ARS Emergency Contact Info

Emergency Contact Form

OMB Number# 0518-0032 (09/2012)

This form has been designed to assist during an actual emergency and/or natural disaster where you cannot report for work at your regular duty station and you cannot be reached at home. Please complete the following form. Please note: This information will be sent only to the ARS COOP team in case of an emergency. There is not a database being created so please only fill out during an actual emergency. No information will be shared to outside sources.

Full Name:
Email:
Verify Email:
Duty Station:	City: State:
Physical Address where you can be reached:
Street Address:
City:
State:
Zip:
Best Number to Reach You:
Cell Phone Number:
Do you have texting capabilities?
Please list the alternate person you may need us to contact
Closest Family Member Name:
Closest Family Member Phone:
Existing Telework Agreement in place?
Do you need to be contacted?
Best Method to reach you:
Additional Information:

The user-friendly URL for this page is: http://www.afm.ars.usda.gov/emergency/contactform.htm

According to the Paperwork Reduction Act of 1995, an agency cannot conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The valid OMB control number for this information collection is 0518-0032. The time required to complete this information is estimated to vary from one to five minutes with an average of three minutes per response, including time for reviewing instructions, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Department of Agriculture, Clearance Officer, OIRM, Room 404-W, Washington, DC 20250, and to the Office of Information and Regulatory Affairs, Office of Management and Budget.

For questions about this page, please contact the COOP Coordinator

Last Updated: 05/13/2013