Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Applicant Impact Survey New 60000 7002 0 Form and Instruction FEMA Form FF-104-FY-22-235 Applicant Impact Survey
Applicant's Benefits Calculation Worksheet Modified 1920 960 0 Form and Instruction FEMA Form FF-104-FY-21-135 (formerly 009-0-128) Applicant's Benefits Calculation Worksheet
Contract Work Summary Modified 6000 1100 0 Form and Instruction FEMA Form FF-104-FY-21-140 (formerly 009-0-126) Contract Work Summary
Damage Information New 72000 90000 0 Form and Instruction FEMA Form FF-104-FY-22-245 Damage Information
Donated Labor Sign-in New 600 40 0 Form and Instruction FEMA Form FF-104-FY-22-237 Donated Labor Sign-in
Equitable Vaccine Administration Information Submission Template Modified 13680 6840 0 Form and Instruction FEMA Template 104-FY-21-100 Equitable Vaccine Response and Recovery: Vaccine Administration Information
FAC-TRAX System Removed 0 0 0 Form 009-0-141 FAC-TRAX System
Force Account Equipment Summary Modified 1920 480 0 Form and Instruction FEMA Form FF-104-FY-21-141 (formerly 009-0-127) Force Account Equipment Summary Record
Force Account Labor Summary Record Modified 1920 960 0 Form and Instruction FEMA Form FF-104-FY-21-137 (formerly 009-0-123) Force Account Labor Summary Record
Impact List New 60000 30000 0 Form and Instruction FEMA Form FF-104-FY-22-236 Impact List
Materials Summary Modified 1920 480 0 Form and Instruction FEMA Form FF-104-FY-21-138 (formerly 009-0-124) Materials Summary Record
Organization Profile New 60000 18000 0 Form and Instruction FEMA Form FF-104-FY-22-233 Organization Profile
PNP Facility Questionnaire Removed 0 0 0 Form FEMA Form 009-0-121 PNP Facility Questionaire
Instruction
Pre-Approval Request New 30000 15000 0 Form and Instruction FEMA Form FF-104-FY-22-238 Pre-Approval Request
Project Application for Building Code and Floodplain Management and Enforcement New 300 70 0 Form and Instruction FEMA Form FF-104-FY-22-243 Project Application for Building Code and Floodplain Management Administration and Enforcement
Project Application for COVID-19 New 3000 1100 0 Form and Instruction FEMA Form FF-104-FY-22-241 Project Application for COVID-19
Project Application for Debris Removal New 60000 45000 0 Form and Instruction FEMA Form FF-104-FY-22-239 Project Application for Debris Removal
Project Application for Emergency Protective Measures New 60000 45000 0 Form and Instruction FEMA Form FF-104-FY-22-240 Project Application for Emergency Protective Measures
Project Application for Infrastructure Restoration New 72000 54000 0 Form and Instruction FEMA Form FF-104-FY-22-242 Project Application for Infrastructure Restoration
Project Application for Management Costs New 60000 13002 0 Form and Instruction FEMA Form FF-104-FY-22-244 Project Application for Management Costs
Project Work Sheet Damage Description and Scope of Work Removed 0 0 0 Form FEMA Form 009-0-91A Project Worksheet - Damage Description and Scope of Work Continuation Sheet
Project Worksheet Removed 0 0 0 Form and Instruction FEMA Form 009-0-91 Project Worksheet
Project Worksheet Cost Estimate Continuation Sheet and Cost Overruns Removed 0 0 0 Form FEMA Form 009-0-91B Project Worksheet-Cost Estimate Continuation Sheet
Project Worksheet Maps and Sketches Sheet Removed 0 0 0 Form FEMA Form 009-0-91C Project Worksheet - Maps and Sketches Sheet
Project Worksheet Photo Sheet Removed 0 0 0 Form FEMA Form 009-0-91D Project Worksheet-Photo Sheet
Quarterly Progress Report Modified 240 144 0 Form and Instruction FEMA Form FF-104-FY-21-132 (formerly 009-0-111) Quarterly Progress Report
Recipient Incident Information New 60 5 0 Form and Instruction FEMA Form FF-104-FY-22-234 Recipient Incident Information
Rented Equipment Summary Modified 1920 960 0 Form and Instruction FEMA Form FF-104-FY-21-139 (formerly 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 Modified 60000 7002 0 Form and Instruction FEMA Form FF-104-FY-21-131 (formerly 009-0-49) Request for Public Assistance
Special Considerations Questions Removed 0 0 0 Form FEMA Form 009-0-120 Special Consideration Questions
State Administrative Plan Modified 60 36 0 Form and Instruction FEMA Form FF-104-FY-22-249 State Administrative Plan
Time Extension Request New 7200 2880 0 Form and Instruction FEMA Form FF-104-FY-22-248 Time Extension
Tribe Administrative Plan New 5 2 0 Form and Instruction FEMA Form FF-104-FY-22-250 Tribal Administrative Plan
Total burden requested under this ICR: 635269 341635 0  
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