National Fire Department Census Survey
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National Fire Department Census Survey
O.M.B. No. 1660-0070 Expires June 30, 2012
Required fields are marked with an *
Survey Completed By
1. Name *
2. Phone Number * 555-555-5555
3. Fax Number 555-555-5555
4. Email Address *
Fire Department Information
5. Fire Department ID 12345
6. Name *
7. Headquarters Address *
9. City *
10. State Pennsylvania
11. Zip Code * 12345-1234
12. County *
13. Mailing Address
15. PO Box
16. City *
17. State *
https://www.usfa.fema.gov/applications/census/survey.cfm[10/13/2011 11:53:15 AM] National Fire Department Census Survey
18. Zip Code * 12345-1234
19. HQ Phone * 555-555-5555
20. HQ Fax 555-555-5555
21. E-mail
22. Website
23. Number of Stations *
24. Organization Type: * Local (includes career, combination, and volunteer) State Government Transportation Authority or Airport F.D. Federal Government - Executive Branch Agency Federal Government - DOD Private or industrial fire brigade Contract fire department Other Unknown
25. Is your fire department the primary agency responsible for community Emergency Management (EM)?: *
Yes No
If No, then what agency is the primary agency responsible for emergency management in your community?
Emergency Management (EM) - Integration and coordination of all-hazards mitigation, prevention, preparedness, response, and recovery activities within a community for all (or most) agencies such as fire, EMS, public works, public information, volunteer service, etc.
26. Population Protected: * (no commas, please) Provide the total permanent resident population protected by your department
27. Source of information: * U.S. Census Estimate Other Unknown
28. Area Protected: * Square Miles (no commas, please) Provide an estimate of the total primary response area in square miles protected by your department.
Staff (numeric values only with no commas)
29. Active Firefighters: Career(s) *
Volunteer(s) *
Paid per Call(s) *
32. Non Firefighting: Civilian Employee(s) *
https://www.usfa.fema.gov/applications/census/survey.cfm[10/13/2011 11:53:15 AM] National Fire Department Census Survey
Non Firefighting Volunteer(s) *
Specialized Services Provided (check all that apply)
34. Specialized Services Wildfire/Urban-Wildland Vehicle Extraction Airport/Aviation Technical Rescue Fireboat Fire Inspection/Code Enforce EMS transport Fire Prevention/Pub Ed. EMS Non transport Training Academy Basic Life Support Fire Investigation Advanced Life Support Sworn HAZMAT Team (Technician) Juvenile Firestarter
United States Fire Administration Programs
35. Is your fire department familiar with United States Fire Administration programs and publications? *
Yes No
If yes, How? (check all that apply)
Web Site http://www.usfa.dhs.gov/ Publications National Fire Academy Courses National Fire Incident Reporting System (NFIRS) Public Fire Education Programs Other
Additional Station Addresses
36. Additional Station Addresses If you entered a number greater than 1 in Question 23, would you like to provide additional station addresses? Yes No
Paperwork Burden Disclosure Notice
Public reporting burden for this data collection is estimated to average 25 minutes 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 survey. You are not required to respond to this collection of information unless a valid OMB control number is displayed on this survey. 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, Paperwork Reduction Project (1660-0070) NOTE: Do not send your completed form to this address.
FEMA FORM 75-100
Census Last Updated: October 13, 2011
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https://www.usfa.fema.gov/applications/census/survey.cfm[10/13/2011 11:53:15 AM] National Fire Department Census Survey
https://www.usfa.fema.gov/applications/census/survey.cfm[10/13/2011 11:53:15 AM]