women. If additional space is needed for your response, please include it in the Additional Information portion within the Narrative section of your application.

Narrative Statement for Volunteer Recruitment and Retention Activity for Fire Departments

The narrative statements must provide all the information necessary for you to justify your needs and for FEMA to make an award decision. A panel of peer reviewers performs the second phase of the applications’ evaluations by using the narrative statements below, along with the answers to the general questions and the activity-specific questions, to determine the worthiness of the request for an award.

Please ensure that your narrative clearly addresses each of the following evaluation criteria elements to the best of your ability. Each element will be evaluated independently by the peer review panelist. The relative weight of the evaluation criteria in the determination of the grant award is listed below.

You may either type your project narrative statements in the spaces provided below; or create the text in your word processing system and then copy it into the appropriate spaces provided below. Please note the narrative block does not allow for formatting. Do not type your narrative using only capital letters. Additionally, do not include tables, special fonts (i.e., quote marks, bullets, etc), or graphs.

Note: Fields marked with an * are required. Statements 1 - 3 are limited to 6000 characters each; Statement 4 is limited to 4000 characters, Statements 5 and 6 are limited to 2000 characters each.

Volunteer Recruitment and Retention Activity Narrative

Element #1 - Project Description (30%): This statement should describe how the applicant will use the grant funds. The project description should include:

 How the recruitment of new volunteer firefighters and/or retention of current volunteer firefighters will impact the department’s identified operational needs or capabilities;

 A description of the specific benefit these firefighters will provide for the fire department(s) or community;

 A description of the recruitment and/or retention problems or issues the department has identified;

 How the activities being requested address those identified needs; and

 Specifics about the recruitment and/or retention plan.

 If your grant will have a regional impact, provide specifics about which activities are part of the regional request and which activities are exclusive to the host applicant, if applicable.

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* Element #2 - Impact on Daily Operations (30%): This statement should explain how the community and current firefighters (or geographic areas of concern for an eligible organization) are at risk without the requested firefighters, and to what extent that risk will be reduced if the applicant is awarded.

* Element #3 - Financial Need (30%): This statement should explain the applicant’s organizational budget and its inability to address the need without federal assistance, including other actions the applicant has taken to meet their staffing needs.

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* Element #4 - Cost/Benefit (10%): This statement should explain, as clearly as possible, what benefits the applicant and/or their community will realize if the project described is funded (e.g. anticipated savings and/or efficiencies). Is there a high benefit for the cost incurred? Are the costs reasonable? Provide justification for the budget items relating to the cost of the requested items.

* Element #5 - Performance (Additional Consideration): Applicants should explain whether they have a proven track record for timely project completion and satisfactory performance in other AFG, FP&S, and SAFER awards.

* Element #6 - Additional Information: If you have any additional comments you would like to include about your organization or this application, please provide them here.

Recruitment and Retention of Volunteer Firefighters Activity for National/State/Local Volunteer Firefighter Interest Organizations

Please provide the following additional information regarding your organization. You must answer all of the project specific questions and specify at least one budget item. If your organization is a Fire Department, please answer the Recruitment and Retention questions on page 1, not these Volunteer Interest Organization specific R+R questions.

As a reminder, the purpose of these grants is to assist fire departments with the recruitment and retention of volunteer firefighters who are involved with, or trained in, the operations of firefighting and emergency response. The grants are intended to create a net increase in the number of trained, certified, and competent firefighters capable of safely responding to emergencies within the grantee’s geographic response area.

Career fire departments are not eligible for this activity. If you are not applying for a Volunteer Interest Organization Recruitment and Retention of Firefighters Activity, please go directly to page 17.

Note: Fields marked with an * are required.

* Is there a grant-writing fee associated with the preparation of this request? (if yes, you must add the cost as a budget item in order to be reimbursed with grant funds)

○ Yes ○ No

Recruitment and Retention of Volunteer Firefighters
* 1. What is the ideal number of active volunteer firefighters needed by your organization to assist the fire departments, benefiting from this grant application, to adequately comply with the NFPA 1710 or NFPA 1720 standard they are attempting to meet? Note: This must be the cumulative total of the number of firefighters needed by all departments participating in this application. This number must also correspond to the information provided within the narrative section relating to the number of volunteer firefighters being recruited and/or retained with this grant application.
* 2. What is the total number of current active volunteer firefighters within your organization? (Include only operational volunteer firefighters; administrative or EMS only members should not be included) Note: This must be the cumulative total of the number of firefighters of all departments participating in this application. This number must also correspond to the information provided within the narrative section relating to the number of volunteer firefighters being recruited and/or retained with this grant application.
* Please describe the method used to determine the numbers provided for questions 1 and 2.

