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NORTH CAROLINA LOCAL GOVERNMENT <br />• APPLICATION FOR FFY 2009 FUNDING <br />INSTRUCTIONS FOR COMPLETING EM FORM 66 <br />1.1 EM Agency Name - Type or print the official legal title of the <br />Emergency Management (EM) agency. <br />1.2 Address, City, Zip Code - Type or print the street address, city, and <br />zip code. <br />1.3 Date Completed - Type or print the date the form was filled out. <br />2.1 EM Director - Type or print the name of the county EM Director. <br />NOTE: Must be the same title on the Position Description and <br />Organization Chart. <br />2.2 Time % - EM Director will type or print the percent of time director <br />devotes to Emergency Management program activities (e.g. 50%, <br />75%,100%). <br />2.3 Current Salary - Type or print the current annual salary for EM <br />Director. (Round to the nearest dollar). <br />• 2.4 Benefits - Type or print the annual benefits for the EM Director <br />to include social security, retirement, insurance, unemployment, etc. <br />(Round to the nearest dollar). <br />2.5 Total Salary - Add the costs for Current Salary plus Benefits and put <br />the total dollar amount in this box. <br />2.6 Cost Share or In-Kind Match - Explain how the county will match <br />the state award grant monies in detail. In FY 2009, EMPG has a 50% <br />County and 50% State cost share cash- or in- kind match <br />requirement. Federal funds cannot be matched with other Federal <br />funds. Additional information in accordance for 44 C.F.R. 13.24 can <br />be found at the link below. <br />http //www.nccrimecontrol.org/div/em/planning/EMPGFreguentlyAske <br />dQuestions.pdf or specifically <br />http //149 168 212 15/mitigation/Library,/44 CFR-Part 13 pdf starting <br />on page 8 with section 13.24 Matching or cost sharing. <br />EM Form 66 (Rev. 01/09) <br />0 <br />