Information Collection

Applicant's Benefits Calculation Worksheet

IC 185903 under ICR 201902-1660-001 · OMB 1660-0017.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1660-0017 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FEMA Form 009-0-12 Applicant's Benefits Calculation Worksheet	Form
FEMA Form 009-0-12 Applicant's Benefits Calculation Worksheet FEMA Form 009-0-128.pdf portal.fema.gov	Form

IC Title:

Applicant's Benefits Calculation Worksheet

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 44 CFR 206

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	FEMA Form 009-0-128	Applicant's Benefits Calculation Worksheet	FEMA Form 009-0-128.pdf	https://portal.fema.gov	Yes	Yes	Fillable Printable

Line of Business: Disaster Management

Subfunction: Disaster Repair and Restore

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 56

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	Previously Approved
Annual Number of Responses for this IC	43,904	43,904
Annual IC Time Burden (Hours)	21,952	21,952
Annual IC Cost Burden (Dollars)	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.