Information Collection

Crisis Counseling Assistance and Training Program, Immediate Services Program Application

IC 21184 under ICR 201406-1660-001 · OMB 1660-0085.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1660-0085 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FEMA Form 00-3-0-1 Crisis Counseling Assistance and Training Program, Immediate Services Program Application	Form
FEMA Form 00-3-0-1 Application for Counseling Program Service (Immediate Se FEMA Form 003-0-1, 6-30-14.pdf media.samhsa.gov/DTAC-CCPToolkit/applying.htm	Form

IC Title:

Crisis Counseling Assistance and Training Program, Immediate Services Program Application

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 206.171

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 00-3-0-1	Application for Counseling Program Service (Immediate Services Program)	FEMA Form 003-0-1, 6-30-14.pdf	http://media.samhsa.gov/DTAC-CCPToolkit/applying.htm	Yes	No	Fillable Printable

Line of Business: Disaster Management

Subfunction: Disaster Preparedness and Planning

Privacy Act System of Records

Title: DHS/FEMA-009 â Hazard Mitigation Assistance Grant Programs

FR Citation: 77 FR 17783

Number of Respondents: 15

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	15	0	15
Annual IC Time Burden (Hours)	120	-960	1,080
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.