Form FEMA Form FF-104-F FEMA Form FF-104-F Mission Assignment (MA)

OMB Control No. 1600-0047
Expiration Date: 6/30/2024

DEPARTMENT OF HOMELAND SECURITY

Federal Emergency Management Agency
MISSION ASSIGNMENT (MA)
I. TRACKING INFORMATION

Incident Location/Incident Name

Internal Control Number

Resource Request Number
Date/Time Created

Program Code/Event Number

II. ASSISTANCE REQUIRED

Assistance Required

See Attached

Delivery Site Location

Date/Time Required

Requestor Name

24 Hour Phone Number

Email Address

Site POC Name

24 Hour Phone Number

Email Address

DRAFT
III. INITIAL FEDERAL COORDINATION

Action to

ESF #

Priority

Other

RSF

1. Lifesaving
3. High

IV. DESCRIPTION

Statement of Work

2. Life sustaining
4. Normal
See Attached

Your agency must validate the unliquidated MA balance at least quarterly as stipulated by FEMA to maintain reimbursable authority. Accrual data must also be provided to
FEMA no later than the third business day after fiscal quarter end close. Information can be submitted to FEMA-Disaster-MA-ULO@fema.dhs.gov. For MA billing and
reimbursement information, please visit https://www.fema.gov/federal-agencies/mission-assignments.

Assigned Agency
New or

Projected Start Date

Projected End Date

Total Cost Estimated

Amendment to MA #:

OFA Action Officer

Phone Number

Email Address

FEMA Project Manager

Phone Number

Email Address

V. COORDINATION
Type of MA

Direct Federal Assistance (DFA)
STT Cost Share (0%,10%,25%)

Federal Operations Support (FOS)
STT Cost Share (0%)

State/Tribe/Territory (STT) Cost Share Percent
Fund Citation
Mission Assignment Manager (Preparer)

STT Cost Share Amount $
Appropriation Code

Date

FEMA Project Manager/Branch Director (Program Approval)

Date

Comptroller/Funds Control (Funds Review)

Date

VI. APPROVAL

*State/Tribal/Territorial Approving Official (Required for DFA)

Date

**Federal Approving Official (Required for all)

Date

Mission Assignment Number
Amendment Number

FEMA Form FF-104-FY-21-119 (formerly 010-0-8) (5/24)

VII. OBLIGATION

Amount This Action

Date/Time Obligated

Cumulative Amount

***Initials

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MISSION ASSIGNMENT (MA)
* STT Signature required for Direct Federal Assistance Mission Assignments only.
**This signature conveys legal authority to begin work in accordance with Stafford Act and 44 CFR guidelines.
*** Initials are a FEMA-only accounting identifier and are not required for an agency to act on a mission assignment.

PRIVACY NOTICE

FEMA collects, uses, maintains, retrieves, and disseminates the records within this form according to the Robert T. Stafford Disaster Relief and Emergency Assistance Act
(42 U.S.C. 5121 et seq) and 44 CFR Part 206.5. FEMA is authorized to provide assistance to States based on needs before, during and after a disaster has impacted the
State. FEMA collects personally identifiable information from the points of contact at the State, local, tribal, and territorial governments; site delivery point of contact; FEMA
program manager; and the other Federal agency point of contact, in order to be able to reach these individuals regarding the associated Mission Assignment that results
from this request form. The non-PII that is collected explains which state(s), local, tribal, or territorial government(s) require assistance, what needs to be accomplished,
details any resource shortfalls, and explains what assistance is required to meet these needs. FEMA may share the personal information of U.S. citizens and lawful
permanent residents contained in their disaster assistance files outside of FEMA as generally permitted under 5 U.S.C. § 552a(b) of the Privacy Act of 1974, as amended,
including pursuant to routine uses published in DHS/ALL-002 –Department of Homeland Security (DHS) Mailing and Other Lists System, 73 Fed. Reg. 71,659 (Nov. 25,
2008), and upon written request, by agreement or as required by law. FEMA may share the personal information of non-citizens, as described in the following Privacy
Impact Assessment: DHS/FEMA/PIA-023 Enterprise Coordination and Approval Processing System (eCAPS).

