1660-0061 Emergency Supporting Statement A 2022 02 14 clean

February 14, 2022

Supporting Statement for

Paperwork Reduction Act Submissions

OMB Control Number: 1660 - 0061

Title: Federal Assistance to Individuals and Households Program

Form Number(s):

FEMA Form FF-104-FY-21-114 (formerly 010-0-11), Individuals and Households Program (IHP) - Other Needs Assistance Administrative Option Selection

Development of State/Tribal Administrative Plan (SAP) for Other Needs Provision of IHP

FEMA Form FF-104-FY-21-115 (English) (formerly 010-0-12), Individuals and Households Program Application for Continued Temporary Housing Assistance

FEMA Form FF-104-FY-21-115-A (Spanish) (formerly 010-0-12S), Programa de Individuos y Familias Solicitud Para Continuar La Asistencia de Vivienda Temporera

Request for Approval of Late Registration

Appeal of Program Decision

FEMA Form FF-104-FY-21-116 (English) (formerly 009-0-95), Request for Advance Disaster Assistance
FEMA Form FF-104-FY-21-116-A (Spanish) (formerly 009-0-95S), Solicitud de Adelanto de la Asistencia por Desastre

FEMA Form FF-104-FY-21-117 (English) (formerly 009-0-96), Request to Stop Payment and Reissue Disaster Assistance Check

FEMA Form FF-104-FY-21-117-A (Spanish) (formerly 009-0-96S), Solicitud para Detener el Pago y Reemitir el Cheque de Asistencia por Desastre

FEMA Form FF-104-FY-21-118 – (English) (formerly 140-003d-1S), Authorization for the Release of Information Under the Privacy Act

FEMA Form FF-104-FY-21-118-A – (Spanish) (formerly 140-003d-1S), Autorización para la Divulgación de Información bajo el Acta de Privacidad

General Instructions

A Supporting Statement, including the text of the notice to the public required by 5 CFR 1320.5(a)(1)(iv) and its actual or estimated date of publication in the Federal Register, must accompany each request for approval of a collection of information. The Supporting Statement must be prepared in the format described below, and must contain the information specified in Section A below. If an item is not applicable, provide a brief explanation. When Item 17 or the OMB Form 83-I is checked “Yes”, Section B of the Supporting Statement must be completed. OMB reserves the right to require the submission of additional information with respect to any request for approval.

Specific Instructions

A. Justification

1. Explain the circumstances that make the collection of information necessary.

Identify any legal or administrative requirements that necessitate the collection. Attach a copy of the appropriate section of each statute and regulation mandating or authorizing the collection of information. Provide a detailed description of the nature and source of the information to be collected.

The Robert T. Stafford Disaster Relief and Emergency Assistance Act (Stafford Act), Pub. L. 93-288, as amended, is the legal basis for the Federal Emergency Management Agency (FEMA) to provide financial assistance and services to individuals applying for disaster assistance benefits in the event of a federally declared disaster. Regulations in 44 CFR, § 206.110 - Federal Assistance to Individuals and Households (IHP) implements the policy and procedures set forth in Section 408 of the Stafford Act, 42 U.S.C. 5174, as amended. This program provides financial assistance and, if necessary, direct assistance to eligible individuals and households who, as a direct result of a major disaster or emergency, have uninsured or under-insured, necessary expenses and serious needs, and are unable to meet such expenses or needs through other means.

This revised Supporting Statement is being submitted to show the updates to the information collection, specifically for home repair, home replacement, and tools the disaster survivor is requesting assistance and the appropriate documentation required.

Second, this information collection provides for FEMA’s Home Replacement Assistance. FEMA may provide financial assistance to owners whose primary residences were destroyed as a result of a Presidentially-declared disaster. Home Replacement Assistance may be applied toward purchasing a new permanent residence even if the new residence’s cost is greater than the financial Housing Assistance maximum award. If FEMA determines the residence was not destroyed by the disaster, the applicant may appeal by submitting supporting documentation form governing authorities giving notice of condemnation, substantial damage, or demolition:

• FEMA will not automatically determine an applicant eligible for Home Replacement Assistance based on submitted documentation, because local authority determinations could be based on non-disaster-caused circumstances.

