Information Collection

Declaration and Release

IC 178884 under ICR 201111-1660-002 · OMB 1660-0002.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1660-0002 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 009-0-3 Declaration and Release	Form
009-0-3 Declaration and Release Form FEMA Form 009-0-3, English (Formerly FF 90-69B) 1-9-12.pdf	Form
009-0-4 Declaration and Release (Spanish) FEMA Form 009-0-4, Spanish (Formerly FF 90-69C) 1-9-12.pdf	Form

IC Title:

Declaration and Release

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 206 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	009-0-3	Declaration and Release Form	FEMA Form 009-0-3, English (Formerly FF 90-69B) 1-9-12.pdf		No		Paper Only
Form	009-0-4	Declaration and Release (Spanish)	FEMA Form 009-0-4, Spanish (Formerly FF 90-69C) 1-9-12.pdf		No		Paper Only

Line of Business: Disaster Management

Subfunction: Emergency Response

Privacy Act System of Records

Title: Disaster Recovery Assistance Files System of Records

FR Citation: 74 FR 48763

Number of Respondents: 1,099,706

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1,099,706	1,099,706
Annual IC Time Burden (Hours)	36,657	36,657
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.