Public Assistance Program

Forms and Documents

Document Name	Status
Form FEMA Form 009-0-49 Request for Public Assistance Form	Modified
Form 009-0-141 FAC-TRAX System Form	New
Form FEMA Form 009-0-91 Project Worksheet Photo Sheet Form	Modified
Form FEMA Form 009-0-91 Project Worksheet Maps and Sketches Sheet Form	Modified
Form FEMA Form 009-0-91 Project Worksheet Cost Estimate Continuation Sheet and Cost Overruns Form	Modified
Form FEMA Form 009-0-91 Project Work Sheet Damage Description and Scope of Work Form	Modified
Form FEMA Form 009-0-12 Force Account Equipment Summary Record Form	Modified
Form FEMA Form 009-0-12 Contract Work Summary Record Form	Modified
Form FEMA Form 009-0-12 Rented Equipment Summary Record Form	Modified
Form FEMA Form 009-0-12 Materials Summary Record Form	Modified
Form FEMA Form 009-0-12 Force Account Labor Summary Form	Modified
Form FEMA Form 009-0-12 PNP Facility Questionnaire Form	Modified
Form FEMA Form 009-0-12 Applicant's Benefits Calculation Worksheet Form	Modified
Form FEMA Form 009-0-12 Special Considerations Questions Form	Modified
Form FEMA Form 009-0-91 Project Worksheet Form and Instruction	Modified
Form FEMA Form 009-0-11 Progress Report Form and Instruction	Modified
SORN - DHS-FEMA-009.docx Supplementary Document	2016-09-13
SORN - DHS-FEMA-004.docx Supplementary Document	2016-09-13
PIA DHS-FEMA-PIA-025.pdf Supplementary Document	2016-09-13
SORN - DHS-ALL-004.docx Supplementary Document	2016-09-13
PIA - DHS-FEMA-PIA-013.pdf Supplementary Document	2016-09-13
stafford_act.pdf Supplementary Document	2016-09-02
CFR-2011-title44-vol1-part206.pdf Supplementary Document	2016-09-01
Published 30 Day FRN for OMB Collection 1660-0017, 8-4-2016.pdf Supplementary Document	2016-09-01
60 Day FRN 1660-0017.pdf Supplementary Document	2016-09-01
1660-0017_Supporting Statement Part A RMD.docx Supporting Statement A	2016-09-14

IC Document Collections

IC ID	Document Title	Status
41294	Request for Public Assistance Form	Modified
223320	FAC-TRAX System Form	New
207702	Request for Abritration	Modified
206469	Project Worksheet Photo Sheet Form	Modified
206468	Project Worksheet Maps and Sketches Sheet Form	Modified
206467	Project Worksheet Cost Estimate Continuation Sheet and Cost Overruns Form	Modified
206466	Project Work Sheet Damage Description and Scope of Work Form	Modified
191941	State Administrative Plan and Amendments	Unchanged
190424	Request for Arbitration and Recommendation from Hurricanes Katrina or Rita	Unchanged
190419	Request for Appeals and Recommendation	Unchanged
185911	Force Account Equipment Summary Record Form	Modified
185910	Contract Work Summary Record Form	Modified
185909	Rented Equipment Summary Record Form	Modified
185908	Materials Summary Record Form	Modified
185907	Force Account Labor Summary Form	Modified
185906	PNP Facility Questionnaire Form	Modified
185903	Applicant's Benefits Calculation Worksheet Form	Modified
185901	Special Considerations Questions Form	Modified
185900	Project Worksheet Form and Instruction	Modified
185897	Progress Report Form and Instruction	Modified

ICR Details

OMB Control No: 1660-0017	ICR Reference No: 201607-1660-002
Status: Historical Active	Previous ICR Reference No: 201402-1660-005
Agency/Subagency: DHS/FEMA	Agency Tracking No:
Title: Public Assistance Program
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/29/2016
	Date Received in OIRA: 09/23/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2019	36 Months From Approved
Responses	398,088	0	0
Time Burden (Hours)	425,736	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Public Assistance Program assist State, Tribal and local governments and certain private Non-Profit entities with the responses to and recovery from disasters following a Presidentially declared major disasters and emergencies. The information collected is utilized by FEMA to make determinations for Public Assistance grants based on the information supplied by the respondents.

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Authorizing Statute(s): PL: Pub.L. 93 - 288 406-407 Name of Law: Robert T. Stafford Disaster Relief and Emergency Assistance Act
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 5 601 Name of Law: American Recovery and Reinvestment Act of 2009

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 30324	05/16/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 51461	08/04/2016
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 20

IC Title	Form No.	Form Name
Project Work Sheet Damage Description and Scope of Work	FEMA Form 009-0-91A	Project Worksheet - Damage Description and Scope of Work Continuation Sheet
Project Worksheet Maps and Sketches Sheet	FEMA Form 009-0-91C	Project Worksheet - Maps and Sketches Sheet
State Administrative Plan and Amendments
Request for Arbitration and Recommendation from Hurricanes Katrina or Rita
Project Worksheet	FEMA Form 009-0-91	Project Worksheet
Force Account Equipment Summary Record	FEMA Form 009-0-127	Force Account Equipment Summary Record
Rented Equipment Summary Record	FEMA Form 009-0-125	Rented Equipment Summary Record
Progress Report	FEMA Form 009-0-111	Quarterly Progress Report
PNP Facility Questionnaire	FEMA Form 009-0-121	PNP Facility Questionaire
Materials Summary Record	FEMA Form 009-0-124	Materials Summary Record
Contract Work Summary Record	FEMA Form 009-0-126	Contract Work Summary Record
Request for Public Assistance	FEMA Form 009-0-49	Request for Public Assistance
Special Considerations Questions	FEMA Form 009-0-120	Special Consideration Questions
Force Account Labor Summary	FEMA Form 009-0-123	Force Account Labor Summary Record
Applicant's Benefits Calculation Worksheet	FEMA Form 009-0-128	Applicant's Benefits Calculation Worksheet
Project Worksheet Photo Sheet	FEMA Form 009-0-91D	Project Worksheet-Photo Sheet
Project Worksheet Cost Estimate Continuation Sheet and Cost Overruns	FEMA Form 009-0-91B	Project Worksheet-Cost Estimate Continuation Sheet
Request for Appeals and Recommendation
Request for Abritration	FEMA Form 055-0-0-1
FAC-TRAX System	009-0-141	FAC-TRAX System

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	398,088	0	0	51,128	0	346,960
Annual Time Burden (Hours)	425,736	0	0	63,910	0	361,826
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: There is a significant increase in the estimated burden hours (63910) and burden cost ($3,467,117) as a result of the inclusion of FEMA Form 009-0-141 FAC-TRAX System. This system can be used in place of FF-009-0-49 Request for Public Assistance and FF 009-0-91A Project Worksheet (PW) - Damage Description and Scope of Work Continuation Sheet. FAC-TRAX collects the same data in a web app format, and will allow Applicants additional flexibility not provided through the use of standard forms.

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Annual Cost to Federal Government: $775,429

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 09/23/2016

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