Form FF-104-FY-21-192 ( FF-104-FY-21-192 ( Sales Calculation Worksheet

DEPARTMENT OF HOMELAND SECURITY

Federal Emergency Management Agency
QUICK REFERENCE INSTRUCTIONS

OMB No: 1660-0138
Expiration Date: XX-XX-XXXX

PAPERWORK BURDEN DISCLOSURE NOTICE
Public reporting burden for this form is estimated to average 30 minutes per response. The burden estimate includes the time for reviewing
instructions, searching existing data sources, gathering and maintaining the needed data, and completing, reviewing, 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 a
valid OMB control number appears in the upper right corner of this form. 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, 500 C Street, SW, Washington, DC, 20472, Paperwork Reduction Project (1660-NEW). Please do not send your
completed survey to the above address.
PRIVACY ACT STATEMENT
AUTHORITY: The Robert T. Stafford Disaster Relief and Emergency Assistance Act as amended, 42 U.S.C. § 5174 and Title 44 C.F.R. Part
206.117.
PRINCIPAL PURPOSE(S): This information is being collected for the primary purpose of advising FEMA Individual Assistance applicants of the
requirements to occupy temporary housing units, of the requirements for final sales of the unit if FEMA offers a sale program for its temporary
housing units as part of its direct housing program under a Presidentially-declared disaster.
ROUTINE USE(S): 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, 78 Fed. Reg. 25282 (Apr. 30, 2013), and upon written request, by agreement, or as required by
law.
DISCLOSURE: The disclosure of information on this form is voluntary; however, failure to provide the information requested may delay or
prevent the individual from receiving the requested disaster-related temporary housing assistance.

DRAFT

CONSULT THE SALES CALCULATOR SOP FOR SPECIFIC INSTRUCTIONS

Requires user entry
Auto-Populated or Auto-Calculated
Important Calculated Field

STEP 1

Enter the Applicant's information into Basic Information Sheet

STEP 2

Enter the Unit information into THU Depreciation Calculator

STEP 3

Use the Sales Worksheet for Price of Unit

If occupant asserts they lack financial ability, then complete the following:

STEP 4

Enter the applicant's financial IHP grant information
Make sure you follow IHP Settle Worksheet Instructions

STEP 5

Enter the applicant's financial information and eligibility information
Make sure you follow Petition Instructions

If petition worksheet states the occupant is eligible for petition then complete:

STEP 6

Complete the Acknowledgement of Sale

FEMA FORM FF-104-FY-21-192 (formerly 009-0-131)
(12/21)

Page 1 of 9

BASIC INFORMATION
APPLICANTION INFORMATION
Applicant's Name (Last, First):

Date:

Applicant's Registration ID #:

12/22/2021

Applicant's Address (Street, City, State, Zip):

County:

Applicant's Telephone #:

Disaster #:

DRAFT
UNIT INFORMATION

Unit Type:

Select
Manufacturer's Serial or VIN #

FEMA FORM FF-104-FY-21-192 (formerly 009-0-131)
(12/21)

Status

Manufactured Year:

Select

Select

FEMA Barcode #

Page 2 of 9

MANUFACTURED HOUSING UNIT DEPRECIATION CALCULATOR
Applicant's Name (Last, First):

Date:
12/22/2021

Applicant's Registration ID Number

Unit Data
S (start) Unit Status at Beginning of Occupancy

Select

Instructions
New units are not previously occupied units.

Y (mfg.) Year Unit was Produced

Select

Year the unit was produced from the Data Plate or LIMS

T (unit) Type of Unit

Select

Type of Unit: MH=Manufactured Home or PM=Park Model

B (no) Number of Bedrooms

Select

Number of Bedroom the unit has

U (m) Number of Months Unit was Occupied
Calculated Data
AP (av) Average Acquisition Price

C (d) Deactivation Costs
D (i) Initial Depreciation rate

Total number of months that any occupant has lived in the
unit. Please be sure to add the month for processing.

DRAFT

Refer to Price Matrix to determine contract price, by first
finding the year the unit was produced and look to the
corresponding bedroom column to determine the Price.

