Information Collection

Application for Reimbursement to Local Governments for Emergency 123.

IC 23854 under ICR 199801-2050-002 · OMB 2050-0077.

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Documents and Forms

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Information Collection (IC) Details

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IC Title:	Application for Reimbursement to Local Governments for Emergency 123.	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1425.04				Yes	Yes

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 36	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 1 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	36	-75	21	90
Annual IC Time Burden (Hours)	324	-2,052	576	1,800
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.