Disaster citation

Under the provisions of Section [Major Disaster citation (401), Emergency citation (501)]of the Robert T. Stafford Disaster Relief and Emergency Assistance Act, 42 U.S.C. §§ 5121-5207 (Stafford Act), and implemented by 44 CFR § [Major Disaster citation (206.36), Emergency citation (206.35)], I request that you declare a [major disaster or emergency] for the (name of the State or Indian tribal government) as a result of (name type of incident and incident date as identified in the declaration request form).

[The following information is required for ALL requests. Provide additional information that is not contained in the form. If requested information is included in the form, it is not necessary to repeat in the cover letter.]

Describe deaths, injuries, or missing individuals associated with the event.

Indicate whether a State of Emergency has been declared, when and to what areas are included in the declaration. Indicate if affected jurisdictions have also declared states of emergency.

Provide a description of damage as a result of the event (such as the impact the event has had on the affected area and population; disruption of normal community functions and services for a period greater than 72 hours, including: disruption to or increased demand for lifesaving and life sustaining services, such as police, fire/EMS, hospital/medical, sewage, and water treatment services; disruptions to or increased demand for essential community services, such as schools, social services programs and providers, child care and eldercare; transportation infrastructure or utility disruptions; damage to any other critical facilities that have been rendered non-operational by the event; emergency conditions that may be present; health and safety hazards; and, status of repairs, and estimated completion date(s), if known.

If applicable, provide a description of any local communities that have incurred high per capita impacts, or particularly significant impacts to local critical infrastructure, or other factors that illustrate significant impact at a localized level.

Provide information on PDA findings and how and where they were conducted, including accessibility concerns, if additional space needed from the form.

The following information is furnished on the nature and amount of State, local, or Indian tribal government resources that have been or will be used to alleviate the conditions of this disaster:

Describe what has been done to respond to the disaster, including actions pending or taken by the State, local, or Indian tribal governments. Describe any State, local or Indian tribal government Individual Assistance programs.

Describe voluntary agency assistance provided to the community in anticipation of or as a result of the event. (Including but not limited to activities taken by the American Red Cross (ARC), Salvation Army, Southern Baptists, and Voluntary Organizations Active in Disaster; voluntary agency and/or municipal shelter information, including the number of shelters open, the peak population, total number of overnight stays, and when the shelters closed; number of mental health contacts made by voluntary agencies; number of ARC cases open and closed; number of clean up kits provided; number of meals served; number of fixed and/or mobile feeding sites; level of ARC operation (I-V); and any other type of assistance that was provided by voluntary organizations).

Provide the disaster history of the State or Indian Tribal government over the past 24 months or longer if the earlier events impact state or local capability to respond, including Stafford Act declarations and declarations by the Governor or Tribal Chief Executive and the extent to which the State or Indian tribal government has expended its own funds; list areas that have sustained damage from this event and the disasters identified; and include any other pertinent factors that would have a bearing on the State or Indian tribal government’s ability to respond, such as economy of the area, terrain, inaccessibility, or capacity of voluntary organizations active in disaster.