Survivor Sheltering Assessment

Forms and Documents

Document Name	Status
Form FEMA Form 009-0-42 Survivor Sheltering Assessment Form and Instruction	New
Emergency Justification Memo_PA NCS COVID19 082620-final.pdf Supplementary Document	2020-09-04
LAD_SSAT User Guide 20170901.pdf Supplementary Document	2017-09-01
1660-0142 Supporting Statement A Emergency.docx Supporting Statement A	2020-09-03
Privacy Notice SSAT.doc Supplementary Document	2017-08-31
DHS-SORN-2013-0029-0001.pdf Supplementary Document	2017-08-30
privacy_PIA_fema_daip_012a_2012.pdf Supplementary Document	2017-08-30
privacy_PIA_fema_027_2012.pdf Supplementary Document	2017-08-30
42 USC 5174.pdf Supplementary Document	2017-08-30
44 CFR Part 206.110.pdf Supplementary Document	2017-08-30
Stafford Act Booklet 042213.pdf Supplementary Document	2017-08-30

IC Document Collections

IC ID	Document Title	Status
243459	Survivor Sheltering Assessment Form and Instruction	New
228136	Survivor Sheltering Assessment Tool Other-Survivor Sheltering Assessment Tool (App)	Unchanged

ICR Details

OMB Control No: 1660-0142	ICR Reference No: 202009-1660-001
Status: Active	Previous ICR Reference No: 201802-1660-010
Agency/Subagency: DHS/FEMA	Agency Tracking No:
Title: Survivor Sheltering Assessment
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 09/05/2020
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/08/2020
	Date Received in OIRA: 09/04/2020
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2021	6 Months From Approved	05/31/2022
Responses	51,200	0	31,200
Time Burden (Hours)	8,535	0	5,201
Cost Burden (Dollars)	0	0	0

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Abstract: This collection is used to collect information from survivors in shelters regarding the pre-disaster housing situation and post disaster housing plans. The information will be used by FEMA to understand the scope of the FEMA requirement to provide housing and rental assistance to those displaced by natural and manmade disaster. This will ensure that FEMA delivers housing and rental services without duplicating the benefits other Agencies are responsible for providing based on survivor’s pre-disaster housing situation. Aggregated reports will be used by staff in the Joint Field Office to plan and execute shelter depopulation strategies. Individual survivor information collected with this assessment will be used solely for the planning and delivery of FEMA services.

Emergency Justfication: FEMA is implementing an alternate method to support immediate needs for Survivor Sheltering Assessment in Support of FEMA Public Assistance Non-Congregate Sheltering Data Sharing during the COVID-19 Public Health Emergency (Interim) FP 104-009-18 to include an alternate process to be utilized by State, Tribal or Territorial (STT) governments to collect information from the Shelter Resident and provide that data to FEMA in response to the COVID-19 pandemic.

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Authorizing Statute(s): US Code: 42 USC 5174 Name of Law: Disaster Mitigation Act of 2000
   PL: Pub.L. 93 - 288 0000 Name of Law: Name of Law: Robert T. Stafford Disaster Relief and Emergency Assistance Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Survivor Sheltering Assessment Tool
Survivor Sheltering Assessment	FEMA Form 009-0-42AV	Survivor Sheltering Assessment Alternate Version

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	51,200	31,200	0	20,000	0	0
Annual Time Burden (Hours)	8,535	5,201	0	3,334	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: For the Survivor Sheltering Assessment collection, previously approved burden hours were estimated at 5,201 for the full collection. The burden hours are increased by 3,334 to add the alternative version for the COVID-19 sheltering data for a total of 8,535 hours.

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Annual Cost to Federal Government: $273,356

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Yes

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 09/04/2020

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