Form 010-0-7 Resource Request Form

O.M.B No. 1660-0047
Expires March 31, 2014
See Reverse for Paperwork
Disclosure Notice

DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY

RESOURCE REQUEST FORM (RRF)

I. REQUESTING ASSISTANCE (To be completed by Requestor)
1. Requestor's Name (Please print)

2. Title

4. Requestor's Organization

5. Fax No.

3. Phone No.
6. E-Mail Address

II. REQUESTING ASSISTANCE (To be completed by Requestor)
1. Description of Requested Assistance:

3. Priority

2. Quantity

Lifesaving

Life Sustaining

Normal

4. Date and Time Needed

High
5. Delivery Site Location

6. Site Point of Contact (POC)
8. Fax No.

7. 24 Hour Phone No.
9. State Approving Official Signature

10. Date and Time

III. SOURCING THE REQUEST - REVIEW/COORDINATION (Operations Section Only)
1.

2.
OPS Review by:
LOG Review by:

Donations
Other (Explain)

Other Coordination:

Requisitions
Interagency Agreement

Other Coordination:

Mission Assignment
Yes

ESF/OFA:
RSF/OFA:

Procurement

Other Coordination:

4. Immediate Action Required

3. Assigned to:

Source:

No

Other:
Date/Time:

IV. STATEMENT OF WORK (Operations Section Only)
1. OFA Action Officer

2. 24 Hour Phone No.

3. Fax No.

4. FEMA Project Manager

5. 24 Hour Phone No.

6. Fax No.
See Attached

7. Statement of Work

8. Estimated Completion Date

9. Estimated Cost

V. ACTION TAKEN (Operations Section Only)
Accepted

Rejected

Requestor Notified

Reason / Disposition

TRACKING INFORMATION (FEMA Use Only)
ECAPS/NEMIS Task ID:

Resource Request No.

Program Code/Event No.

Received by (Name and Organization)

State

Date/Time Received

FEMA Form 010-0-7, (11/2013)

PREVIOUSLY FF 90-136

Originated
as verbal

PAPERWORK BURDEN DISCLOSURE NOTICE
Public reporting burden for this form is estimated to average 20 minutes per response. The burden estimate includes the time for reviewing
instructions, searching existing data sources, gathering and maintaining the needed data, and completing and submitting this 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 this
burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency, 1800 South
Bell Street, Arlington, VA 20598-3005, Paperwork Reduction Project (1660-0047). NOTE: Do not send your completed form to this
address.

INSTRUCTIONS
Items on the Resource Request form that are not specifically listed are self-explanatory. Indicate "see attached" in any field for which
additional space or more information is required.
I. Who is requesting assistance?

Completed by requestor.

II. What needs to be done? Completed by requestor.
Description of Requested Assistance: Detail of resource shortfalls, statement of deliverable, or simply state problem/need.
Priority: The requestor's priority, which may differ from the priority in BOX III.
Site POC: The person at the delivery site coordinating reception and utilization of the requested resources. 24-hour contact information
required.
If for Direct Federal Assistance (DFA), State Approving Official: Signature certifies that:
(1) State and local governments cannot perform, nor contract for the performance of the requested work;
(2) Work is required as a result of the event, not a pre-existing condition; and
(3) The State is providing the required assurances found in 44 CFR, Section 206.208.
III. Action Review/Coordination (OPS Section Use Only): Completed by the Operations Section Chief or Resource Capability Branch Director.
Accept/Reject: Operations Section Chief or Resource Capability Branch Director accepts or rejects the request; provide reason if rejection. If
request accepted, coordinates with others, i.e., Branch Directors or Group Supervisors, begins to determine best means of fulfilling request.
All involved in coordination should check appropriate box and initial or print their name.
Assigned to: Operations Section Chief or Resource Capability Branch Director assigns tasks origination, may indicate the OFA Action Officer.
Operations Section Chief may also indicate the Action Officer if known, or tasked organization may make this assignment. This may be
Emergency Support Function, internal FEMA Organization (i.e.; Logistics), or other organization.
Date/Time Assigned: Operations Section Chief or Resource Capability Branch Director provides date and time of when sourcing should
begin.
IV. Statement of Work (OPS Section Use Only): Completed by the Operations Section Chief or Resource Capability Branch Director.
OFA Action Officer: Ops Section Chief obtains from OFA if request fulfilled by a MA; 24-hr phone/fax required. Information used in eCAPS.
FEMA Project Manager: Provided by Operations Section Chief; a Region PFT; 24-hr phone/fax required. Information used in eCAPS.
Statement of Work: Description of tasks to be performed. Could be to assess a problem and report back, or could be to proceed with a
specific action. If 40-1 or MA, this goes in "justification" tab in eCAPS.
V. Action Taken (OPS Section Use Only): Completed by Operations Section Chief, Resource Capability Branch Director, MA Unit or
Logistics.
Resource Request Results: Ops Section Chief, Resource Support Section Chief, MA Unit, or LOG should note what type of document the
action resulted in by "checking" the appropriate box i.e., Mutual Aid, Donations, Requisition, Procurement, IA, MA, Other. If "Other" is selected
write in appropriate response or state "see below" and give detail description in "Disposition" field. "Disposition" field should note steps taken
to complete the Action, and personnel, sub-tasked agencies, contracts and other resources utilized.
TRACKING INFORMATION. Completed by Action Tracker. Required for all requests.