• After receiving appeal documentation from the applicant, FEMA will review the request to determine if another inspection is necessary in order to verify if the residence was destroyed due to disaster-caused damage.

Similarly, FEMA’s Home Repair Assistance seeks to support low income and other vulnerable disaster survivors who may not have the means to immediately address disaster damage by increasing the amount of assistance FEMA’s Home Repair Assistance provides for repairs. The IHP recently expanded this assistance to allow for disaster caused damage-related repair assistance for utilities such as wells, furnaces and septic systems where local ordinances require repair or construction of the same. FEMA may provide assistance or reimbursement for the average cost of a licensed technician’s professional assessment associated with the repair or replacement. FEMA will accept verifiable receipts or estimates submitted on appeal evidencing the actual cost on the receipt or total cost shown.

Third, this information collection provides the process for disaster survivors who must meet specific eligibility requirements for each category of item for which they are requesting Personal Property Assistance. For essential tools, FEMA assistance is based on a need to replace disaster-damaged essential tools, supplies, equipment, items required by an employer as a condition of employment or required for education. This includes disaster-damaged tools and equipment, or other items required for a specific trade or profession, not provided or supplied by the employer. Tools, uniforms, computers, supplies, or other items used for self-employment are not eligible for IHP assistance. Applicants may be asked to provide the following documentation for essential tools:

• A statement from the employer on company letterhead documenting the applicant is required to provide their own tools or computer as a condition of employment

• A statement on school letterhead documenting a computer is required as a condition of education and the school does not provide access to computers to use outside of class, such as a school computer lab.

• An itemized list of the tools required by the employer, also on company letterhead.

• An itemized receipt, estimate, or bill for repair or replacement of the disaster-damaged items.

• A written statement signed by the applicant verifying that the items were disaster-damaged and the following statement, “I hereby declare under penalty of perjury that the foregoing is true and correct.”

This information collection provides disaster survivors the opportunity to request approval of late applications, continued temporary housing assistance, request advance disaster assistance, stop payments not received in order to be reissued funds, and to appeal program decisions. This collection also allows for the establishment of an annual agreement between FEMA and states, territories, and tribal governments regarding how the Other Needs provision of IHP will be administered: by FEMA, by the state, territory, or tribal government, or jointly. If the information in this collection is not collected, a delay in assistance provided to disaster survivors would occur. For any declared disaster, unless FEMA is able to accept the increased documentation options, applicants who cannot satisfy the current and more limited documentation options will likely be denied assistance. In order for FEMA to provide disaster-related financial assistance and services to individuals under the Stafford Act, adhering to the standard PRA timeframe to accept verification documentation from applicants without expanding the range of acceptable documents would hinder FEMA’s ability to provide swift assistance to all applicable individuals and households. And as a result, expanding the documents that are now accepted will be a permanent fixture from this request.

2. Indicate how, by whom, and for what purpose the information is to be used. Except for a new collection, indicate the actual use the agency has made of the information received from the current collection. Provide a detailed description of: how the information will be shared, if applicable, and for what programmatic purpose.

The information collected is used to ensure disaster survivors are provided with eligible assistance for disaster related necessary expenses or serious needs that are unable to be met through other means in an efficient and timely manner.

FEMA Form 104-FY-21-114 (formerly 010-0-11) – States, territories, and tribal governments must submit an IHP ONA Administrative Option Selection form, which includes a Standard Personal Property List for the calendar year, to FEMA annually. This form establishes the state, territory, or tribal government’s proposed level of support and participation in the delivery of assistance under Section 408 of the Stafford Act. The FEMA Regional Director or designee and the state, territory, or tribal government use the agreement for planning purposes and to develop program implementation procedures to be used during the upcoming calendar year for programs under Section 408 of the Stafford Act. This agreement also includes the determination if an Administrative Plan is warranted.