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* Have you discussed this application with all participating departments? Note: If awarded, you may be required to provide documentation of the fire departments consent to participate in the application.			○ Yes ○ No
* 3. What is the current total number of volunteer members in your interest organization? (This should include both administrative and operational members.) (Whole Numbers only)
* 4. How many active volunteer firefighters joined the fire departments, participating in this application, over the last three years? Note: This must be the cumulative total of the number of firefighters by all departments participating in this application. (Whole Numbers only)
* 5. How many active volunteer firefighters left the fire departments, participating in this application, over the last three years? Note: This must be the cumulative total of the number of firefighters by all departments participating in this application. (Whole Numbers only)
* 6. Will your interest organization periodically evaluate your proposed program's impact?			○ Yes ○ No
If Yes, please provide an explanation of how the evaluation will be conducted.
*7. Do you currently have a recruitment and/or retention volunteer coordinator’s position?		○ Yes ○ No, but will appoint one outside of the grant ○ Included in this request ○ No
* 8. Do you currently have a marketing plan as part of your recruitment and/or retention program?		○ Yes ○ No, but will be developing one as part of this grant ○ No

(continued on next page)

(continued from previous page)

*9. Do you currently provide entry-level physicals in accordance with NFPA 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments 2003 Edition, Chapter 6?	○ Yes, NFPA 1582 compliant ○ No, but will provide other physicals not to NFPA 1582 specifications ○ Included in this request (for new recruits only) ○ No
* 10a. Do you assure that your organization will, to the extent practicable, seek, recruit, and hire members of racial and ethnic minority groups and women to increase their ranks within the fire departments participating in this application?	○ Yes ○ No
* 10b. If so, explain what efforts your organization has instituted and how successful those efforts have been. If not, explain what policies and procedures you will implement to assure that, to the extent possible, you will seek, recruit, and hire minorities and women. If additional space is needed for your response, please include it in the Additional Information portion within the Narrative section of your application.

Narrative Statement for Volunteer Recruitment and Retention Activity

The narrative statements must provide all the information necessary for you to justify your needs and for FEMA to make an award decision. A panel of peer reviewers performs the second phase of the applications’ evaluations by using the narrative statements below, along with the answers to the general questions and the activity-specific questions, to determine the worthiness of the request for an award.

Please ensure that your narrative clearly addresses each of the following evaluation criteria elements to the best of your ability. Each element will be evaluated independently by the peer review panelist. The relative weight of the evaluation criteria in the determination of the grant award is listed below.

You may either type your project narrative statements in the spaces provided below; or create the text in your word processing system and then copy it into the appropriate spaces provided below. Please note the narrative block does not allow for formatting. Do not type your narrative using only capital letters. Additionally, do not include tables, special fonts (i.e., quote marks, bullets, etc), or graphs.

Note: Fields marked with an * are required. Statements 1 - 3 are limited to 6000 characters each; Statement 4 is limited to 4000 characters, Statements 5 and 6 are limited to 2000 characters each.

Volunteer Recruitment and Retention Activity Narrative

* Element #1 - Project Description (30%): This statement should describe how the applicant will use the grant funds. The project description should include:

 How the recruitment of new volunteer firefighters and/or retention of current volunteer firefighters will impact the identified operational needs and/or capabilities of the fire departments participating in this application;

 A description of the specific benefit these firefighters will provide to fire departments and their respective communities;

 A description of the recruitment and/or retention problems or issues the departments have identified ;

 How the activities being requested will address those identified needs; and

 Specifics about the recruitment and/or retention plan

(continued from previous page)

* Element #2 - Impact on Daily Operations (30%): This statement should explain how the regions and/or all the fire departments (participating in this application) communities, and their current firefighters are at risk without the requested firefighters, and to what extent that risk will be reduced if the applicant is awarded.

* Element #3 - Financial Need (30%): This statement should explain the applicant’s organizational budget and its inability to address the need without federal assistance, including other actions the applicant has taken to meet their staffing needs.

(continued from previous page)

* Element #4 - Cost/Benefit (10%): This statement should explain, as clearly as possible, what benefits the applicant and/or fire departments participating in this application will realize if the project described is funded (e.g. anticipated savings and/or efficiencies). Is there a high benefit for the cost incurred? Are the costs reasonable? Provide justification for the budget items relating to the cost of the requested items.

