Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Applicant's Benefits Calculation Worksheet Unchanged 43904 21952 0 Form FEMA Form 009-0-128 Applicant's Benefits Calculation Worksheet
Contract Work Summary Record Unchanged 5264 2632 0 Form FEMA Form 009-0-126 Contract Work Summary Record
FAC-TRAX System Unchanged 51128 63910 0 Form 009-0-141 FAC-TRAX System
FEMA Template 104-FY-21-100 Equitable COVID-19 Response and Recovery: Vaccine Administration Information New 51016 25508 0 Form and Instruction FEMA Template 104-FY-21-100 Equitable Vaccine Administration Information Submission
Force Account Equipment Summary Record Unchanged 5264 1316 0 Form FEMA Form 009-0-127 Force Account Equipment Summary Record
Force Account Labor Summary Unchanged 5264 2632 0 Form FEMA Form 009-0-123 Force Account Labor Summary Record
Materials Summary Record Unchanged 5264 1316 0 Form FEMA Form 009-0-124 Materials Summary Record
PNP Facility Questionnaire Unchanged 5264 2632 0 Form FEMA Form 009-0-121 PNP Facility Questionaire
Instruction
Progress Report Unchanged 224 22400 0 Form and Instruction FEMA Form 009-0-111 Quarterly Progress Report
Instruction
Project Work Sheet Damage Description and Scope of Work Unchanged 43904 65856 0 Form FEMA Form 009-0-91A Project Worksheet - Damage Description and Scope of Work Continuation Sheet
Project Worksheet Unchanged 47040 70560 0 Form and Instruction FEMA Form 009-0-91 Project Worksheet
Project Worksheet Cost Estimate Continuation Sheet and Cost Overruns Unchanged 43904 58537 0 Form FEMA Form 009-0-91B Project Worksheet-Cost Estimate Continuation Sheet
Project Worksheet Maps and Sketches Sheet Unchanged 40768 61152 0 Form FEMA Form 009-0-91C Project Worksheet - Maps and Sketches Sheet
Project Worksheet Photo Sheet Unchanged 40768 61152 0 Form FEMA Form 009-0-91D Project Worksheet-Photo Sheet
Rented Equipment Summary Record Unchanged 5264 2632 0 Form FEMA Form 009-0-125 Rented Equipment Summary Record
Request for Appeals and Recommendation Unchanged 504 1512 0
Request for Arbitration and Recommendation from Hurricanes Katrina or Rita Unchanged 20 60 0
Request for Public Assistance Unchanged 7224 1806 0 Form FEMA Form 009-0-49 Request for Public Assistance
Special Considerations Questions Unchanged 47040 23520 0 Form FEMA Form 009-0-120 Special Consideration Questions
State Administrative Plan and Amendments Unchanged 56 448 0
Total burden requested under this ICR: 449084 491533 0  
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