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⚠️ Notice: This information collection may be referencing outdated material.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) Form 519-0-41 Assessment Survey-Electronic v2.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: Modified

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)	Form 519-0-41 Assessment Survey-Electronic v2.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: 4,032	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	4,032	960	3,072
Annual IC Time Burden (Hours)	806	139	667
Annual IC Cost Burden (Dollars)	0	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.