Information Collection

Summary Sheet For Assurances and Certifications

IC 182640 under ICR 201309-1660-003 · OMB 1660-0025.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

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.