Applications and Forms

Application and Forms

Damage Assessment Form (DAF) Submittal Package

A DAF must be filled out for each site and approved by FHWA to qualify the site for ER funding. The required elements of a DAF Submittal Package are as follows:

1. DAF Cover Sheet

2. DAF Cost Estimate (a.k.a. Engineers Estimate; may use multiple pages, as needed)

  • Permanent Repair work items separated from the Emergency Repair work items
  • No "Contingencies" [not allowed in the ER program]
  • Separate Estimates (may use multiple Cost Est. pages, as needed) for Emergency Opening CON and Permanent Repairs / Permanent Restoration
  • Betterment work items and quantities should be identified (may asterisk in cost estimate(s), with a footnote explanation)
  • Must have signatures from both the local agency and District Local Assistance prior to FHWA review

3. Photos of the Damage before repairs began (may use multiple pages, as needed)

4. Sketch and/or narrative of damage and proposed solution (may use multiple pages, as needed)

  • May be a rough hand sketch showing the disaster damage and the proposed solution
  • May include quantity calculations

5. Betterments & Benefit Cost Analysis (only if betterments present on project)

  • Defined as any construction ER construction feature not existing at the location just prior to the disaster event
  • If betterment(s) is/are used a justification should be provided for why it/they should be ER eligible, if seeking ER reimbursement for Betterment(s)
  • May be justified using a Benefit-Cost Analysis (simplified worksheet available in the BCA link to the left)

Damage Assessment Forms (DAF)

Damage Assessment Submittal Supplemental Information and Reference 

 

Contacts:
Bill Huang, ER Coordinator, Division of Local Assistance