Form FEMA Form FF-104-F FEMA Form FF-104-F Urban Search and Rescue Response System Semi-Annual Perf

---

Overview

Instructions
Narrative Perf Report
Funds Report
Continuation B
Continuation C
Continuation D

---

Sheet 1: Instructions

Department of Homeland Security

OMB 1660-0073 Expires XX XX, 20XX

Federal Emergency Management Agency

URBAN SEARCH AND RESCUE RESPONSE SYSTEM

SEMI-ANNUAL PERFORMANCE REPORT

PAPERWORK BURDEN DISCLOSURE NOTICE FEMA Form FF-104-FY-21-175 (formerly 089-0-11)

Public reporting burden for this data collection is estimated to average 2 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 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 a valid OMB control number is displayed on this form. 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 20472-3100, Paperwork Reduction Project (1660-0073) NOTE: Do not send your completed form to this address.

INSTRUCTIONS

This report is due on the date outlined in the current US&R Notice of Funding Opportunity/Statement of Work

Fill in all highlighted sections in all pages of the workbook

File a copy of this report within all open Task Force cooperative agreements files

Type in the name and title of person submitting report. After printing document, sign and date to submit

Submit completed report in accordance with current procedure

Performance Report - Narrative Section

This report is used to provide information to the US&R Branch, FEMA Leadership and the

Grant Programs Directorate on Task Force activities within the 4 budget categories

Report activities from the last 6 months of all open cooperative agreements

Performance Report - Funds Supplement

Fill in the highlighted boxes with your task force information

This document is used to report all open US&R cooperative agreements during this time period

The "Grant Fiscal Year" represents the year the funds were allocated

The "Grant ID Number" represents the grant award number

The "Beginning Balance" is the amount of funds available at the beginning of this reporting time period

The "Funds Spent" represent the actual amount of funds fully paid during this reporting time period

The 'Remaining Balance" will be calculated automatically

The actual "Period of Performance" dates are required to be filled in for each open grant

For each cooperative agreement worksheet, provide any minor changes made in space allotted, by category

FEMA FORM 089-0-11

Page 1 of 9

---

Sheet 2: Narrative Perf Report

Semi-Annual Performance Report - Narrative

Task Force:

For Time Period:

to

Reporting Date:

A.

Management

1. Describe the adequacy of staffing for the Task Force Program Management Team (Full Time/ Significant Part Time members) including actual or anticipated vacancies and expected fill dates.

2. Provide status of all open Cooperative Agreements as to whether there are any anticipated budget changes, extensions or delays in closeout package submission.

3. Identify Local and National meetings attended and National work groups supported.

4. Provide at least 3 overall Task Force management goals or objectives for the next 6 months.

5. Discuss any anticipated problems/issues you foresee within the next 6 months that may impact the management objectives defined in the Task Force's budget plan(s).

FEMA FORM 089-0-11

Page 2 of 9

B.

Training and Exercises

1. Summarize local general and/or specialized training conducted and National (sponsored) courses attended during the previous 6-month period. Identify number of participants attending training and associated costs.

Cost

Number of TF attendees

Course Title

Course Date

Course Location

2. Indicate number of Task Force Members:

Prior Period

Current Period

Rostered Members:

Deployable Members:

Fully Trained Members:

New Recruits:

3. Provide at least 3 overall Task Force training and/or exercise goals or objectives for the next 6 months and briefly describe any performance benefits from the cooperative agreement funding.

4. Discuss any anticipated problems/issues you Task Force foresees within the next 6 months that may impact the training and/or exercise objectives defined in the Task Force's budget plan(s):

FEMA FORM 089-0-11

Page 3 of 9

C.

Equipment

1. US&R Task Force Tools and Equipment cache – identify the adequacy, shortfalls, and procurement actions in progress and/or associated problems. Identify the number of inventories conducted. Discuss any equipment replacement issues or delays.

2. Provide any overall Task Force equipment procurement/accountability goals or objectives for the next 6 months.

3. Discuss any anticipated problems/issues your Task Force foresees within the next 6 months that may impact the equipment procurement/accountability objectives defined in the Task Force's budget plan(s):

D.

