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FEMA Form 519-0-5 (OCT 14) OMB No. 1660-0130
Paperwork Reduction Act Notice
Public reporting burden for this form is estimated to be an average of 10 minutes per response. The burden includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the needed data, and completing, reviewing and submitting the form. Although voluntary, 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 the burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency, 500 C St. SW, Washington, DC 20472, Paperwork Reduction Project (1660-0032) NOTE: Please do not send your completed form to the above address.