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, 500 C Street, SW Washington, DC 20472-3100, Paperwork Reduction Project (1660-0047). NOTE: Do not send your completed form to this address.

INSTRUCTIONS

DRAFT

Fields on the Mission Assignment (MA) form that are not listed below are self-explanatory. Fields that are in italics are system generated.
Mission Assignment form used only if solution is to request Federal agency to perform reimbursable work under MA. Deliberate validation and
verification of information must occur before MA is completed and issued.
I. TRACKING INFORMATION. Completed by MA Staff.
Incident Location / Incident Name: If multi-State, choose State most likely to receive resource(s) (only applicable when using 7220-SU Program
Code). For EM/DR declarations to a tribal government this field indicates the state in which the tribal headquarters is located and the incident name.
Internal Control Number: Internal system-generated tracking number.
Resource Request Number: Based on chronological number assigned on Resource Request Form (RRF). If no RRF, identify document directing
action (as applicable).
Program Code/Event Number: The pre-declaration, emergency, or major disaster number assigned for funding the event. Examples: 7220-SU, 3130EM, 1248-DR.
II. ASSISTANCE REQUIRED. Completed by MA Staff.
Assistance Required: Assistance FEMA is tasking to assigned agency. May provide details of resource shortfalls, specific deliverables, or simply
state the problem. Information concerning assistance requested may be provided on the Resource Request Form (RRF).
Delivery Site Location: Site name and address. For multiple delivery locations, input “various locations see attached” in site name, include attachment
with delivery sites and POCs for each location, and breakdown of requirements for each location as appropriate.
Date/Time Required: This is the Date/Time that the resource needs to be delivered or should be operational.
Requestor Name: The individual making the request, or the POC for the request.
Site POC Name: The person at the delivery site coordinating reception and utilization of the requested resources. 24-hour contact information required.
III. INITIAL FEDERAL COORDINATION. Completed by MA Staff.
Action to: Maybe Emergency Support Function (ESF), Recovery Support Function (RSF), or other organization.
IV. DESCRIPTION. Completed by MA Staff.
Statement of Work: Description of work to be performed which may include objectives, tasks, resources, personnel, and/or deliverables. Specific
locations, period of performance, and cost estimates should not be included in the SOW. The SOW must be specific enough to identify the required task,
but general enough to allow flexibility to accomplish the task. For additional direction for writing SOWs reference mission assignment doctrine and FAR.
Assigned Agency: Agency receiving the MA from FEMA. Activities within the scope of an ESF/RSF may result in an MA to primary or support
agency. Cite subordinate organization if applicable. For example: DOT-FAA,COE-SAD.
Projected Start/End Date: If end date is not clear, estimate and budget for 30, 60, or 90 days, then reevaluate. TBD is not acceptable; a date must be
entered.
Total Cost Estimate: The cost estimate should include the total cost projection for the MA across the entire length of the MA. Enter dollar value and
provide supporting documentation with a breakdown outlining eligible costs. Eligible costs are identified in 44 CFR 206.8(c) and may include
personnel, equipment, contract, travel,and other costs.
V. COORDINATION. Completed by MA Staff, except for Project Manager and Comptroller signatures.
Type of MA: Select only one.
Appropriation Code: Static data. Do not change. This is for information only, should not be used to report internal agency finances to Treasury.
VI. APPROVAL. Completed by STT Approving Official and Federal Approving Official.
State/Tribal/Territorial Approving Official: Signature certifies that STT and local government cannot perform, nor contract for the performance of the
requested work.
VII. OBLIGATION. Completed by MA Staff.
Amendment Number: Note the supplement number. For example: HHS-01, Amendment Number 01, or DOD-08, Amendment Number 03. Amount
Amount this Action: Amount obligated for this action (new MA or amendment).
Cumulative Amount: Cumulative amount for this MA, including amendments.
Initials: The initials located on financially processed MAs are not required to initiate immediate OFA resource and capability deployment activities.
The initials are a FEMA only accounting identifier used to indicate completion of an automated system process and are not required for an agency to
act on an MA.

FEMA Form FF-104-FY-21-119 (formerly 010-0-8) (5/24)

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