0.18
D (m) Average Monthly Depreciation rate
AP (D) Acquisition Price minus Initial Depreciation
U (d) Used Deduction
FMV Fair Market Value
AFMV Adjusted Fair Market Value

FEMA FORM FF-104-FY-21-192 (formerly 009-0-131)
(12/21)

0.04
$0.00

0

$0.00
$0.00

Pre-determined deactivation costs for the unit type (see
Price Matrix)
Initial Depreciation is the depreciation occurred when a unit
is initially occupied for the first time. Depreciation rate for
MH = .2 and PM =.18
Depreciation rate for the number of months the unit is
occupied. MH=.0041 and PM=.04
Average Acquisition Price minus the Initial Depreciation

Deductions for the use period (depreciation of used unit
over period of time)
Fair Market Value before Use Deduction times the Used
Deduction rate
Fair Market Value minus FEMA's deactivation costs

Page 3 of 9

MANUFACTURED HOUSING UNIT SALES CALCULATION WORKSHEET
1. DISASTER #

2. NAME OF PURCHASER/APPLICANT

3. APPLICANT REGISTRATION #

4. TELEPHONE #

5. CURRENT ADDRESS (STREET, CITY, STATE, ZIP) - COUNTY

7. VIN

6. UNIT TYPE

8. UNIT BAR CODE

Select

DRAFT

9. OCCUPANCY AND RESIDENCY
9A. Occupancy - Is the applicant currently occupying the housing unit?
Yes, the applicant is currently occupying the housing unit.

No, the applicant is NOT currently occupying the housing unit. (Unit cannot be Sold)
9B. Is the occupant a pre-disaster owner or renter?
Owner

Renter (May not proceed if current date is less than 6 months from disaster declaration date)
10. UNIT PLACEMENT ADDRESS (Street, City, State, Zip)

11. SALES PRICE
$0.00

12. COMMENTS

13. PREPARED BY (If different from Sales Representative)

14. APPROVAL
Approved

Printed name of FEMA Sales Representative

Date

FEMA FORM FF-104-FY-21-192 (formerly 009-0-131)
(12/21)

Disapproved

Signature of IA Branch Chief

Date

Signature of IA Branch Chief

Date

Page 4 of 9

IHP SETTLEMENT WORKSHEET
Name

Applicants Registration ID
Category
A.

Amount

Repair or Replacement Award

RE #1
RE #2
RE #3

RE #4
Building Supplies (e.g., Drywall, Nails, Lumber)

RE #5

DRAFT

B.

RE #6
RE #7
RE #8

RE #9

RE #10

Total

RE #1
RE #2
RE #3
RE #4

Refuse Removal (e.g., Bulk Trash Removal, Dumping
Fee)

C.

RE #5

RE #6
RE #7
RE #8
RE #9

RE #10
Total

RE #1
RE #2
RE #3

RE #4
Contract Costs (e.g., Plumbing, Electrical)

D.

RE #5
RE #6
RE #7
RE #8

RE #9
RE #10
Total
E.

Total (Sum B, C & D)

F.

Remaining Repair or Replacement Award (A Minus E)

G.

IHP Settlement Payment

FEMA FORM FF-104-FY-21-192 (formerly 009-0-131)
(12/21)

$0.00

Page 5 of 9

SETTLEMENT WORKSHEET INSTRUCTIONS
The Settlement Worksheet uses applicant provided receipts and NEMIS data to calculate the unused portion of Repair or Replacement
Assistance the applicant must return to FEMA prior to the completion of a sale. This Settlement Worksheet must be used for every applicant.
Section A - Repair or Replacement Award. To determine the dollar amount given to the applicant as a repair or replacement award, access
the applicant's NEMIS file. In NEMIS, do not use the total amount listed for housing assistance as this may include rental assistance. Only
consider amounts labeled "Housing Assistance". Do not include any awards labeled "EA Housing Assistance" in the calculator. If more than
one "Housing Assistance" award is present, add them manually before placing the total dollar amount in section A.
The Category titles of sections B through D describe the various "real property" costs of a disaster. The "R/E" refers to a Receipt or Estimate
provided by an applicant. The R/E labels are numbered to identify individual receipts. The dollar amounts inputted for each for each of the R/E
lines should correspond to the sales total on the individual receipts provided by the applicant.

