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Application for Reimbursement to Local Governments for Emergency 123.
Application for Reimbursement to Local Governments for Emergency 123.
OMB: 2050-0077
IC ID: 23854
OMB.report
EPA/OLEM
OMB 2050-0077
ICR 199801-2050-002
IC 23854
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2050-0077 can be found here:
2023-09-07 - Reinstatement with change of a previously approved collection
2022-03-25 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
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
Federal Enterprise Architecture Business Reference Module
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 New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
36
0
-75
21
0
90
Annual IC Time Burden (Hours)
324
0
-2,052
576
0
1,800
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.