FEMA-Administered Disaster Case Management (DCM)

Forms and Documents

Document Name	Status
Form FEMA Form FF-104-F FEMA-Administered DCM Consent Form Form	New
Form FEMA Form FF-104-F FEMA-Administered DCM Intake Form Form	New
1660-NW132 - Published 30-Day FRN 2021 11 17.pdf Supplementary Document	2021-11-17
60-Day FRN published.pdf Supplementary Document	2021-11-09
PTA, FEMA - FEMA IA Administered DCM Program, 20210405, PRIV final [amended].pdf Supplementary Document	2021-11-09
USCODE-2019-title42-chap68-subchapIV-sec5189d.pdf Supplementary Document	2021-11-09
1660-NW132 Supporting Statement A - 2021 11 17 clean.docx Supporting Statement A	2021-11-17

IC Document Collections

IC ID	Document Title	Status
250278	FEMA-Administered DCM Consent Form Form	New
250277	FEMA-Administered DCM Intake Form Form	New

ICR Details

OMB Control No:	ICR Reference No: 202111-1660-002
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: DHS/FEMA	Agency Tracking No: 1660-NW132
Title: FEMA-Administered Disaster Case Management (DCM)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 12/07/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	75,000	0
Time Burden (Hours)	48,000	0
Cost Burden (Dollars)	0	0

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Abstract: This collection tool will primarily be used as a guide to support FEMA-administered Disaster Case Management (DCM) case managers by outlining the allowable data elements they can collect from survivors on behalf of FEMA. While there will be a paper collection tool, the case managers will primarily be using the tool as a reference of data elements they can collect, and using their own case management database systems to guide the order in which the elements are collected. The elements within the tool are used to assess, screen, and refer disaster survivors to available resources that address their specific disaster-related unmet needs. Case managers then take the information from the intake form and manually upload the data into their secured case management database. Prior to any data collection, survivors will complete and sign a FEMA-administered DCM Consent Form, authorizing FEMA, or its agent, to collect data from the survivor in order to effectively provide case management services.

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Authorizing Statute(s): US Code: 42 USC 5189d Name of Law: Case Management Services
  

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
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 34266	06/29/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 64223	11/17/2021
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
FEMA-Administered DCM Consent Form	FEMA Form FF-104-FY-21-147	FEMA-Administered DCM Concent Form
FEMA-Administered DCM Intake Form	FEMA Form FF-104-FY-21-146	FEMA-Administered DCM Intake Form

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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	75,000	0	0	75,000	0	0
Annual Time Burden (Hours)	48,000	0	0	48,000	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: This is a new collection.

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Annual Cost to Federal Government: $51,640,374

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.     No

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? No

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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: 12/07/2021

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