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NORTH CAROLINA LOCAL GOVERNMENT <br />APPLICATION FOR FFY 2013 FUNDING <br />INSTRUCTIONS FOR COMPLETING EM FORM 66 <br />1.1 EM Agency Name - Type or print the official legal title of your <br />Emergency Management (EM) agency. <br />1.2 Street Address, City, Zip Code - Type or print the street address, <br />city, and zip code. <br />1.3 Application Completion Date - Type or print the date the form was <br />completed. <br />1.4 EM Program Manager - Type or print the name of the county EM <br />Program Manager. NOTE: Must be the same title on the Position <br />Description and Organization Chart. <br />1.5 Time % - EM Director will type or print the percentage of time the <br />director devotes to Emergency Management program activities <br />(e.g. 50 %, 75 %, and 100 %). <br />1.6 Current Salary - Type or print the current annual salary for EM <br />Director. (Round to the nearest dollar). <br />1.7 Date of Employment in Current Position — Enter the start date of <br />your position as Local Emergency Management Program Manager, <br />e.g. 02/04/2012. <br />1.8 Personnel Data Table — Complete the specific questions that deal <br />with EM program staff. For the Cost Share or In -Kind Match question, <br />explain how the county will match the federal award grant monies. In <br />FY 2013, EMPG has a 50% County and 50% Federal cost share <br />cash- or in- kind match requirement. Federal funds cannot be <br />matched with other Federal funds. The data requested will assist in <br />documenting the extent to which EMPG Program funding contributes <br />to enhancing or sustaining emergency management capacity in terms <br />of personnel support at the local level. <br />Funds allocated towards Local emergency management personnel? <br />Enter the dollar amount budgeted for your county EM personnel in the dollar <br />column. If for example all EM personnel have other duties and only 75% of <br />anyone's time is developed to EMPG work, then only enter 75% of the budgeted <br />amount allocated to EM personnel salaries and benefits. <br />EM Application Form 66 (Rev. 9/12) Page 1 <br />