Information Collection

Governor's Request for Disaster Declaration

IC 35675 under ICR 202011-3245-001 · OMB 3245-0121.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
3245-0121 Economic Injury Worksheet Final Template 11-20-2020.pdf	Other-Economic Injury Worksheet
3245-0121 Economic Injury Worksheet Final Template 11-20-2020.pdf	Other-Economic Injury Worksheet

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 13 CFR 123.3

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
Other-Economic Injury Worksheet			3245-0121 Economic Injury Worksheet Final Template 11-20-2020.pdf		Yes	No	Paper Only

Line of Business: Disaster Management

Subfunction: Disaster Monitoring and Prediction

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: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	56	-5	61
Annual IC Time Burden (Hours)	1,200	-20	1,220
Annual IC Cost Burden (Dollars)	0	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.