Fema Form 078-0-1 - Request For Fire Management Assistance Declaration
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1
2DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
O.M.B. No. 1660-0058
REQUEST FOR FIRE MANAGEMENT ASSISTANCE DECLARATION
Expires: January 31, 2018
PAPERWORK BURDEN DISCLOSURE NOTICE
Public reporting burden for this data collection is estimated to average 1 hour 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., Room 7NE, Washington, DC 20472-3100, Paperwork Reduction Project (1660-0058) NOTE: Do not send your completed
form to this address.
1. STATE
2. DATE OF REQUEST
3. TIME OF REQUEST
4. NAME OF GOVERNOR OR AUTHORIZED REPRESENTATIVE
PHONE NO. INCLUDING AREA CODE
b. Night
a. Day
5. AGENCY REPRESENTED
ADDRESS (Street, City, Zip)
NOTE: In making this request, the Government agrees to abide by provisions contained in FEMA-State Agreement for Fire Management
Assistance under Section 420, PI 93-288 as amended. This request must be signed below by the Governor personally or by his authorized
representative, whom he has previously authorized to sign this request in the FEMA - State Agreement.
TITLE
DATE
6. SIGNATURE
I. EXISTING CONDITIONS
a. TEMPERATURE
b. RELATIVE HUMIDITY
c. DIRECTION AND VELOCITY OF WIND
7.
EXISTENCE OF
HIGH
d. PREVAILING WEATHER CONDITIONS AND PREDICTIONS FOR NEXT 24 HOURS
FIRE DANGER
CONDITIONS
8. NUMBER OF WILD FIRES
a. CONTROLLED
ACRES BURNED
b. UNCONTROLLED
ACRES BURNED
c. EXISTENCE OF OTHER FIRES NEARBY WHICH LIMITS THE COMMITMENT OF STATE FIRE FIGHTING
RESOURCES #
d. EXISTENCE OF OTHER FIRES NEARBY THAT MAY RESULT IN A
CONFLAGRATION #
9. INDICIES
10. BURN BANS
NATIONAL FIRE DANGER RATING
YES
NO
SYSTEM
11. NATIONAL WATCHES
WARNINGS
OTHER (KBDI, SPI, HAINES, PALMER,
ETC.)
YES
NO
YES
NO
II. FIRE SITUATION REPORT
12. TIME OF REPORT
13. NAME OF UNCONTROLLED FIRE
14. DATE
16. ACRES BURNING:
15. LOCATION OF UNCONTROLLED FIRE: (County)
a. FEDERAL
%
b. STATE
%
c. PRIVATE
%
17. MANPOWER AND RESOURCES COMMITTED (Attach separate sheet if necessary)
LOCAL:
STATE:
18. TYPE AND AMOUNT OF FEDERAL OR OTHER ASSETS & RESOURCES NEEDED: (FEMA does not order resources)
FEMA FORM 078-0-1 (08/14)
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