DRAFT

Note: Write the appropriate section letter and R/E # on each receipt or estimate inputted into the worksheet. For example, the first
receipt for building supplies placed in the worksheet should have B-RE #1 clearly written on it.
Section B - Building Supplies. If the applicant has receipts for all real property items use this section to record those items. Some examples
of these costs include drywall, nails, and lumber. Before inputting receipt totals in this section, examine each receipt and eliminate all non-real
property items, i.e flashlights. For example, an applicant has a $1000 receipt for purchase of lumber, but the receipt also includes a flashlight
for $25. Subtract the flashlight price of $25 from the receipt total. Then write the adjusted total of $975 on the receipt and input the adjusted
dollar amount into the calculator. It is not necessary to calculate the tax on the excluded items, merely subtract their retail cost from the receipt
total. Write the adjusted total on the receipt.
Section C - Refuse Removal. If the applicant has receipts for trash and debris removal services use this section to record those items.
Examples of these costs include bulk trash removal and dumping fees. Input each receipt total in the amount column and label the receipt with
the appropriate receipt number.
Section D- Contract Costs. If the applicant has receipts or estimates given to an applicant by a contractor who provided services related to the
applicant's dwelling use this section to record those items. Plumbing and electrical work are examples of applicable contractor costs. Input each
receipt total in the amount column and label the receipt with the appropriate receipt number. This section may also include receipts or estimates
for building supplies bought or used by contractors. Only count building supplies in section B if they were separately billed by the contractor or if
the building supplies were independently purchased.
Section G - Final Settlement Payment. This section is automatically calculated based on the values inputted from the applicant's receipts
presented, the receipts in sections B through D, and the sales price of the manufactured home unit. The Final Settlement Payment reflects the
dollar amount of unused IHP funds the applicant owes FEMA.

FEMA FORM FF-104-FY-21-192 (formerly 009-0-131)
(12/21)

Page 6 of 9

TEMPORARY HOUSING UNIT SALES PETITION CALCULATOR
1. Name:

2. DR

3. Application #
4. Was the applicant denied SBA loan due to debt owed to the Federal Government?

Yes

No

5. Applicant failed to purchase and maintain flood insurance as a condition of previous disaster assistance?

Yes

No

6. Petition Eligibility (if yes to Question 4 or 5, then not eligible for petitioning)
7. Income

Amount

Contribution

a) Wages and salaries, overtime pay, commissions, fees, tips, bonuses and other
compensation for personal services

DRAFT

b) Interest, dividends and other gross income of any kind from real or personal
property

c) Full amount of periodic amounts received from Social Security, annuities, insurance
policies, retirement funds, pensions, disability or death benefits and other similar types
of periodic receipts
d) Payments in lieu of earnings, such as unemployment and disability compensation,
worker's compensation and severance pay
e) Government assistance (e.g. Temporary Assistance for Needy Families (TANF)

$0.00

Total Income
8. Assets

Amount

Contribution

a) Stocks, bonds, Treasury bills, certificates of deposit, money market accounts
b) Individual retirement and Keogh accounts
c) Retirement and pension funds
d) Cash held in savings and checking accounts, safe deposit boxes, homes, etc
e) Cash value of whole life insurance policies available to the individual before death
f) Equity in rental property and other capital investments
g) Personal property held as an investment
$0.00

Total Assets
9. Remaining FEMA Repair/Replacement Assistance ("Cash-in-Hand") - Line G of the "Settlement Worksheet"

$0.00

10. Total Amount of an Applicant's Income and Assets and FEMA Assistance Capable of being Contributed

$0.00

11. Adjusted Fair Market Price for the Unit (Auto populated from Sales Worksheet)

$0.00

12. 25% AFMV (25% of the Fair Market Value Sales Price Quoted for the Unit)

$0.00

13. Calculation of Eligible Petition Sales Price
13A: If the Total Applicant Income/Assets and FEMA Assistance is greater than or
0
equal to AFMV, then Line 11
13B: If the Total Applicant Income/Assets and FEMA Assistance is less than AFMV
0
but more than 25% of the AFMV, then use Adjusted Cost (Line 10)
13C: If the Total Applicant Income/Assets and FEMA Assistance is less than or equal
0
to 25% AFMV then Line 12
14. Final Adjusted Sales Price
FEMA FORM FF-104-FY-21-192 (formerly 009-0-131)
(12/21)

