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<span class="txt12"><p><b>Service Rep:</b><br/>
Please read the following statement to each Delta Call applicant, as they will not have heard it from the phone recorded message.</p>

<p>We are required to provide you with the following Privacy Act Statement.</p>

<p>The Privacy Act of 1974 protects your rights as to how FEMA uses and shares your information with entities such as states, tribes, local governments, and other organizations. The Stafford Act and other laws allow FEMA to collect information to determine eligibility and provide assistance as a result of a Presidentially declared disaster.</p>

<p>If you receive FEMA assistance and your insurance covers the same loss, you may be required to return some or all of the FEMA assistance you received.</p>

<p>To be eligible for assistance, you must declare under penalty of perjury, that you or someone in your household is a citizen, non-citizen national, or a qualified alien of the United States. If you hide information or lie in an attempt to obtain assistance, it is a violation of federal and state laws, which carry criminal or civil penalties or both.</p>

<p>You authorize FEMA and the state, tribe, or local government to verify all the information you provide and request documentation from your insurance company, or other third parties, to determine your eligibility for assistance.</p>

<p>The disclosure of information, including the SSN, on this form is voluntary; however, failure to provide the information requested may delay or prevent you from receiving disaster assistance.</p>