Assessment Survey (Electronic)

Federal Emergency Management Agency Individual Assistance Customer Satisfaction Surveys

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1660-0143 can be found here:

Documents and Forms

Document Name Document Type
Form FEMA Form 519-0-41 Assessment Survey (Electronic) Form and Instruction
FEMA Form 519-0-41 Assessment Survey (Electronic) IA Assessment Survey Electronic Draft 8-10.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Assessment Survey (Electronic)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 44 CFR 206.101

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	FEMA Form 519-0-41	Assessment Survey (Electronic)	IA Assessment Survey Electronic Draft 8-10.docx		Yes	Yes	Fillable Fileable

Line of Business: Disaster Management

Subfunction: Disaster Preparedness and Planning

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,072	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,072	3,072
Annual IC Time Burden (Hours)	667	667
Annual IC Cost Burden (Dollars)	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.