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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
1660-0155
ICR Reference No:
202302-1660-001
Status:
Historical Active
Previous ICR Reference No:
202211-1660-001
Agency/Subagency:
DHS/FEMA
Agency Tracking No:
Second Emergency (Hermit's Peak)
Title:
Notice of Loss and Proof of Loss
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Emergency
Approval Requested By:
02/15/2023
OIRA Conclusion Action:
Approved without change
Conclusion Date:
02/16/2023
Retrieve Notice of Action (NOA)
Date Received in OIRA:
02/15/2023
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
08/31/2023
6 Months From Approved
05/31/2023
Responses
143,625
0
57,450
Time Burden (Hours)
689,401
0
667,857
Cost Burden (Dollars)
0
0
0
Abstract:
The Hermit’s Peak/Calf Canyon Fire Assistance Act is intended to provide persons who suffered injuries as a result of Hermit’s Peak/Calf Canyon Fires with a simple, expedited process to seek compensation from the United States. To obtain benefits under this legislation, an Injured Person must submit all Hermit’s Peak/Calf Canyon Fires related claims against the United States to the Federal Emergency Management Agency (FEMA). An Injured Person who elects to proceed under the Act is barred from bringing a claim under the Federal Tort Claims Act or filing a civil action against the United States for damages resulting from the Hermit’s Peak/Calf Canyon Fires.
Emergency Justfication:
This information is necessary to support the Act implemented by the Hermit’s Peak/Calf Canyon Fire Assistance regulation (44 CFR part 296) which was added by FEMA’s November 10, 2022, Hermit’s Peak/Calf Canyon Fire Assistance Interim Final Rule (RIN 1660-AB14). The purpose of this authority is to ensure the expeditious consideration and settlement of claims to compensate victims of the Hermit’s Peak/Calf Canyon Fires. The Hermit’s Peak Fire began on April 6, 2022, after a prescribed burn exceeded the containment capabilities of the U.S. Forest Service and was declared a wildfire. On April 19, the Calf Canyon Fire began burning on Federal land and was later identified as the result of a pile burn in January 2022 that remained dormant under the surface before reemerging. The Hermit’s Peak and Calf Canyon Fires merged on April 27, 2022. By May 2, 2022, the fire had grown, causing evacuations in multiple villages and communities. On May 4, 2022, President Biden issued a major disaster declaration for the counties of Colfax, Mora, and San Miguel, New Mexico. The U.S. Forest Service has assumed responsibility for the Hermit’s Peak/Calf Canyon Fire, which was not 100 percent contained until August 21, 2022. On September 30, 2022, Congress passed the Act authorizing FEMA to establish a claims process for victims of the Hermit’s Peak/Calf Canyon Fire. Congress tasked FEMA with providing expeditious consideration and settlement of claims for injuries as a result of the Hermit’s Peak/Calf Canyon Fire. In doing so, Congress set strict deadlines around the claims process. First, FEMA is required to publish interim regulations establishing the process by November 14, 2022. Once the process is established in regulation, Claimants will have two years from the date the regulation is published to submit their Notice of Loss to FEMA. The Notice of Loss provides confirmation that the Claimant has elected to use the process under the Act to seek compensation for injuries resulting from the Hermit’s Peak/Calf Canyon Fires and formally begins the claims process. Without immediate access to the Notice of Loss, Claimants will not have the full period of time available under the statute to submit their claim. Following the normal clearance procedures for approval, this information collection will delay FEMA’s ability to expeditiously consider and settle claims arising from injuries as a result of the Hermit’s Peak/Calf Canyon Fire. The victims of this Fire deserve compensation for their injuries and Congress has demanded immediate action to compensate them. It is vital that FEMA implement the information collection as soon as possible to support immediate needs in response to the Hermit’s Peak/Calf Canyon Fire. In accordance with the Paperwork Reduction Act (PRA) and the Office of Management and Budget’s (OMB) implementing regulations at 5 C.F.R. § 1320.13: (1) this information is necessary to the mission of the agency, (2) this information is necessary prior to the expiration of time periods established under PRA, (3) public harm is reasonably likely to result if normal clearance procedures are followed, and (4) an unanticipated event has occurred.
