Forms Revision Chart for FEMA Form 119-17-1

FORMS ACTION REQUEST

FEMA Form 119-17-1

V. FORMS REVISION CHART (ONLY COMPLETE if a Revision to a Form being Requested):
Location of Text (e.g., Page 2, Line 3)	Current Text (e.g., Action Office: RMD)	Revised Text (e.g., Action Office: Records Management Division (RMD))
In Paperwork Burden Disclosure Box	1800 South Bell Street, Arlington, VA 20598-3005	500 C Street SW, Washington DC 20472
Line item above columns	It is requested that the following people be provided Housing at NETC	It is requested that the following individual(s) be provided housing at NETC.
Remove column I RE	Remove column labeled Personal Identification Number	No replacement, removal of column
Title of column	Handicapped (Y/N)	Disability or Access and Functional Needs (Y/N)
Line item	Special Accommodations Needed	Accessibility Accommodations Required
	See below for last change
I
I I I
I I
I I I !
I I I
Note: If additional space is needed, please print and attach as a separate sheet.

^{FEMA FORM 112-2-1 (02114)} pg 2

Line item

Change from:

I certify that the housing requested above is in accordance

with FEMA instructions covering housing policy will be paid

with a NETC fee schedule at NETC.

Change to:

Requestor certifies that the housing requested above is in accordance with NETC SOP No. 119-3, Facility Utilization

and Expenses at the National Emergency Training Center.