Draft DHS A Number Submission Template.xlsx

Introduction

Federal Emergency Management Agency DRAFT A-Number Submission Template

Please enter the following five fields in the next sheet entitled "Input":

Information (where available) should be provided for all noncitizen migrants (NCMs) served by funding requested for this application.

Column A: Input 9-digit Alien Registration Number (A-Number) or evidence of DHS Processing (e.g. I-94, I-385, I-860, I-862) Column B: Input first name without any prefixes/suffixes Column C: Input last name without any suffixes Column D: Input Department of Homeland Security (DHS) release date in MM/DD/YYYY format Column E: Input the service dates of the served population

Once you have entered your information and verified that it is correct, please save this file and submit through the FEMA GO system under the "Project Worksheet" field.

If you have any questions or concerns, please reach out to fema-ssp@fema.dhs.gov.

PAPERWORK BURDEN DISCLOSURE NOTICE

Public reporting burden for this data collection is estimated to average 16 hours per response. The burden estimate includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and submitting this form. You are not required to respond to this collection of information unless a valid OMB control number is displayed on this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing the burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency, 500 C Street. SW, Washington, DC 20472-3100, Paperwork Reduction Project (1660-0156) NOTE: Do not send your completed form to this address.

PRIVACY NOTICE

GENERAL: This information is being collected for the primary purpose of determining eligibility and administration of SSP and to ensure compliance with existing laws and regulations regarding SSP.

AUTHORITY: The collection of this information is authorized by 2 CFR Part 200.

USES AND SHARING: FEMA will not share the information collected from POCs, including personally identifiable information, outside of the collecting agency. Further information regarding FEMA’s use and sharing of information can be found within the DHS/FEMA/PIA-013 Grant Management Programs Privacy Impact Assessment. The Department’s list of Privacy Impact Assessments can be found on the Department’s website at https://www.dhs.gov/privacy-impact-assessments.

EFFECTS OF NONDISCLOSURE: The disclosure of information on this form is voluntary; however, failure to provide the information requested may delay or prevent the organization from receiving grant funding.

End of Sheet

&G

&P of &N

~500 char.

~1,000 char.

~1,500 char.

~2,000 char.

~2,500 char.

~3,000 char.

~3,500 char.

~500 char.

~1,000 char.

~1,500 char.

~2,000 char.

~2,500 char.

~3,000 char.

~3,500 char.

Input

Data - Hide Before Use

Dropdowns - Hide Before Use

image1.jpeg