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FY 2022 - 2023 EMPA AGREEMENT <br />ATTACHMENT F -REPORTING FORMS <br />FLORIDA DIVISION OF EMERGENCY MANAGEMENT <br />2022-2023 EMERGENCY MANAGEMENT PREPAREDNESS AND ASSISTANCE GRANT - EMPA <br />DIVISION FORM 4 - STAFFING DETAIL <br />COUNTY EMERGENCY MANAGEMENT AGENCY <br />ANTICIPATED SALARIES & BENEFITS <br />SUB -RECIPIENT: POINT OF CONTACT: Jane Doe, Planner <br />EMPLOYEE INFORMATION LOCAL <br />STATE AND FEDERAL <br />Only funded Staff Name, Position <br />Title & Annual % % % <br />Area of Responsibility Total Salaries County Other EMPA <br /># (Preparedness, Response, Recovery, General <br />Mitigation & Finance & Benefits $ Fund Local Base Grant <br />by Position (Local) Funds (State) <br />[1] 2 3 4 5 <br />$ % <br />EMPA EMPG <br />Base Grant Base Grant <br />(State) (Federal) <br />[6] <br />$ <br />EMPG <br />Base Grant <br />(Federal) <br />181 <br />% <br />Total <br />All <br />Funds <br />9 <br />1 Ex. Jane Doe, Director, ALL $ 60,000.00 50% <br />$ 30,000.00 50% <br />$30,000.00 <br />100% <br />2 <br />$ - <br />$0.00 <br />0% <br />3 <br />$ <br />$0.00 <br />0% <br />4 <br />$ <br />$0.00 <br />0% <br />5 <br />$ <br />$0.00 <br />0% <br />6 <br />$ <br />$0.00 <br />0% <br />7 <br />$ <br />$0.00 <br />0% <br />8 <br />$ - <br />$0.00 <br />0% <br />9 <br />$ <br />$0.00 <br />0% <br />10 <br />$ <br />$0.00 <br />0% <br />11 <br />$ <br />$0.00 <br />0% <br />12 <br />$ <br />$0.00 <br />0% <br />13 <br />$ <br />$0.00 <br />0% <br />14 <br />$ <br />$0.00 <br />0% <br />15 <br />$ <br />$0.00 <br />0% <br />16 <br />$ <br />$0.00 <br />0% <br />17 <br />$ <br />$0.00 <br />0% <br />18 <br />$ <br />$0.00 <br />0% <br />19 <br />$ <br />$0.00 <br />0% <br />20 <br />$ <br />$0.00 <br />0% <br />TOTAL <br />$ 30,000.00 <br />$30,000.00 <br />DIRECTIONS: <br />1. In Column #1, list the name, position title and area of responsibility(s) for all funded EMPA Emergency Management staff . <br />2. In Column #2, list total anticipated annual amount of Salaries and Benefits to be paid for each EM funded position. <br />3. In Columns #3-5 & 7, protide the funding distribution (%) in each applicable column. <br />4. In Column #6, list the amount of Salaries and Benefits to be paid out of EMPA grant funds. <br />5. In Column #8, list the amount of Salaries and Benefits to be paid out of EMPG grant funds. <br />6. Column #9 calculates the sum of percentages entered in Columns 3 - 5 & 7 and must equal 100% of the anticipated annual salaries and benefits per EM position. <br />7. Please provide to the Division updates or revisions to this forth throughout the period of the agreement, as necessan <br />8. This form is to be submitted to the Division along with the 1st Quarter submission, or by November 15, 2022, whichever occurs first. <br />57 <br />