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⚠️ Notice: This information collection may be referencing outdated material.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 FEMA Forms 112-0-3, 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	FEMA Forms 112-0-3, A,B,C.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: 56	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	3,573	-25,502	29,075
Annual IC Time Burden (Hours)	6,074	-43,354	49,428
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.