Storage and Maintenance

1. Provide information on the adequacy of your warehouse facility, management of this facility and any lease, owernship, or security issues. Discuss any issues or planned actions to improve your facilities.

2. Provide an explanation of availability of all needed vehicles to deploy your Task Force. Identify any Task Force shortfalls and plan to resolve these issues, including completion dates.

FEMA FORM 089-0-11

Page 4 of 9

E.

Overall Performance

Feel free to provide any information you feel should be relayed to either the US&R Program Office or Grant Programs Directorate on the performance of your Task Force or any issues you are facing in the administration your US&R cooperative agreement(s).

Submitted by:

Name Printed

Signature

Title

Date

FEMA FORM 089-0-11

Page 5 of 9

---

Sheet 3: Funds Report

			Cooperative Agreement Summary Information Page
Task Force:		Enter your task force designator in this box.
Reporting Period:		Reporting Periods are January 31 and July 31 each year. Enter the appropriate reporting period in this box. 7/31/20xx		For Time Period		Time periods are: January 1 to June 30 and July 1 to December 31 each year. Enter the appropriate corresponding time period in these boxes. 1/1/20xx	to	Time periods are: January 1 to June 30 and July 1 to December 31 each year. Enter the appropriate corresponding time period in these boxes. 6/30/20xx
Columns A, B and C are linked to page 1 Linked to Page 1				Columns E, F and G are linked to page 2 Linked to Page 2				Columns I, J and K are linked to page 3 Linked to Page 3
Grant Fiscal Year		Enter Fiscal Year this Cooperative Agreement is associated with. FY 20xx		Grant Fiscal Year		FY 20xx		Grant Fiscal Year		FY 20xx
Federal Grant ID Number:	Enter Cooperative Agreement number into this box.			Federal Grant ID Number:				Federal Grant ID Number:
Grant Award Amount:		Enter total initial grant award in this box $-		Grant Award Amount:	600000	$-		Grant Award Amount:		$-
Beginning Period Balance:		Enter the beginning balance in this box. If the funding is just beginning, enter $-		Beginning Balance:		$-		Beginning Balance:		$-
Funds Spent this Period:		Current Expenditures		Funds Spent this Period:		Current Expenditures		Funds Spent this Period:		Current Expenditures
Administration/Management		Enter the previous 6 month expenditures in these boxes. $-		Administration/Management		$-		Administration/Management		$-
Training		$-		Training		$-		Training		$-
Equipment Purchases		$-		Equipment Purchases		$-		Equipment Purchases		$-
Storage and Maintenance		$-		Storage and Maintenance		$-		Storage and Maintenance		$-
Total Funds Spent:		$-		Total Funds Spent:		$-		Total Funds Spent:		$-
Remaining Grant Balance:		$-		Remaining Grant Balance:		$-		Remaining Grant Balance:		$-
Additional General Grant Information entered below this line
Catalog of Federal Domestic Assistance				Old CFDA #
				New CFDA #
Period of Performance		FY 20xx		0		Enter the Period of Performance for each Cooperative Agreement into these boxes. 00/00/20xx	to	00/00/20xx
		FY 20xx		0		00/00/20xx	to	00/00/20xx
		FY 20xx		0		00/00/20xx	to	00/00/20xx
Total funds remaining		$-
Name of Person Submitting Report				(Typed Name)
				Program Manager		Signature				Date
				Title