$0.00
Page 7 of 9

PETITION CALCULATOR INSTRUCTIONS
The Information entered into this worksheet will determine the adjusted sales price of the unit. In order to complete the Petition Calculator, you
will need the applicant's completed Temporary Housing Unit Sales Calculation Worksheet and IHP Settlement Worksheet. In addition, the
applicant must be prepared to provide detailed information on their household's monthly income and assets.
1. Name: This will be auto populated from information provided on Basic Information Sheet
2. DR: this will be auto populated from information provided on Basic Information Sheet
3. Application No.: This will be auto populated from information provided on Basic Information Sheet
4. Was the Applicant denied SBA loan due to debt owed to the Federal government? Review the SBA denial Codes
5. Applicant failed to purchase and maintain, as a condition of previous disaster assistance, flood insurance? Review the Housing Assistance
code to determine if the applicant has code associate with non-compliance with flood insurance.
6. Petition Eligibility: If the applicant has debt owed to Federal government or failed to purchase and maintain flood insurance as a requirement
for previous disaster assistance, then the applicant will be ineligible for sales petition.

DRAFT

ADVISORY: In the Monthly Income and Total Assets sections all dollar amounts should be placed in the Amount column. Dollar amounts
entered should include the total for all adult household members over the age of 18 currently authorized to occupy the unit. If an applicant or
household has no income or assets of a particular type, leave the entry line blank.
7. Income
a) Enter the total dollar amount of all wages and salaries, overtime pay, commissions, fees, tips, bonuses and other compensation for personal
services. Note: If wages are weekly, multiply wages by 4 before entering into calculator. If wages are biweekly-weekly, multiply wages by 2
before entering into calculator.
b) Enter the total dollar amount of all interests , dividends and other gross income of any kind from real or personal property.
c) Enter the total dollar amount received from all Social Security, annuities, insurance policies, retirement funds, pensions, disabilities or death
benefits and other similar types of periodic receipts.
d) Enter the total dollar amount of all payments in lieu of earnings, such as unemployment and disability compensation, worker's compensation
and severance pay.
e) Enter the total dollar amount of all government assistance (e.g. Temporary Assistance for Needy Families - TANF). Note: if the assistance is
received more than once a month, include assistance amount for a one month period.
Total Income Amount - the amount will automatically be filled by the calculator.
Total Income Contribution - The amount will automatically be filled by the calculator. The amount represents the total portion of their monthly
income the applicant or household is required to contribute toward purchasing the unit.
8. Assets
a) Enter the total dollar amount of all stocks, bonds, treasury bills, certificates of deposits and money market accounts.
b) Enter the total dollar amount of all retirement and Keogh accounts.
c) Enter the total dollar amount of all retirement and pension funds.
d) Enter the total dollar amount of all cash held in savings and checking accounts, safe deposit boxes, homes, etc.
e) Enter the total cash value of all whole life insurance policies available before death.
f) Enter the total dollar amount of equity in all rental property and other capital investments.
g) Enter the total dollar amount of all personal property held as an investment.
Total Assets Amount - the amount will automatically be filled by the calculator.
total Assets Contribution - the amount will automatically be filled by the calculator. The amount represents the portion of their total assets the
applicant or household is required to contribute toward purchasing the unit.
9. FEMA Repair/Replacement Assistance ("Cash-In-Hand"): This is the amount the applicant indicated that they have available for the purchase
of the unit. This amount should not be counted in the Total Assets. NOTE: All applicants are required to complete the IHP Settlement
Worksheet. Any remaining funds from their FEMA award WILL be counted in the Petition worksheet unless the applicant can provide
acceptable proof that the FEMA assistance has been obligated for housing repair/replacement. Acceptable proof of obligated funds include:
signed and executed contract(s) for repairs/rebuild or copy of Buyer's agent contract with a licensed real estate agent.
10. Total Amount of applicant's Income and Assets and FEMA Assistance Capable of being contributed: This is auto totaled from lines 7, 8, & 9.
11. AFMV for the unit (Sales Price Quoted for the Unit) - This amount is automatically filled from the Sales Worksheet.
12. 25% of the Fair Market Value Sales Price: This is auto calculated from 25% of the Adjusted Fair Market Price of the THU Depreciation
Calculator.
13. Calculation of Eligible Petition Sales Price:
13A: If the Total Applicant Income/Assets and FEMA Assistance is greater than or equal to AFMV, then Total Amount of applicant's Income
& Assets and FEMA Assistance capable of being contributed (Line 10).
13B: If the Total Applicant Income/Assets and FEMA Assistance is less than AFMV but more than 25% of the AFMV, then use Adjusted
Cost (Line 11)
13C: If the Total Applicant Income/Assets and FEMA Assistance is less than or equal to AFMV (Line 11), then use 25% of AFMV (Line 12).
14. Final Adjusted Sales Price: The Amount will be automatically generated. The Amount that appears in this column will be the Sales Price
for the applicant if they meet the conditions for acceptance of Sales Price Adjustment Petition.
FEMA FORM FF-104-FY-21-192 (formerly 009-0-131)
(12/21)