Development of State/Tribal Administrative Plan for the Other Needs provision of IHP – When the state, territory, or tribal government’s request for a FEMA grant to provide financial assistance to individuals and households under the Other Needs provision of IHP is approved, the state, territory, or tribal government must provide an Administrative Plan to address the necessary level of managerial and resource support. This ensures FEMA can effectively monitor and account for program costs and ensure equitable and timely delivery of assistance.

FEMA Forms FF-104-FY-21-115 (English) (formerly 010-0-12) and FF-104-FY-21-115-A (Spanish) (formerly 010-0-12S) – After initial assistance is provided to an individual, FEMA may provide continued rental assistance based on need. Applicants requesting continued rental assistance are required to submit a signed Application for Continued Temporary Housing Assistance (English) or Solicitud para Continuar la Asistencia de Vivienda Temporera (Spanish) which includes gross income information, household expenses, and a plan for permanent housing. FEMA caseworkers review the submitted information in accordance with established program criteria and procedures to determine the individual’s eligibility for continued rental assistance.

Request for Approval of Late Registration – After the registration period for a declared disaster ends (60 days from date of declaration), FEMA will accept late registration requests for an additional 60 days. For FEMA to effectively review the late registration request, the individual’s request must explain the reason(s) for the registration delay and must be provided in writing to FEMA.

Appeal of Program Decision – After an initial eligibility decision is made, FEMA provides applicants with the opportunity to inquire or appeal any assistance eligibility determination. For FEMA to effectively respond to an applicant’s signed appeal, the applicant must indicate what determination is being appealed, the reason, and must submit the appeal in writing. A FEMA Appeals Officer reviews the information submitted in accordance with established program criteria and procedures to determine the validity of the appeal and if the applicant should be awarded further disaster assistance as a result of the appeal.

FEMA Forms FF-104-FY-21-116 (English) (formerly 009-0-95) and FF-104-FY-21-116-A (Spanish) (formerly 009-0-95S) – For an applicant with homeowners, renters, mobile home, or condominium insurance to be determined eligible for rental assistance, the applicant must provide FEMA with verifiable documentation confirming insurance does not cover Additional Living Expenses (ALE) for temporary housing costs, the full policy ALE coverage/amount has been exhausted, there is less than one month Fair Market Rent (FMR) coverage remaining, or ALE is denied for the applicable cause of damage. The Request for Advance Disaster Assistance (English) and Solicitud de Adelanto de la Asistencia por Desastre (Spanish) forms allow the applicant the option to request advanced rental assistance for insured disaster related expenses if the insurance company takes longer than 30 days to provide the verifiable documentation needed by FEMA.

FEMA Forms FF-104-FY-21-117 (English) (formerly 009-0-96) and FF-104-FY-21-117-A (Spanish) (formerly 009-0-96S) – When an applicant is determined eligible for IHP financial assistance but did not select the electronic funds transfer option to receive payment, the award check is sent via postal mail to the applicant’s mailing address. If the applicant contacts FEMA and indicates the award check has not been received more than 14 days after the check was issued, the applicant can complete the Request to Stop Payment and Reissue Disaster Assistance Check (English) or Solicitud para Detener el Pago y Reemiter el Cheque de Asistencia por Desastre (Spanish) form to request FEMA stop payment on the previous check issued, and to reissue the award to the applicant for the same amount. The form also allows the applicant to confirm the current mailing address to ensure the new award check is sent to the correct location.

