Iowa 911 Program Shared System Notice of Intent and Intake Information
Form to be completed by the local 911 service board/PSAP

This agreement is not binding, but simply indicates to HSEMD interest in formally exploring the possibility of joining the shared services environment.

Prior to final system acceptance and installation, all parties will sign a detailed user agreement.
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Email *
Service Board Name: *
Name of Lead Local Contact: *
Lead Contact Phone Number: *
Lead Contact Email Address: *
PSAP Name: *
The Public Safety Answering Point (PSAP) named below hereby indicates its desire to join the statewide host/remote Call Processing Equipment (CPE) environment.  (If multiple PSAPs within a County, please submit one form per PSAP)
Current PSAP and CPE Information:
 **All CPE costs, maintenance, and upgrades will be the responsibility of Iowa Homeland Security and Emergency Management except where indicated.**  
Number of seats: *
Please provide the current number of call taker seats at the PSAP.
Current CPE name: *
Please provide the name of your current CPE.
Current CPE vendor: *
Please provide the name of your current CPE vendor.
Administrative line functionality through CPE: *
**Admin line integration is the funding responsibility of the 911 Service Board/PSAP rather than HSEMD**
If the answer to the question above is "No," how do you manage your administrative lines:
Proposed time frame for implementation:
Please provide any time frames you'd like to work within.  Note, this is only for planning purposes and is not binding.
Additional Service and Functionality:
Under the current funding arrangement, HSEMD will pay for the Non-Recurring costs (installation, hardware/software) associated with the additional services and functionality.  

 **The local 911 service board/PSAP will be responsible for funding the annual costs.**  These cost estimates will be provided after a review of the information provided on this form.  
Desired services and functionality: *
Please indicate your desire to cost share additional services and functionality under the HSEMD 911 Program’s Shared Services Contract.  Select as many services/functionality as applicable.  Clicking a service or function merely expresses interest and is not binding.
Required
Current Vendors:
Please list current vendors for services and functionality currently in the PSAP.  This information is needed regardless of interest in shared services in the previous question
CAD: *
Logging Recorder: *
Mapping: *
Emergency Medical Dispatch: *
Radio Console: *
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