---

Sheet 4: Continuation B

Task Force:
Reporting Period:		7/31/20xx			For Time Period		1/1/20xx	to	6/30/20xx
		Original or Modified		Previously	Remaining		Amount
		Budgeted		Expended Total	Actual		(+ or -) of
Linked to Funds Report Page		Amount		Amount	Amount		BUDGET
Grant Fiscal Year		FY 20xx
Federal Grant ID Number:		0
Local Grant ID Number
Award Amount:		$-
Beginning Period Balance:					$-
Funds Expended:		Budgeted		Previous Expenditures	Current Expenditures		+ or - Budget		% Not Spent
Administration/Management		Enter the amounts from your original or modified Form 20-20 into these boxes $-		Enter all previous reporting periods expenditures into these boxes. If there were none, enter zero or leave blank. $-	$-		$-		#DIV/0!
Training		$-		$-	$-		$-		#DIV/0!
Equipment Purchases		$-		$-	$-		$-		#DIV/0!
Storage and Maintenance		$-		$-	$-		$-		#DIV/0!
Total Funds Expended:				$-	$-		$-	`
Remaining Grant Balance:							$-		#DIV/0!
Period of Performance		FY 20xx			0		00/00/20xx	to	00/00/20xx
Explanation on Spending Plan: Describe your progress to meet your spending plan goals
Administration/Management
Training
Equipment
Storage and Maintenance
Name of Person Submitting Report
		(Typed Name)
		Program Manager		Signature				Date
		Title
FEMA FORM 089-11								Page 7 of 9

---

Sheet 5: Continuation C

Task Force:
Reporting Period:		7/31/20xx			For Time Period		1/1/20xx	to	6/30/20xx
		Original or Modified		Previously	Remaining		Amount
		Budgeted		Expended Total	Actual		(+ or -) of
Linked to Funds Report Page		Amount		Amount	Amount		BUDGET
Grant Fiscal Year		FY 20xx
Federal Grant ID Number:		0
Local Grant ID Number:
Award Amount:		$-
Beginning Period Balance:					$-
Funds Expended:		Budgeted		Previous Expenditures	Current Expenditures		+ or - Budget		% Not Spent
Administration/Management		Enter the amounts from your original or modified Form 20-20 into these boxes $-		Enter all previous reporting periods expenditures into these boxes. If there were none, enter zero or leave blank. $-	$-		$-		#DIV/0!
Training		$-		$-	$-		$-		#DIV/0!
Equipment Purchases		$-		$-	$-		$-		#DIV/0!
Storage and Maintenance		$-		$-	$-		$-		#DIV/0!
Total Funds Expended:				$-	$-		$-
Remaining Grant Balance:							$-		#DIV/0!
Period of Performance		FY 20xx			0		00/00/20xx	to	00/00/20xx
Explanation on Spending Plan: Describe your progress to meet your spending plan goals
Administration/Management		(Example: We are on target to meet our spending plan goals.)
Training
Equipment
Storage and Maintenance
Name of Person Submitting Report
		(Typed Name)
		Program Manager		Signature				Date
		Title

---

Sheet 6: Continuation D

Task Force:
Reporting Period:		7/31/20xx			For Time Period		1/1/20xx	to	6/30/20xx
		Original or Modified		Previously	Remaining		Amount
		Budgeted		Expended Total	Actual		(+ or -) of
Linked to Funds Report Page		Amount		Amount	Amount		BUDGET
Grant Fiscal Year		FY 20xx
Federal Grant ID Number:		0
Local Grant ID Number:
Award Amount:		$-
Beginning Period Balance:					$-
Funds Expended:		Budgeted		Previous Expenditures	Current Expenditures		+ or - Budget		% Not Spent
Administration/Management		Enter the amounts from your original or modified Form 20-20 into these boxes $-		Enter all previous reporting periods expenditures into these boxes. If there were none, enter zero or leave blank. $-	$-		$-		#DIV/0!
Training		$-		$-	$-		$-		#DIV/0!
Equipment Purchases		$-		$-	$-		$-		#DIV/0!
Storage and Maintenance		$-		$-	$-		$-		#DIV/0!
Total Funds Expended:				$-	$-		$-
Remaining Grant Balance:							$-		#DIV/0!
Period of Performance		FY 20xx			0		00/00/20xx	to	00/00/20xx
Explanation on Spending Plan: Describe your progress to meet your spending plan goals
Administration/Management		(Example: We are on target to meet our spending plan goals.)
Training
Equipment
Storage and Maintenance
Name of Person Submitting Report
		(Typed Name)
		Program Manager		Signature				Date
		Title