DEPARTMENT OF HOMELAND SECURITY O.M.B. No. 1660-0002
Federal Emergency Management Agency
   RESOURCE REQUEST FORM (RRF)

 
O.M.B. No. 1660-0002
 I. REQUESTING ASSISTANCE (To be completed by Requestor)
 1. Requestor's Name
  		 2. Title
  		 3. Phone No.
 
 4. Requestor's Organization
  		 5. Fax No.
  		 6. E-Mail
 
 II. REQUESTING ASSISTANCE (To be completed by Requestor)
 1. Description of Requested Assistance:
 
 2. Quantity
  		 3. Priority  
Lifesaving Life Sustaining High Normal		  4. Date and Time Needed  
 
 5. Delivery Site Location
  		 6. Site Point of Contact (POC)
 
 7. 24 Hour Phone No
  		 8. Fax No.
 
 9. State Approving Official Signature  10. Date and Time  
III. SOURCING THE REQUEST - REVIEW/COORDINATION (Operations Section Only)
  1.Reviews
  OPS Review by:
  LOG Review by:
  Other Coordination:
  Other Coordination:
 Other Coordination:

  2. Source:
  Donations
  Requisitions Procurement
  Interagency Agreement
  Mission Assignment
  Other (Explain)
 

  3. Assigned to:
  ESF/OFA:
  RSF/OFA:
  Other:
  Date/Time

 4. Immediate Action Required: YES NO
IV. STATEMENT OF WORK (Operations Section Only)
 1. OFA Action Officer
  		 2. 24 Hour Phone #
  		 3. Fax #
 

 4. FEMA Project Manager
  		 5. 24 Hour Phone #
  		 6. Fax #
 
 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:
 Received by (Name) 		 Resource Request #
 State 		 Program Code/Event #
 

Originated as verbal

                                      FEMA FORM 010-0-7
Ver 1.9 KE4LWT