Page 8 of 9

ACKNOWLEDGEMENT OF CONDITIONS OF SALE
day of
, 20
the Federal Emergency Management Agency (FEMA), acting through
On this
a designated representative or agent, agrees to sell the Manufactured Housing Unit (MHU) with Vehicle Identification Number (VIN)
and FEMA Unit Bar Code
(the "MHU") to
the eligible Occupant or Co-Occupant listed on the FEMA registration for the MHU (Collectively "Purchaser"). The Purchaser agrees to
purchase the MHU for the total price of $0

,

to be paid to FEMA.

1. Purchaser has provided a certified check or money order to FEMA in the amount of $

.
2. Purchaser represents to FEMA that he/she currently occupies the MHU and the unit will be used as the Purchaser's permanent residence.
Purchaser is purchasing the MHU currently occupied. No substitution or exchange of units is permitted.

DRAFT

3. Purchaser accepts all responsibility and liability for the MHU, including but not limited to the requirement to obtain all necessary local and/
or state permits, licenses, and proof of inspections for moving the unit and placement on the Purchaser's proposed site.
4. If the MHU is located on a FEMA group or FEMA-leased commercial site, the Purchaser will move the unit (if applicable) within 30 days of
the date of this acknowledgement.
5. Purchaser agrees to pay all applicable State sales taxes and any other charges that may be imposed by the State or local government on
the sale. FEMA is not responsible for collection of State or local taxes.
6. Purchaser agrees to obtain and maintain hazard and flood insurance on the MHU. If the selected site for the unit is located within the 100year floodplain or a designated Special Flood Hazard Area (SFHA), Purchaser also agrees to comply with local floodplain management
codes. If Purchaser fails to obtain and maintain insurance, and the MHU is damaged or destroyed by a future declared event, the Purchaser
will not be eligible for FEMA assistance.
7. Any repairs necessary to make the unit habitable were completed prior to the sale of the unit. There are no implied warranties of any kind.
No expressed warranties and no representations, promises or statements have been made by FEMA or its agent. FEMA will provide no
maintenance or repairs to the MHU after the execution of this document.
8. Purchaser has received a completed SF-97 "The United States Government Certificate to Obtain Title to a Vehicle", which constitutes
transfer of title for the MHU to the Purchaser and closing of the purchase transaction.
9. Upon completion of sale, the Purchaser and all members housed under the Purchaser's FEMA registration are no longer eligible for FEMA
Temporary Housing Assistance for FEMA-DR-

.

10. This acknowledgement contains the final and entire agreement between the Purchaser and FEMA and the parties shall not be bound by
any conditions, statements, representations (oral or written), not contained herein. Any modifications or amendments to this document must
be in writing.
11. This Acknowledgement of Conditions of Sale shall be interpreted under Federal Law.
12. Purchaser represents that he/she has not knowingly or willfully falsified, or made any false, fictitious, or fraudulent statements or
representations concerning the purchase and placement of this MHU and that he/she is aware that criminal penalties may be imposed for
such statements or representations.
By signing this agreement, I, the Applicant, have read the terms of this agreement in its entirety, and acknowledge and agree to
comply with the requirements stated herein. As the Applicant, I am signing this form on behalf of all members of my household
listed above as Authorized Users.

Purchaser

Date

Co-Purchaser

Date

FEMA Sales Representative

Date

FEMA Approving Official

Date

To Be Completed By FEMA Sales Lead
Purchaser has shown me copies of:
Documentation of acceptable alternate location or assumption of pad lease and proof of ability to move the MHU.

Initial

Copies of permits or completed inspections required by state or local government for sale and siting of the MHU.

Initial

Purchaser has initialed that they will obtain and maintain hazard and flood insurance for the MHU.

Initial

FEMA FORM FF-104-FY-21-192 (formerly 009-0-131)
(12/21)

Page 9 of 9