Authorizing Statute(s):
PL:
Pub.L. 117 - 180 136-2114
Name of Law: Hemits Peak/Calf Canyon Fire Assistance Act
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
15
IC Title
Form No.
Form Name
Banking Information - Individuals and Households
FEMA Form FF-104-FY-22-251, FEMA Form FF-104-FY-22-251-A
Banking Information
,
Banking Information (Spanish)
Banking Information - Private Sector
FEMA Form FF-104-FY-22-251, FEMA Form FF-104-FY-22-251-A
Banking Information
,
Banking Information (Spanish)
Banking Information - State, Local & Tribal Governement
FEMA Form FF-104-FY-22-251, FEMA Form FF-104-FY-22-251-A
Banking Information
,
Banking Information (Spanish)
Notice of Loss - Individuals and Households
FEMA Form FF-104-FY-22-230-A, FEMA Form FF-104-FY-22-230
Notice of Loss
,
Notice of Loss (Spanish)
Notice of Loss - Private Sector
FEMA Form FF-104-FY-22-230-A, FEMA Form FF-104-FY-22-230
Notice of Loss
,
Notice of Loss (Spanish)
Notice of Loss - State, Local, and Tribal Governments
FEMA Form FF-104-FY-22-230-A, FEMA Form FF-104-FY-22-230
Notice of Loss
,
Notice of Loss (Spanish)
Partial Payment Release and Certification Form (Entity) - Private Sector
FEMA Form FF-104-FY-22-253, FEMA Form FF-104-FY-22-253-A
Partial Payment Release and Certification Form (Entity)
,
Partial Payment Release and Certification Form (Entity) (Spanish)
Partial Payment Release and Certification Form (Entity) - State, Local and Tribal Governments
FEMA Form FF-104-FY-22-253, FEMA Form FF-104-FY-22-253-A
Partial Payment Release and Certification Form (Entity)
,
Partial Payment Release and Certification Form (Entity) (Spanish)
Partial Payment Release and Certification Form - Individuals and Households
FEMA Form FF-104-FY-22-252, FEMA Form FF-104-FY-22-252-A
Partial Payment Release and Certification Form
,
Partial Payment Release and Certification Form (Spanish)
Proof of Loss - Individuals and Households
FEMA Form FF-104-FY-22-231-A, FEMA Form FF-104-FY-22-231
Proof of Loss
,
Proof of Loss (Spanish)
Proof of Loss - Private Sector
FEMA Form FF-104-FY-22-231-A, FEMA Form FF-104-FY-22-231
Proof of Loss
,
Proof of Loss (Spanish)
Proof of Loss - State, Local, and Tribal Governments
FEMA Form FF-204-FY-22-231-A, FEMA Form FF-204-FY-22-231
Proof of Loss
,
Proof of Loss (Spanish)
Request to Supplement Claim - Individuals and Households
FEMA Form FF-104-FY-22-254-A, FEMA Form FF-104-FY-22-254
Request to Supplement Claim
,
Request to Supplement Claim (Spanish)
Request to Supplement Claim - Private Sector
FEMA Form FF-104-FY-22-254, FEMA Form FF-104-FY-22-254-A
Request to Supplement Claim
,
Request to Supplement Claim (Spanish)
Request to Supplement Claim - State, Local and Tribal Governments
FEMA Form FF-104-FY-22-254, FEMA Form FF-104-FY-22-254-A
Requeset to Supplement Claim
,
Request to Supplement Claim (Spanish)
ICR Summary of Burden
Total Approved
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
143,625
57,450
0
86,175
0
0
Annual Time Burden (Hours)
689,401
667,857
0
21,544
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
Yes
Burden Increase Due to:
Miscellaneous Actions
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
This is a new information collection. Therefore, no historical data is available and all of the estimates in this information collection are new
Annual Cost to Federal Government:
$65,103,002
Does this IC contain surveys, censuses, or employ statistical methods?
No
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.
Yes
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.
Yes
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
No
Agency Contact:
Krista Robinson 202 394-6377 krista.robinson@fema.dhs.gov
Common Form ICR:
No
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:
02/15/2023
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