* Element #5 - Performance (Additional Consideration): Applicants should explain whether they have a proven track record for timely project completion and satisfactory performance in other AFG, FP&S, and SAFER awards.

* Element #6 - Additional Information: If you have any additional comments you would like to include about your organization or this application, please provide them here.

Budget Object Class Definitions

The following definitions will allow you to complete your budget items appropriately.

Personnel	The costs in this area will cover personnel costs within your department, if they are allowed. (The program narrative should list the Employee Title, hours x hourly rate.)
Fringe Benefits	Fringe benefits in the form of regular compensation paid to employees during periods of authorized absences from the job, such as vacation leave, sick leave, military leave, and the like, are allowable, provided such costs are absorbed by all organization activities in proportion to the relative amount of time or effort actually devoted to each. Fringe benefits in the form of employer contributions or expenses for social security, employee insurance, workmen's compensation insurance, pension plan costs and the like, are allowable, provided such benefits are granted in accordance with established written organization policies. Such benefits, whether treated as indirect costs or as direct costs, shall be distributed to particular awards and other activities in a manner consistent with the pattern of benefits accruing to the individuals or group of employees whose salaries and wages are chargeable to such awards and other activities.
Travel	The costs in this area are for any allowed travel, for example airfare, mileage, lodging, etc. The rates must be in accordance with your written department policy and cannot exceed the government-authorized rates.
Equipment	"Equipment" means an article of nonexpendable, tangible personal property having a useful life of more than one year and an acquisition cost which equals or exceeds the lesser of (a) the capitalization level established by the organization for the financial statement purposes, or (b) $5000.
Supplies	The costs of materials and supplies necessary to carry out an award are allowable. Such costs should be charged at their actual prices after deducting all cash discounts, trade discounts, rebates, and allowances received by the organization. Incoming transportation charges may be a proper part of material cost. Materials and supplies charged as a direct cost should include only the materials and supplies actually used for the performance of the contract or grant, and due credit should be given for any excess materials or supplies retained, or returned to vendors.
Contractual	The costs in this area should cover any contracts that you issue that are not already covered under equipment or supplies, for example, the costs incurred if you hire a grant writer or contractor to handle your Fire Prevention Program.
Other	This area is for a cost that will not fit into the other areas, e.g., administrative costs. If you put a cost in this category you must describe it in your program.
Indirect Costs	These costs are allowed but you must have a Federally approved indirect cost rate agreement.

Add Budget Item

Please provide the following information. Please use an additional page for each new item.

Note: Fields marked with an * are required.

Recruitment and Retention of Volunteer Firefighters – Add Budget Item
* Item Name: (select one)
Select Object Class:	○ Personnel ○ Fringe Benefits ○ Travel ○ Equipment ○ Supplies ○ Contractual ○ Indirect Charges ○ Other
If you selected Other above, please specify:
* Cost	_______ First 12-Month Period of Your Grant _______ Second 12-Month Period of Your Grant _______ Third 12-Month Period of Your Grant _______ Fourth 12-Month Period of Your Grant
* Description The space to the right must be used to provide further clarification on the costs being requested. The cost estimates should include a description of what is included (i.e. personnel costs: number of hours and rate; member incentives: type of incentive and how the members will qualify to receive the incentive, etc.), the quantity being requested (if applicable), and a budget plan for each 12-month period. Additional budget justification should be included in the project narrative.

Budget

Recruitment and Retention of Volunteer Firefighters:
There is no local match requirement for this activity and there are no maximum Federal share limits. Therefore, any items requested under Recruitment and Retention will be 100% federally funded.

Using the information you entered for your item(s) please enter and review the budget information below. Include totals in the right-hand column and bottom row.

	First 12-Month Period	Second 12-Month Period	Third 12-Month Period	Fourth 12-Month Period	Total
Personnel					Sum of all Personnel blocks
Fringe Benefits					Sum of all Fringe Benefit blocks
Travel					Sum of all Travel blocks
Equipment					Sum of all Equipment blocks
Supplies					Sum of all Supplies blocks
Contractual					Sum of all Contractual blocks
Other					Sum of all Other blocks
Indirect Charges					Sum of all Indirect Charges blocks
Federal Share					Sum of all Federal Share blocks
Applicant Share	0	0	0	0	0
Total	Federal Share + Applicant Share	Federal Share + Applicant Share	Federal Share + Applicant Share	Federal Share + Applicant Share	Sum of all Total blocks to the left

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