FEMA Form FF-104-FY-21-118 – (English) (formerly 140-003d-1), Authorization for the Release of Information Under the Privacy Act; FEMA Form FF-104-FY-21-118-A – (Spanish) (formerly 140-003d-1S), Autorización para la Divulgación de Información bajo el Acta de Privacidad – FEMA must have written consent from an applicant or co-applicant to release registration information to a third party, unless otherwise allowed by law. Currently, there is not a standard OMB approved form for applicants or co-applicants to use to provide written consent. An applicant or co-applicant must submit either a handwritten or typed statement outlining personal identifying information, what information can be released, the parties the information can be released to, the applicant or co-applicant’s signature, and must either be notarized or include a declarative statement regarding the validity of the information in the written statement. The creation of the Authorization for the Release of Information Under the Privacy Act and Autorización para la Divulgación de Información bajo el Acta de Privacidad reduces applicant burden by providing them with a standardized form, which will save the applicant or co-applicant time and reduce confusion regarding what information is necessary for written consent.

3. Describe whether, and to what extent, the collection of information involves the use of automated, electronic, mechanical, or other technological collection techniques or other forms of information technology, e.g., permitting electronic submission of responses, and the basis for the decision for adopting this means of collection. Also describe any consideration of using information technology to reduce burden.

FEMA Form FF-104-FY-21-114 (formerly 010-0-11) – This form, and the Standard Personal Property List for the calendar year included with the form, must be submitted to FEMA via email annually by states, territories, and tribal governments. The form is emailed to a designated FEMA Program Management Section (PMS) distribution list and requires original signatures by the Governor or Tribal Chief Executive or designee, and the FEMA Regional Administrator or designee.

Development of State/Tribal Administrative Plan for the Other Needs provision of IHP – When a state, territory, or tribal government selects Joint or State Option to administer the Other Needs provision of IHP, a signed Administrative Plan must be submitted to the FEMA Regional Administrator via email. The Regional Office will send the Administrative Plan to FEMA PMS via email for evaluation and visibility.

FEMA Forms FF-104-FY-21-115 (English) (formerly 010-0-12)and FF-104-FY-21-115-A (Spanish) (formerly 010-0-12S) – In an effort to reduce applicant burden and expedite the review process, applicants may submit these forms to FEMA via mail, fax, in person at a local Disaster Recovery Center (DRC), or through scanning and uploading to their Disaster Assistance Center Applicant Inquiry (DAC AI) account, if an account was created at the time of initial disaster assistance registration. Applicants may locate local DRCs on the www.disasterassistance.gov website or by calling FEMA’s Helpline at 800-621-3362 (FEMA). Local DRC information may also be provided via local media blasts via radio, TV, etc.

Request for Approval of Late Registration – In an effort to reduce applicant burden and expedite the review process, applicants may submit a written request to FEMA via mail, fax, in person at a local Disaster Recovery Center (DRC), or through scanning and uploading to their Disaster Assistance Center Applicant Inquiry (DAC AI) account, if an account was created at the time of initial disaster assistance registration. Applicants may locate local DRCs on the www.disasterassistance.gov website or by calling FEMA’s Helpline at 800-621-3362 (FEMA). Local DRC information may also be provided via local media blasts via radio, TV, etc.

Appeal of Program Decision – In an effort to reduce applicant burden and expedite the review process, applicants may submit a written request to FEMA or use the Optional Appeal Request Form submitted via mail, fax, in person at a local Disaster Recovery Center (DRC), or through scanning and uploading to their Disaster Assistance Center Applicant Inquiry (DAC AI) account, if an account was created at the time of initial disaster assistance registration. The request must include the applicant’s signature, full name, FEMA Application Number and Disaster Number, the address of the pre-disaster primary residence, current phone number, and address. Applicants may locate local DRCs on the www.disasterassistance.gov website or by calling FEMA’s Helpline at 800-621-3362 (FEMA). Local DRC information may also be provided via local media blasts via radio, TV, etc.

