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DocuSign Envelope ID:7AC7CCCD-2FEA-4C09-B2A3-FA4F14F912CE <br /> NORTH CAROLINA LOCAL GOVERNMENT <br /> APPLICATION FOR FFY 2017 EMPG 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+4 - Type or print the street address, <br /> city, and nine digit zip code. <br /> 1.3 EIN/Tax ID Number- Type or print the unique nine digit identification <br /> number for your county's agency. NOTE: Your financial personnel <br /> should be able to provide you with this number. <br /> 1.4 D-U-N-S Number- Type or print the unique nine digit identification <br /> number for your county's agency. NOTE: Your financial personnel <br /> should be able to provide you with this number. <br /> 1.5 Zip Code+4 — Enter your nine digit zip code for your county <br /> government agency mailing address, e.g., 281230465. <br /> 1.6 SAM Registered — Each applicant must be registered in the Federal <br /> System for Award Management (SAM) annually in order to be eligible <br /> to receive EMPG monies. The URL is https://www.sam.gov/. <br /> Expiration Date — What is the expiration date for your SAM account? <br /> 1.7 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 /> 1.8 Finance Manager - Type or print the name of the county Financial <br /> Manager. NOTE: Must be the same title on the Position <br /> Description and Organization Chart. <br /> 1.9 Time (%) - EM Director will type or print the percentage of time the <br /> director devotes to Emergency Management program activities <br /> (e.g. 50%, 60%, 90%, etc.). <br /> 1.10 Current Salary - Type or print the current annual salary for EM <br /> Director. (Round to the nearest dollar). <br /> 1.11 Date of Employment in Current Position — Enter the start date of <br /> your position as Local Emergency Management Program Manager, <br /> e.g. 02/04/2014. <br /> EM Application Form 66 (Rev.7/16) Page 1 <br />