Notice of Interest State Mitigation Program Applicant Name: Type of Applicant: Project Point of Phone #: Contact: Address: E-Mail Address: Provide a description of the proposed project or mitigation plan: Please type your narrative description here. If you are proposing a construction or land disturbance project, include concept drawings and site plans. Attach additional pages as needed. List the specific area affected by the project or plan (Counties, City/Town, Tribal Entity, street address): Natural hazard(s) the project or plan mitigates: Total estimated cost of project or plan: Does applicant guarantee that non-federal match is available (25% of project cost standard)? Is the project covered by a FEMA approved mitigation plan? If yes, name of mitigation plan: If this is a construction project, estimate the benefit-cost ratio (Benefits are the monetary value for future damages avoided. Costs equal all associated studies, project management, application development, etc.) All information in this form is true and correct and the document has been duly approved by the governing body of the applicant. Name/Title (print) Signature (Authorized Agent) This is not an application and does not constitute funding approval by DHSEM Send to the State Mitigation Program at
Notice of Interest State Mitigation Program Applicant Name: Type of Applicant: Project Point of Contact: Phone #: Address: E-Mail Address: Provide a description of the proposed project or mitigation plan: Please type your narrative description here. If you are proposing a construction or land disturbance project, include concept drawings and site plans. Attach additional pages as needed. List the specific area affected by the project or plan (Counties, City/Town, Tribal Entity, street address): Natural hazard(s) the project or plan mitigates: Total estimated cost of project or plan: Does applicant guarantee that non-federal match is available (25% of project cost standard)? Is the project covered by a FEMA approved mitigation plan? If yes, name of mitigation plan: If this is a construction project, estimate the benefit-cost ratio (Benefits are the monetary value for future damages avoided. Costs equal all associated studies, project management, application development, etc.) All information in this form is true and correct and the document has been duly approved by the governing body of the applicant. Name/Title (print) Signature (Authorized Agent) This is not an application and does not constitute funding approval by DHSEM Send to the State Mitigation Program at
NOI%20Mitigation%20Program%20Aug%202018%20FINAL.docx