FEMA Forms FF-104-FY-21-116 (English) (formerly 009-0-95) and FF-104-FY-21-116-A (Spanish) (formerly 009-0-95S)– In an effort to reduce applicant burden and expedite the review process, applicants may submit these forms to FEMA via mail, fax, in person at a local Disaster Recovery Center (DRC), or through scanning and uploading to their Disaster Assistance Center Applicant Inquiry (DAC AI) account, if an account was created at the time of initial disaster assistance registration. Applicants may locate local DRCs on the www.disasterassistance.gov website or by calling FEMA’s Helpline at 800-621-3362 (FEMA). Local DRC information may also be provided via local media blasts via radio, TV, etc.

FEMA Forms FF-104-FY-21-117 (English) (formerly 009-0-96) and FF-104-FY-21-117-A (Spanish) (formerly 009-0-96S) – In an effort to reduce applicant burden and expedite the review process, applicants may submit these forms to FEMA via mail, fax, in person at a local Disaster Recovery Center (DRC), or through scanning and uploading to their Disaster Assistance Center Applicant Inquiry (DAC AI) account, if an account was created at the time of initial disaster assistance registration. Applicants may locate local DRCs on the www.disasterassistance.gov website or by calling FEMA’s Helpline at 800-621-3362 (FEMA). Local DRC information may also be provided via local media blasts via radio, TV, etc.

FEMA Form FF-104-FY-21-118 – (English) (formerly 140-003d-1), Authorization for the Release of Information Under the Privacy Act; FEMA Form FF-104-FY-21-118-A – (Spanish) (formerly 140-003d-1S), Autorización para la Divulgación de Información bajo el Acta de Privacidad – In an effort to reduce applicant burden and expedite the review process, applicants may submit these forms to FEMA via mail, fax, in person at a local Disaster Recovery Center (DRC), or through scanning and uploading to their Disaster Assistance Center Applicant Inquiry (DAC AI) account, if an account was created at the time of initial disaster assistance registration. Applicants may locate local DRCs on the www.disasterassistance.gov website or by calling FEMA’s Helpline at 800-621-3362 (FEMA). Local DRC information may also be provided via local media blasts via radio, TV, etc.

4. Describe efforts to identify duplication. Show specifically why any similar information already available cannot be used or modified for use for the purposes described in Item 2 above. 

This information is not collected in any form, and therefore is not duplicated elsewhere.

5. If the collection of information impacts small businesses or other small entities (Item 5 of OMB Form 83-I), describe any methods used to minimize.

This information collection does not have an impact on small businesses or other small entities.

6. Describe the consequence to Federal/FEMA program or policy activities if the collection of information is not conducted, or is conducted less frequently as well as any technical or legal obstacles to reducing burden.

If the information is not collected from an applicant, several negative impacts could occur. Applicants who failed to apply within the initial registration timeframe will be unable to receive disaster assistance; applicants with a continuing need for rental assistance will be unable to receive said assistance; applicants who disagree with FEMA program eligibility decisions will have no recourse to have eligibility decisions reviewed; insured applicants will be unable to receive disaster assistance in a timely manner due to waiting for insurance documentation; applicants who did not receive an issued assistance check will be unable to request the previous payment be stopped and the assistance reissued; and the burden placed on applicants wishing to provide written consent to third parties who may be able to further assist them with disaster related needs will more substantial.

If the information collection from the states, territories, and tribal governments is not conducted or is conducted less frequently, there will be a negative impact on FEMA’s ability to implement the Other Needs provision of IHP. The information collected is used for disaster preparation and the assistance implementation process, which includes determining staffing levels and resource allocation. The information collected allows FEMA to understand the requirements and capabilities of states, territories, and tribal governments, which includes the ability to determine the level of federal dedication the states, territories, and tribal governments expect from FEMA. Failure to collect this information may result in delay or rejection of a state, territory, or tribal government’s request to administer the Other Needs provision of IHP.

7. Explain any special circumstances that would cause an information collection to be conducted in a manner:

1. Requiring respondents to report information to the agency more often than quarterly.

This information collection is conducted in a manner consistent with the guidelines in 5 CFR 1320.5(d)(2).

