Summary Sheet For Assurances and Certifications

FEMA Emergency Preparedness and Response Directorate Grants Administration Forms

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1660-0025 can be found here:

Documents and Forms

Document Name Document Type
Form FEMA Forms 112-0-3 Summary Sheet For Assurances and Certifications Form and Instruction
FEMA Forms 112-0-3 Summary Sheet for Assurances and Certification 112-0-3 A B C previously 20-16 A B C.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Summary Sheet For Assurances and Certifications	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 44 CFR Part 13 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	FEMA Forms 112-0-3 A, B, C	Summary Sheet for Assurances and Certification	112-0-3 A B C previously 20-16 A B C.pdf		Yes	No	Fillable Printable

Line of Business: Disaster Management

Subfunction: Disaster Preparedness and Planning

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 56	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	29,075	236	28,839
Annual IC Time Burden (Hours)	49,428	402	49,026
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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