Industry Liaison Program Vendor Profile

Format YYYY-MM-DD 
This field cannot be a future date.
This code is assigned through System for Award Management (SAM). If you have not registered, please go to to register prior to completing this form.
Limit 5, separated by comma(s).

Commodities section 1

Please select the primary commodity(s)/service(s) your company provides.

Commodities section 2

Building lease - Please specify:
Food/meals - Please specify:
Generators - Please specify:
Utilities - Please specify:
Water - Please specify:
Name of person completing the form.
Email address of person completing the form.


AUTHORITY: 6 U.S.C § 796 "Registry of disaster response contractors"
Purpose: DHS/FEMA collects this information to facilitate communication between FEMA and the participants of FEMA's Industry Liaison Program.  

Routine Use(s): This information is used for the principal purpose(s) noted above. The information on this form may be disclosed internally within DHS as generally permitted under 5 U.S.C. § 552a(b)(1) of the Privacy Act of 1974, as amended, and will not be shared outside of DHS.  

Disclosure: The disclosure of information on this form is voluntary; however, failure to provide the information requested may delay or prevent FEMA's sharing of information related to its Industry Liaison Program.

3 + 1 =
Tính các phép tính đơn giản này và nhập kết quả vào. Ví dụ: cho 1+3, hãy nhập 4.
Câu hỏi này dùng để kiểm tra xem bạn là người hay là chương trình tự động.