 (b) Requiring respondents to prepare a written response to a collection of information in fewer than 30 days after receipt of it.

This information collection is conducted in a manner consistent with the guidelines in 5 CFR 1320.5(d)(2).

3. Requiring respondents to submit more than an original and two

copies of any document.

This information collection is conducted in a manner consistent with the guidelines in 5 CFR 1320.5(d)(2).

3. Requiring respondents to retain records, other than health,

medical, government contract, grant-in-aid, or tax records for more than three years.

This information collection is conducted in a manner consistent with the guidelines in 5 CFR 1320.5(d)(2).

3. In connection with a statistical survey, that is not designed to

produce valid and reliable results that can be generalized to the universe of study.

This information collection is conducted in a manner consistent with the guidelines in 5 CFR 1320.5(d)(2).

 (f) Requiring the use of a statistical data classification that has not

been reviewed and approved by OMB.

This information collection is conducted in a manner consistent with the guidelines in 5 CFR 1320.5(d)(2).

 (g) That includes a pledge of confidentiality that is not supported by authority established in statute or regulation, that is not supported by disclosure and data security policies that are consistent with the pledge, or which unnecessarily impedes sharing of data with other agencies for compatible confidential use.

This information collection is conducted in a manner consistent with the guidelines in 5 CFR 1320.5(d)(2).

 (h) Requiring respondents to submit proprietary trade secret, or other confidential information unless the agency can demonstrate that it has instituted procedures to protect the information’s confidentiality to the extent permitted by law.

This information collection is conducted in a manner consistent with the guidelines in 5 CFR 1320.5(d)(2).

8. Federal Register Notice: 

 a. Provide a copy and identify the date and page number of publication in the Federal Register of the agency’s notice soliciting comments on the information collection prior to submission to OMB. Summarize public comments received in response to that notice and describe actions taken by the agency in response to these comments. Specifically address comments received on cost and hour burden.

As this revised Supporting Statement is being provided to support an Emergency Request, the 60-Day and 30-Day Federal Register Notices (FRNs) will not be utilized at this time due to time constraints.

 b. Describe efforts to consult with persons outside the agency to obtain their views on the availability of data, frequency of collection, the clarity of instructions and recordkeeping, disclosure, or reporting format (if any), and on the data elements to be recorded, disclosed, or reported.

c. Describe consultations with representatives of those from whom information is to be obtained or those who must compile records. Consultation should occur at least once every three years, even if the collection of information activities is the same as in prior periods. There may be circumstances that may preclude consultation in a specific situation. These circumstances should be explained.

9. Explain any decision to provide any payment or gift to respondents, other than remuneration of contractors or grantees.

FEMA does not provide payments or gifts to respondents in exchange for benefits.

10. Describe any assurance of confidentiality provided to respondents. Present the basis for the assurance in statute, regulation, or agency policy.



A Privacy Threshold Analysis was approved by DHS on February 10, 2022. This collection is supported by an existing Privacy Impact Assessment (PIA), DHS/FEMA/PIA-009(b) Document Management and Records Tracking System, approved by DHS on April 6, 2018, and an existing System of Records Notice (SORN), DHS/FEMA 008 Disaster Recovery Assistance Files, 78 FR 25282 approved by DHS on April 30, 2013. In addition, as required by the Privacy Act, a Privacy Act Statement is provided with any form that asks respondents to provide personal information about themselves, which is then saved into a system of records.

There are no assurances of confidentiality provided to the respondents for this information collection.

11. Provide additional justification for any question of a sensitive nature (such as sexual behavior and attitudes, religious beliefs and other matters that are commonly considered private). This justification should include the reasons why the agency considers the questions necessary, the specific uses to be made of the information, the explanation to be given to persons from whom the information is requested, and any steps to be taken to obtain their consent.

There are no questions of a sensitive nature.

