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Attachment 4 <br /> U.S. DFPARTMFNT OF HOMFI AND SFC:IIRITY O.M.B.No.1660-0017 <br /> FELIERAL EMERGENCY MANAGEMENT 4OC14C'Y <br /> F:xltares October,11,2008 <br /> PAPERWORK BURDEN DISCLOSURE NOTICE <br /> Public rc:portnap burden for this form is ostunated to average 90 an mutes per msportsc Burden mcans tlto krnac,'efPort and financial resources <br /> e peraded by persons Ess ereeaate,naanataraa;discl€ne.Car to prraj ide naltarr iataon to ars You pray send comments regar dnag the burden estimate or any <br /> aspect of floc colloction,including suaggcstio as for reducinp klrc burdon to_Information Collections Management,U.S_Ltciaartrnent of Horncland <br /> Sea un(y,Federlal Emergency Nlanagataenl Agency,500 C Sfteet,Sl'T,Washington,DC 2E1472,Paperwork Reduction Project(OMB Cuntrol Nmuber <br /> 1660-01117) You are not recpdred to respondto this collection ofinformation awnless a valid t7N48 number appears in the tapper right comer of dais <br /> forrn. NOT E.Do not send your completed questionnaire to this ail dress. <br /> DISASTER RRa,IFC;T NO. PA ID NO, 17ATF C:ATFOORY <br /> FFMA- -DR- <br /> IIAMABFD FAC:II I I WORK COMPLETE AS OF <br /> %n <br /> APPLICANT COUNTY <br /> LOCAL GUN LATITODI LONGITUDE <br /> DAMAGE DESCRIPTION AND DIMENSIONS <br /> SCOPE OF WORK <br /> Does the Scope or 4auorf change,the pre-disaastcT conditions at the site? Yes Cj No <br /> Spccial Cortsaderations issues included? Yes No 14,amrd 9vfat9gation proposal included? Macs $Sca <br /> Is there insurance coverage can this facility? Yeti No <br /> PROJECT COST <br /> ITEM CODE NARRATIVE QUANTITYIUNIT UNIT PRICE COST <br /> Stitt i,1 l i {tz, <br /> S t ( s t <br /> I <br /> } <br /> TOTAL GEST <br /> PREPARED BY TITLE SIGNATURE <br /> APPLICANT REP TITLE SIGNATURE <br /> FFMA Form 4303-431,FFS 06 REPLACES ALL PREY'OUS EDITIONS. <br /> Indian River County Comprehensive Emergency Management Plan Annex IA- Page 31 <br />