Information Collection

Promissory Note

IC 188996 under ICR 201202-1660-002 · OMB 1660-0083.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1660-0083 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FEMA Form 116-0-1 Promissory Note	Form
FEMA Form 116-0-1 Promissory Note FEMA Form 116-0-1, 5-15-2012.pdf	Form

IC Title:

Promissory Note

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 206

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	FEMA Form 116-0-1	Promissory Note	FEMA Form 116-0-1, 5-15-2012.pdf		Yes	No	Fillable Printable

Line of Business: Disaster Management

Subfunction: Disaster Preparedness and Planning

Privacy Act System of Records

Title: DHS/FEMA-004 Grant Management Information Files System of Records

FR Citation: 74 FR 39705

Number of Respondents: 50

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	200	200
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.