Public Assistance Program

Forms and Documents

Document Name	Status
Form FEMA Form 009-0-49 Request for Public Assistance Form	Unchanged
Form FEMA Template 104- FEMA Template 104-FY-21-100 Equitable COVID-19 Response and Recovery: Vaccine Administration Information Form and Instruction	New
Form 009-0-141 FAC-TRAX System Form	Unchanged
Form FEMA Form 009-0-91 Project Worksheet Photo Sheet Form	Unchanged
Form FEMA Form 009-0-91 Project Worksheet Maps and Sketches Sheet Form	Unchanged
Form FEMA Form 009-0-91 Project Worksheet Cost Estimate Continuation Sheet and Cost Overruns Form	Unchanged
Form FEMA Form 009-0-91 Project Work Sheet Damage Description and Scope of Work Form	Unchanged
Form FEMA Form 009-0-12 Force Account Equipment Summary Record Form	Unchanged
Form FEMA Form 009-0-12 Contract Work Summary Record Form	Unchanged
Form FEMA Form 009-0-12 Rented Equipment Summary Record Form	Unchanged
Form FEMA Form 009-0-12 Materials Summary Record Form	Unchanged
Form FEMA Form 009-0-12 Force Account Labor Summary Form	Unchanged
Form FEMA Form 009-0-12 PNP Facility Questionnaire Form	Unchanged
Form FEMA Form 009-0-12 Applicant's Benefits Calculation Worksheet Form	Unchanged
Form FEMA Form 009-0-12 Special Considerations Questions Form	Unchanged
Form FEMA Form 009-0-91 Project Worksheet Form and Instruction	Unchanged
Form FEMA Form 009-0-11 Progress Report Form and Instruction	Unchanged
1660-0017 - Signed OMB 83C - 2021 05 17.pdf Justification for No Material/Nonsubstantive Change	2021-06-08
1660-0017 - Emergency Justification Memo_PA-COVID19 Vaccine Report 04152021.pdf Supplementary Document	2021-04-16
1660-0017 Supporting Statement A - Emergency - 2021 04 08 clean.docx Supporting Statement A	2021-04-08
Equitable COVID-19 Response and Recovery Job Aid 3-15-21.pdf Supplementary Document	2021-03-30
stafford_act.pdf Supplementary Document	2016-09-02
CFR-2011-title44-vol1-part206.pdf Supplementary Document	2016-09-01

IC Document Collections

IC ID	Document Title	Status
41294	Request for Public Assistance Form	Unchanged
247457	FEMA Template 104-FY-21-100 Equitable COVID-19 Response and Recovery: Vaccine Administration Information Form and Instruction	New
223320	FAC-TRAX System Form	Unchanged
206469	Project Worksheet Photo Sheet Form	Unchanged
206468	Project Worksheet Maps and Sketches Sheet Form	Unchanged
206467	Project Worksheet Cost Estimate Continuation Sheet and Cost Overruns Form	Unchanged
206466	Project Work Sheet Damage Description and Scope of Work Form	Unchanged
191941	State Administrative Plan and Amendments	Unchanged
190424	Request for Arbitration and Recommendation from Hurricanes Katrina or Rita	Unchanged
190419	Request for Appeals and Recommendation	Unchanged
185911	Force Account Equipment Summary Record Form	Unchanged
185910	Contract Work Summary Record Form	Unchanged
185909	Rented Equipment Summary Record Form	Unchanged
185908	Materials Summary Record Form	Unchanged
185907	Force Account Labor Summary Form	Unchanged
185906	PNP Facility Questionnaire Form	Unchanged
185903	Applicant's Benefits Calculation Worksheet Form	Unchanged
185901	Special Considerations Questions Form	Unchanged
185900	Project Worksheet Form and Instruction	Unchanged
185897	Progress Report Form and Instruction	Unchanged

ICR Details

OMB Control No: 1660-0017	ICR Reference No: 202105-1660-001
Status: Received in OIRA	Previous ICR Reference No: 202103-1660-008
Agency/Subagency: DHS/FEMA	Agency Tracking No:
Title: Public Assistance Program
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 04/30/2021
Date Submitted to OIRA: 06/08/2021

	Requested	Previously Approved
Expiration Date	10/31/2021	10/31/2021
Responses	449,084	398,068
Time Burden (Hours)	491,533	466,025
Cost Burden (Dollars)	0	0

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Abstract: The Public Assistance Program assist State, Tribal and local governments and certain private Non-Profit entities with the responses to and recovery from disasters following a Presidentially declared major disasters and emergencies. The information collected is utilized by FEMA to make determinations for Public Assistance grants based on the information supplied by the respondents.

