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pdfPAPERWORK REDUCTION ACT
CHANGE WORKSHEET
Agency/subagency
OMB Control Number
Department of Homeland Security/FEMA
0125
1660
___ ___
___ ___ - ___
___ ___ ___
Enter only items that change
Current record
Agency form number (s)
There is no current record.
FEMA Forms: 089-0-27
089-16 Dynamic 508 Compliant
089-20
New record
See attached PRA Revision Form for
new added statement which does not
fit in this box
Annual reporting and recordkeeping hour
burden
Number of respondents
39
Total annual responses
39
Percent of these responses
collected electronically
%
100
Total annual hours
No Change
Difference
0
Explanation of difference
NA
Program change
Adjustment
Annual reporting and recordkeeping cost
burden (in thousands of dollars)
%
Added new "Branding Statement"
Total annualized Capital/Startup costs
No Change
Total annual costs (O&M)
No Change
Total annualized cost requested
No change
Difference
0
Explanation of difference
0
Program change
Adjustment
0
Other changes**
The added statement for this revision for the top of each page does not fit into the Record box. I attached it in the PRA
Revision Forms as the new added "safeguard branding statement". for Customs Border Patrol forms.
Signature of Senior Official or designee:
BRIAN J
COPELAN
Brian Copeland, Branch Chief PDSB
D
** This form cannot be used to extend an expiration date.
OMB 83-C
Digitally signed by BRIAN J
COPELAND
DN: c=US, o=U.S. Government,
ou=Department of Homeland
Security, ou=FEMA, ou=People,
cn=BRIAN J COPELAND,
0.9.2342.19200300.100.1.1=0547
677221.FEMA
Date: 2017.07.05 12:04:12 -04'00'
Date:
07/05/2017
For OIRA Use
___________________________________
___________________________________
10/95
| File Type | application/pdf |
| File Title | Paperwork Reduction Act Submission (OMB 83-I) |
| Subject | Paperwork Reduction Act Submission (OMB 83-I) |
| Author | OMB |
| File Modified | 2017-07-05 |
| File Created | 1999-03-02 |