OMB 83-C Form

PAPERWORK REDUCTION ACT

CHANGE WORKSHEET

OMB Control Number

Agency/subagency
Department of Homeland Security/FEMA

.0002
1660
- ­- ­ - - ­
Enter only items that change
Current record

Agency form number (s)

-

New record
FEMA
FEMA
FEMA
FEMA

FEMA Form 009-0-1 (primary)
FEMA Form 009-0-2 (primary)

Form
Form
Form
Form

009-0-H (English)
009-0-1Int (English)
009-0-2T (Spanish)
009-0-2Int (Spanish)
-

Annual reporting and recordkeeping hour
burden

I

Number of respondents
Total annual responses
Percent of these responses
collected electronically

%

%

Total annual hours
Difference
Explanation of difference
Program change
Adjustment
Annual reporting and record keeping cost
burden (in thousands of dollars)
Total annualized Capital/Startup costs
Total annual costs (O&M)
Total annualized cost requested

I

Difference
Explanation of difference
Program change
Adjustment

I

Other changes**
FEMA is requesting additional vers ions of form numbers for FEMA Forms 009-0-1 and 009-0-2 . The intent is to make
inclusions to the primary form numbers in the current record. adding the additional four form numbers . These changes do not
c~~ burden or the scope of the collection .
,5lgn ture

L(o,

Official O~Signee:

~
, l ankS' O;re

-

or, Records Management O;v;s;on

** ThiS form cannot be used to extend an expiration date.
OMB S3-C

Date:

ForOIRA Use

/IFI le}o/ /
10/95