 12. Provide estimates of the hour burden of the collection of information. The statement should:

 a. Indicate the number of respondents, frequency of response, annual hour burden, and an explanation of how the burden was estimated for each collection instrument (separately list each instrument and describe information as requested). Unless directed to do so, agencies should not conduct special surveys to obtain information on which to base hour burden estimates. Consultation with a sample (fewer than 10) of potential respondents is desired. If the hour burden on respondents is expected to vary widely because of differences in activity, size, or complexity, show the range of estimated hour burden, and explain the reasons for the variance. Generally, estimates should not include burden hours for customary and usual business practices.

Forms completed by states, territories, and tribal governments:

• FEMA Form FF-104-FY-21-114 (formerly 010-0-11), Individuals and Households Program (IHP) – Other Needs Assistance Administrative Option Selection – The estimated number of respondents for this collection instrument is 555 (50 states, 5 territories, and 500 federally recognized tribal governments). The substantial increase in estimated respondents is due to ongoing training and outreach conducted by the Regions to assist tribal governments in understanding and participating in the Other Needs provision of IHP. The frequency of completing this instrument is once annually. Each form is estimated to take 1.1 hours to complete. The total annual hour burden is 611 hours.

• Development of State/Tribal Administrative Plan for the Other Needs provision of IHP – The estimated number of respondents for this collection instrument is 4 and the frequency of completing this instrument is once annually. The estimated number of respondents is based on the current number of states, territories, and tribal governments requesting to participate in the administration and management of the Other Needs provision of IHP through selecting Joint or State Option on FEMA Form FF-104-FY-21-114 (formerly 010-0-11), Individuals and Households Program Other Needs Assistance Administrative Option Selection. Each document is estimated to take 2 hours to complete. The total annual hour burden is 8 hours.

Forms completed by applicants:

The number of applicant forms completed as part of this information collection is driven by the number and magnitude of declared disasters each year and varies substantially from year to year. The below annual estimates for applicant forms were obtained from FEMA’s Recovery Reporting and Analytics Division (RAD) and are based on historical data from 2005 through 2019.

• FEMA Form FF-104-FY-21-115 (formerly 010-0-12), Individuals and Households Program Application for Continued Temporary Housing Assistance – The number of respondents for this collection instrument is estimated at 13,110 and the frequency of completing this instrument is four times annually, for a total of 52,440 submissions. Each form is estimated to take 1 hour to complete. The total annual hour burden is 52,440 hours.

• FEMA Form FF-104-FY-21-115-A (formerly 010-0-12S), Programa de Individuos y Familias Solicitud para Continuar la Asistencia de Vivienda Temporera – The number of respondents for this collection instrument is estimated at 1,658 and the frequency of completing this instrument is four times annually, for a total of 6,632 submissions. Each form is estimated to take 1 hour to complete. The total annual hour burden is 6,632 hours.

• Request for Approval of Late Registration – The number of respondents for this collection instrument is estimated at 4,405 and the frequency of completing this instrument is one time annually. This instrument is a letter written and submitted by the applicant and is estimated to take 0.80 (48 minutes) to complete. The total annual hour burden is 3,524.

• Appeal of Program Decision – The number of respondents for this collection instrument is estimated at 43,591 and the frequency of completing this instrument is one time annually. This instrument is a letter written and submitted by the applicant and is estimated to take 0.80 (48 minutes) to complete. The total annual hour burden is 34,873.

  • Other Needs Assistance- Personal Property Assistance (Tools and Computers): The number of respondents for this collection instrument is estimated at 971 and the frequency of completing this instrument is one time annually. This instrument is a letter written and submitted by the applicant and is estimated to take 0.80 (48 minutes) to complete. The total annual hour burden is 777.

  • Home Replacement Assistance- Notice of Condemnation for demolition and removal, Letter of Substantive Damage, and Notice of Demolition. The number of respondents for this collection instrument is estimated at 62 and the frequency of completing this instrument is one time annually. This instrument is a letter written and submitted by the applicant and is estimated to take 0.80 (48 minutes) to complete. The total annual hour burden is 50.

