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pdfPAPERWORK REDUCTION ACT
CHANGE WORKSHEET
Agency/subagency
OMB Control Number
Department of Homeland Security/FEMA
0002
1660
___ ___
___ ___ - ___
___ ___ ___
Enter only items that change
Current record
Agency form number (s)
New record
Privacy Act Statement screen (see
attachment)
Privacy Act Statement and Declaration
of Eligibility screen (see attachment)
Number of respondents
1,151,255
1,151,255
Total annual responses
1,151,255
1,151,255
FEMA Form: 009-0-1T
Annual reporting and recordkeeping hour
burden
Percent of these responses
collected electronically
100
Total annual hours
%
345,377
100
%
345,377
Difference
0
Explanation of difference
Program change
Adjustment
Annual reporting and recordkeeping cost
burden (in thousands of dollars)
Total annualized Capital/Startup costs
0
0
Total annual costs (O&M)
0
0
Total annualized cost requested
0
0
Difference
0
Explanation of difference
Program change
Adjustment
Other changes**
see attachment.
Signature of Senior Official or designee:
KENNETH W JACKSON
Digitally signed by KENNETH W JACKSON
DN: c=US, o=U.S. Government, ou=Department of Homeland Security, ou=FEMA,
ou=People, cn=KENNETH W JACKSON, 0.9.2342.19200300.100.1.1=0870602085.FEMA
Date: 2017.09.25 17:05:49 -04'00'
** This form cannot be used to extend an expiration date.
OMB 83-C
Date:
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 | 2017-09-25 |
| File Created | 1999-03-02 |