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4D <br />4D <br />4W <br />STATE OF FLORIDA <br />HAZARD MITIGATION GRANT PROGRAM (HMGP) <br />FLOOD MITIGATION ASSISTANCE (FMA) <br />Application <br />FEMA• •UR -FL D Standard "MGP a 5% initiative Application 11 Application Complete <br />O Standard FMA o Initial Submission or ❑ Resubmission <br />Support Documents Eligible Applicant Project Type(s) <br />❑ Conforms with State 409 Plan ❑ State or Local Government ® Wind <br />in Declared Area 0 Private Non -Profit (Tax ID Received) U Flood <br />t] Statewide URecognized Indian Tribe or Tribal Organization a Other <br />Community NFIP Status: (ch-a—a,ncoy) <br />❑ Participating Community ID #: Reviewer Phone # <br />❑ In Good Standing ❑ Non-Participali ng 0 CRS ReviewerFax # <br />State Application ID Reviewer Email: <br />State Reviewer Date Applicallon Received <br />Date: <br />This application is for all Federal Emergency Management Agency (FEMA Region IV) Hazard Mitigation grant Program (HMGP) <br />and Flood Mitigation Assistance (FMA) proposals. Please complete ALL sections and provide the documents requested. If you <br />require technical assistance with this application, please contact your State Emergency Management Division at (850) 922.5269. <br />Page 2 of 15 <br />