Forms and Documents

Document Name	Status
Form FEMA Form 009-0-49 Request for Public Assistance Form	Modified
Form FEMA Template 104- FEMA Template 104-FY-21-100 Equitable COVID-19 Response and Recovery: Vaccine Administration Information Form and Instruction	Modified
Form 009-0-141 FAC-TRAX System Form	Modified
Form FEMA Form 009-0-91 Project Worksheet Photo Sheet Form	Modified
Form FEMA Form 009-0-91 Project Worksheet Maps and Sketches Sheet Form	Modified
Form FEMA Form 009-0-91 Project Worksheet Cost Estimate Continuation Sheet and Cost Overruns Form	Modified
Form FEMA Form 009-0-91 Project Work Sheet Damage Description and Scope of Work Form	Modified
Form FEMA Form 009-0-12 Force Account Equipment Summary Record Form	Modified
Form FEMA Form 009-0-12 Contract Work Summary Record Form	Modified
Form FEMA Form 009-0-12 Rented Equipment Summary Record Form	Modified
Form FEMA Form 009-0-12 Materials Summary Record Form	Modified
Form FEMA Form 009-0-12 Force Account Labor Summary Form	Modified
Form FEMA Form 009-0-12 PNP Facility Questionnaire Form	Modified
Form FEMA Form 009-0-12 Applicant's Benefits Calculation Worksheet Form	Modified
Form FEMA Form 009-0-12 Special Considerations Questions Form	Modified
Form FEMA Form 009-0-91 Project Worksheet Form and Instruction	Modified
Form FEMA Form 009-0-11 Progress Report Form and Instruction	Modified
Simplified Procedures Final Rule_FR Published.pdf Supplementary Document	2022-08-08
1660-0017 Final Rule Supporting Statement A 20220803.docx Supporting Statement A	2022-08-08
stafford_act.pdf Supplementary Document	2016-09-02
CFR-2011-title44-vol1-part206.pdf Supplementary Document	2016-09-01

IC Document Collections

IC ID	Document Title	Status
41294	Request for Public Assistance Form	Modified
247457	FEMA Template 104-FY-21-100 Equitable COVID-19 Response and Recovery: Vaccine Administration Information Form and Instruction	Modified
223320	FAC-TRAX System Form	Modified
206469	Project Worksheet Photo Sheet Form	Modified
206468	Project Worksheet Maps and Sketches Sheet Form	Modified
206467	Project Worksheet Cost Estimate Continuation Sheet and Cost Overruns Form	Modified
206466	Project Work Sheet Damage Description and Scope of Work Form	Modified
191941	State Administrative Plan and Amendments	Modified
190424	Request for Arbitration and Recommendation from Hurricanes Katrina or Rita	Modified
190419	Request for Appeals and Recommendation	Modified
185911	Force Account Equipment Summary Record Form	Modified
185910	Contract Work Summary Record Form	Modified
185909	Rented Equipment Summary Record Form	Modified
185908	Materials Summary Record Form	Modified
185907	Force Account Labor Summary Form	Modified
185906	PNP Facility Questionnaire Form	Modified
185903	Applicant's Benefits Calculation Worksheet Form	Modified
185901	Special Considerations Questions Form	Modified
185900	Project Worksheet Form and Instruction	Modified
185897	Progress Report Form and Instruction	Modified

ICR Details

OMB Control No:	ICR Reference No:
Status:	Previous ICR Reference No:
Agency/Subagency:	Agency Tracking No:
Title:
Type of Information Collection:	Common Form ICR:
Type of Review Request:	Date Received in OIRA:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract:

---

Authorizing Statute(s): None

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:

---

Federal Register Notices & Comments

Did the Agency receive public comments on this ICR?

---

Number of Information Collection (IC) in this ICR: 0

---

ICR Summary of Burden

	Total	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	0	0	0	0	0	0
Annual Time Burden (Hours)	0	0	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion:

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion:

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government:

Does this IC contain surveys, censuses, or employ statistical methods?

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.    

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.    

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?

Is this ICR related to the Pandemic Response?

---

Common Form ICR: 

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date:

---