Emergency Justfication: The White House declared a nationwide emergency with Proclamation 9994 on March 13, 2020, and subsequent major disaster declarations, to provide federal assistance under the Robert T. Stafford Disaster Relief and Emergency Assistance Act, 42 U.S.C. §§5121–5207 for emergency protective measures to address the COVID-19 pandemic. The purpose of this revision to the information collection is to update the PA Program in support of FEMA Policy #104-21-0004: “Coronavirus (COVID-19) Pandemic: Medical Care Eligible for PA (Interim) (Version 2).” This interim policy defines the framework and requirements for determining the eligibility of medical care work and costs under the PA Program to ensure consistent and appropriate implementation across all COVID-19 emergency and major disaster declarations. There is no substantive change to the information collected for eligible medical care; however, in support of the Executive Order (EO) 13995 on Ensuring an Equitable Pandemic Response and Recovery dated January 21, 2021, additional information collection is necessary.

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Authorizing Statute(s): PL: Pub.L. 93 - 288 406-407 Name of Law: Robert T. Stafford Disaster Relief and Emergency Assistance Act
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 5 601 Name of Law: American Recovery and Reinvestment Act of 2009

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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: 20

IC Title	Form No.	Form Name
Applicant's Benefits Calculation Worksheet	FEMA Form 009-0-128	Applicant's Benefits Calculation Worksheet
Contract Work Summary Record	FEMA Form 009-0-126	Contract Work Summary Record
FAC-TRAX System	009-0-141	FAC-TRAX System
FEMA Template 104-FY-21-100 Equitable COVID-19 Response and Recovery: Vaccine Administration Information	FEMA Template 104-FY-21-100	Equitable Vaccine Administration Information Submission
Force Account Equipment Summary Record	FEMA Form 009-0-127	Force Account Equipment Summary Record
Force Account Labor Summary	FEMA Form 009-0-123	Force Account Labor Summary Record
Materials Summary Record	FEMA Form 009-0-124	Materials Summary Record
PNP Facility Questionnaire	FEMA Form 009-0-121	PNP Facility Questionaire
Progress Report	FEMA Form 009-0-111	Quarterly Progress Report
Project Work Sheet Damage Description and Scope of Work	FEMA Form 009-0-91A	Project Worksheet - Damage Description and Scope of Work Continuation Sheet
Project Worksheet	FEMA Form 009-0-91	Project Worksheet
Project Worksheet Cost Estimate Continuation Sheet and Cost Overruns	FEMA Form 009-0-91B	Project Worksheet-Cost Estimate Continuation Sheet
Project Worksheet Maps and Sketches Sheet	FEMA Form 009-0-91C	Project Worksheet - Maps and Sketches Sheet
Project Worksheet Photo Sheet	FEMA Form 009-0-91D	Project Worksheet-Photo Sheet
Rented Equipment Summary Record	FEMA Form 009-0-125	Rented Equipment Summary Record
Request for Appeals and Recommendation
Request for Arbitration and Recommendation from Hurricanes Katrina or Rita
Request for Public Assistance	FEMA Form 009-0-49	Request for Public Assistance
Special Considerations Questions	FEMA Form 009-0-120	Special Consideration Questions
State Administrative Plan and Amendments

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ICR Summary of Burden

	Total Request	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	449,084	398,068	0	51,016	0	0
Annual Time Burden (Hours)	491,533	466,025	0	25,508	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: The burden increase is due to an instrument that was part of the recent Emergency Request, but was inadvertently left out of the ROCIS file. The instrument was referred to as "Equitable Vaccine Administration Information / No Form" during the Emergency Request because it was still being developed. The instrument is now final and referred to as "FEMA Template 104-FY-21-100 Equitable Vaccine Administration Information Submission." Once again, this instrument was part of the recent Emergency Request approved by OMB, but this instrument was inadvertently left out of the ROCIS IC list.

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Annual Cost to Federal Government: $1,891,473

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: 06/08/2021

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