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OMB Control No: 1660-0160	ICR Reference No: 202303-1660-003
Status: Active	Previous ICR Reference No:
Agency/Subagency: DHS/FEMA	Agency Tracking No: 1660-NW153
Title: State, Tribe, and Territory Disaster Case Management Federal Award
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 02/06/2024
	Date Received in OIRA: 06/06/2023
Terms of Clearance: Agency uploaded a new version of the form.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2027	36 Months From Approved
Responses	209	0	0
Time Burden (Hours)	577	0	0
Cost Burden (Dollars)	0	0	0

Abstract: This collection tool will primarily be used as a guide to support state, tribal, and territorial governments (STTs) when applying, requesting a modification, or appealing a FEMA determination for Disaster Case Management Federal funding to supplement and expand their existing capacity. In extraordinary circumstances, the STT may request that FEMA provide an opportunity for a local government agency or qualified private organization to apply for the DCM Federal Award directly. Once awarded, the STT will utilize the monthly reporting form to report aggregate data about the performance of their program. All information collected within these forms will be submitted to FEMA by the STT. When applying for the STT DCM Federal award, the STT will respond to the questions within the application form, developing an overall assessment that details activities that have occurred since the start of the disaster; what resources and capabilities are currently available or anticipated to be available; and the estimated population to be served. The STT will also outline the implementation of their program by detailing their service delivery and work plans. If the STT is awarded a STT DCM Federal award, the STT may need to modify their initial award. In doing so, the STT will utilize the Request for Modification collection instrument to answer questions that will assist them in justifying the need to request additional time or funding to further support their program implementation. If the STT chooses to appeal a FEMA determination, the STT will outline the purpose for their submission and provide new, justifying information that was not included in their initial or modification request by using the Request to Appeal collection instrument. For each of the three forms mentioned above, the STT may also need to request initial or supplemental funding by using the Budget Workbook. This collection instrument enables the STT to outline line items that are necessary to implement the program, including personnel, travel, supplies, and contractual items among others. The STT can use this workbook to detail the request at all levels in program implementation so that it can calculate the total amount of funding needed. Once awarded, the STT will report aggregate data on all aspects of program implementation, including staffing, caseloads, survivor/client needs, and the types of referrals being made, as well as challenges faced during the month and best practices/lessons learned. This information assists FEMA in confirming the effectiveness of the program, providing technical assistance to ensure all survivors are able to receive DCM services, and to continuously evolve programmatic implementation through the collection of best practices/lessons learned

Authorizing Statute(s): PL: Pub.L. 93 - 288 426 Name of Law: Robert T. Stafford Disaster Relief and Emergency 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
60-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 57214	09/19/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 23449	04/17/2023
Did the Agency receive public comments on this ICR? Yes

Number of Information Collection (IC) in this ICR: 5

IC Title	Form No.	Form Name
DCM Federal Award Application	FEMA Form FF-104-FY-22-204
DCM Federal Award Budget Workbook	FEMA Form FF-104-FY-22-209
DCM Federal Award Modification Request	FEMA Form FF-104-FY-22-206
DCM Federal Award Monthly Report	FEMA Form FF-104-FY-22-208
DCM Federal Award Request for Appeal	FEMA Form FF-104-FY-22-207

ICR Summary of Burden

	Total Approved	Change Due to Agency Discretion
Annual Number of Responses	209	209
Annual Time Burden (Hours)	577	577
Annual Cost Burden (Dollars)	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 collection.

Annual Cost to Federal Government: $132,946

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

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