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PublicDamages+OtherCostsSurvey_2.1.21
ICR 202102-0710-001 · OMB 0710-0017 · Object 108321601.
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| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
|---|---|
| File Title | PublicDamages+OtherCostsSurvey_2.1.21 |
| Author | Schuff, Nicholas A CTR WHS ESD |
| Last Modified By | Writer |
| File Modified | 2021-02-01 |
| File Created | 2026-08-24 |
| Conversion State | complete |
Extracted Text
OMB CONTROL NUMBER: 0710-0017 OMB EXPIRATION DATE: XX/XX/XXXX AGENCY DISCLOSURE NOTICE The public reporting burden for this collection of information, 0710-0017, is estimated to average 20 minutes per survey, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services, at [email protected]. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. PUBLIC DAMAGES AND OTHER COSTS 1. Name of Governmental Entity: _______________________________ 2. Agency: ______________________________________ 3. Phone Number: ______________________________________ 4. Dates of Flooding/ Coastal Storm: ______________________________________ 5. Source(s) of Flooding: ______________________________________ 6. In the table below list the damages that occurred to public property in your jurisdiction as a result of the (date) flood. Type of Property $ Damage Primary Cause of Damage (inundation, wave, erosion, etc.) Buildings $____________ Equipment $____________ Vehicles $____________ Supplies $____________ Streets, highways, roads $____________ Water supply system plant and equipment distribution system $____________ Sewage system plant and equipment distribution system $____________ Drainage system $____________ Bridges $____________ Docks $____________ Marinas $____________ Boardwalks $____________ Parks $____________ Other $____________ 7. Please list any other public cost that resulted from the flooding in your jurisdiction. Type of Costs $ Costs Volunteer (unpaid hours) Emergency operations and floodfighting $________________________ ________ Hours Police protection $________________________ ________ Hours Additional costs of water supply $________________________ ________ Hours Additional costs of sewage treatment $________________________ ________ Hours Additional costs of flood cleanup $________________________ ________ Hours Additional costs of trash collection and disposal $________________________ ________ Hours Replacement of business records $________________________ ________ Hours Repairs to levee, sand dunes, or other flood or coastal protection $________________________ ________ Hours Cleanup of hazard waste $________________________ ________ Hours Other costs $________________________ ________ Hours Total $________________________ ________ Hours 8. Please describe any harmful public health and other environmental effects that flooding may have caused by inundation of landfills, sewage treatment plants, or other hazardous waste sites. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ If you had a damaged sewage treatment facility in the most recent flood, please answer questions 9-13. (If not, skip to question 14.) 9. What is the capacity of the damage facility in gallons per day? _______________ Gallons per Day 10. What is the estimated replacement cost of the plant? $_________________ 11. How high did the water get above the lowest ground elevation of the plant? _____________ FEET 12. What was the repair cost to the plant? $_______________ 13. How many days was the plant not operating because of the flood damage? ________________ DAYS If you had a damaged WATER treatment facility in the most recent flood, please answer questions 9-13. (If not, the survey is complete.) 14. What is the capacity of the damage facility in gallons per day? _______________ Gallons per Day 15. What is the estimated replacement cost of the plant? $_________________ 16. How high did the water get above the lowest ground elevation of the plant? _____________ FEET 17. What was the repair cost to the plant? $_______________ 18. How many days was the plant not operating because of the flood damage? ________________ DAYS