FEDERAL EMERGENCY MANAGEMENT AGENCY
SPECIAL CONSIDERATIONS QUESTIONS	
1,	APPLICANT'S NAME
     	2.	FIPS NUMBER
     	3.	DATE
     	
4.	PROJECT NAME
     	5.	LOCATION
     	
Form must be filled out—for each project.	
1.	Does the damaged facility or item of work have insurance and/or is it an insurable risk?  (e.g., buildings, equipment, vehicles, etc.)	
 Yes	 No	 Unsure	Comments	     		
	     		
	
2.	Is the damaged facility located within a floodplain or coastal high hazard area, or does it have an impact on a floodplain or wetland?	
 Yes	 No	 Unsure	Comments	     		
	     		
	
3,	Is the damaged facility or item of work located within or adjacent to a Coastal Barrier Resource System Unit or an Otherwise Protected Area?	
 Yes	 No	 Unsure	Comments	     		
	     		
	
4.	Will the proposed facility repairs/reconstruction change the pre-disaster condition?  (e.g., footprint, material, location, capacity, use or function)	
 Yes	 No	 Unsure	Comments	     		
	     		
	
5.	Does the applicant have a hazard mitigation proposal or would the applicant like technical assistance for a hazard mitigation proposal?	
 Yes	 No	 Unsure	Comments	     		
	     		
	
6.	Is the damaged facility on the National Register of Historic Places or the state historic listing?  Is it older than 50 years?  Are there more, similar buildings near the site?	
 Yes	 No	 Unsure	Comments	     		
	     		
	
7.	Are there any pristine or undisturbed areas on, or near, the project site?  Are there large tracts of forestland?	
 Yes	 No	 Unsure	Comments	     		
	     		
	
8.	Are there any hazardous materials at or adjacent to the damaged facility and/or item of work?	
 Yes	 No	 Unsure	Comments	     		
	     		
	
9.	Are there any other environmentally or controversial issues associated with the damaged facility and/or item of work?	
 Yes	 No	 Unsure	Comments	     		
	     		
	
FEMA Form 90-120, NOV 98