Information Collection

Application for Surplus Federal Real Property Public Benefit Conveyance and BRAC Program for Emergency Management Use

IC 21177 under ICR 201609-1660-002 · OMB 1660-0080.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1660-0080 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FEMA Form 119-0-1 Application for Surplus Federal Real Property Public Benefit Conveyance and BRAC Program for Emergency Management Use Application for Surplus Federal Real Property Public Benefit Conveyance and BRAC Program for Emergency Management Use	Form and Instruction
FEMA Form 119-0-1 Application for Surplus Federal Real Property Public Ben FEMA Form 119-0-1 Final 11-9-2016.pdf	Form and Instruction

IC Title:

Application for Surplus Federal Real Property Public Benefit Conveyance and BRAC Program for Emergency Management Use

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 41 CFR 102-75.750-815 (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 Form 119-0-1				Yes	Yes	Fillable Printable

Line of Business: Disaster Management

Subfunction: Disaster Preparedness and Planning

Privacy Act System of Records

Title: DHS/All-F002 Department of Homeland Security Mailing and Other Lists System of Records

FR Citation: 73 FR 71659

Number of Respondents: 20

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	20	-30	50
Annual IC Time Burden (Hours)	100	-100	200
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.

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