  • Professional Assessment: The number of respondents for this collection instrument is estimated at 11,049 and the frequency of completing this instrument is one time annually. This instrument is a letter written and submitted by the applicant and is estimated to take 0.80 (48 minutes) to complete. The total annual hour burden is 8,839.

  • All other Appeal of Program Decisions: The number of respondents for this collection instrument is estimated at 31,509 and the frequency of completing this instrument is one time annually. This instrument is a letter written and submitted by the applicant and is estimated to take 0.80 (48 minutes) to complete. The total annual hour burden is 25,207.

• FEMA Form FF-104-FY-21-116 (English) (formerly 009-0-95), Request for Advance Disaster Assistance – The number of respondents for this collection instrument is estimated at 381 and the frequency of completing this instrument is one time annually. This instrument is a letter written and submitted by the applicant and is estimated to take 0.2 (12 minutes) to complete. The total annual hour burden is 76.

• FEMA Form FF-104-FY-21-116-A (Spanish) (formerly 009-0-95S), Solicitud de Adelanto de la Asistencia por Desastre – The number of respondents for this collection instrument is estimated at 52 and the frequency of completing this instrument is one time annually. This instrument is a letter written and submitted by the applicant and is estimated to take 0.2 (12 minutes) to complete. The total annual hour burden is 10.

• FEMA Form FF-104-FY-21-117 (English) (formerly 009-0-96), Request to Stop Payment and Reissue Disaster Assistance Check – The number of respondents for this collection instrument is estimated at 2,922 and the frequency of completing this instrument is one time annually. This instrument is a letter written and submitted by the applicant and is estimated to take 0.1 (6 minutes) to complete. The total annual hour burden is 292.

• FEMA Form FF-104-FY-21-117-A (Spanish) (formerly 009-0-96S), Solicitud para Detener el Pago y Reemitir el Cheque de Asistencia por Desastre – The number of respondents for this collection instrument is estimated at 780 and the frequency of completing this instrument is one time annually. This instrument is a letter written and submitted by the applicant and is estimated to take 0.1 (6 minutes) to complete. The total annual hour burden is 78.

• FEMA Form FF-104-FY-21-118 – (English) (formerly 140-003d-1), Authorization for the Release of Information Under the Privacy Act – The number of respondents for this collection instrument is estimated at 231 and the frequency of completing this instrument is one time annually. This instrument is a letter written and submitted by the applicant and is estimated to take 0.2 (12 minutes) to complete. The total annual hour burden is 46.

• FEMA Form FF-104-FY-21-118-A – (Spanish) (formerly 140-003d-1S), Autorización para la Divulgación de Información bajo el Acta de Privacidad – The number of respondents for this collection instrument is estimated at 96 and the frequency of completing this instrument is one time annually. This instrument is a letter written and submitted by the applicant and is estimated to take 0.2 (12 minutes) to complete. The total annual hour burden is 19.

 b. If this request for approval covers more than one form, provide separate hour burden estimates for each form and aggregate the hour burdens in Item 13 of OMB Form 83-I.

c. Provide an estimate of annualized cost to respondents for the hour burdens for collections of information, identifying and using appropriate wage rate categories. NOTE: The wage-rate category for each respondent must be multiplied by 1.4 and this total should be entered in the cell for “Avg. Hourly Wage Rate”. The cost to the respondents of contracting out or paying outside parties for information collection activities should not be included here. Instead, this cost should be included in Item 13.

Estimated Annualized Burden Hours and Costs
Type of Respondent	Form Name / Form No.	No. of Respondents	No. of Responses per Respondent	Total No. of Responses	Avg. Burden per Response (in hours)	Total Annual Burden (in hours)	Avg. Hourly Wage Rate	Total Annual Respondent Cost
State, Local, or Tribal Government	Other Needs Assistance Administrative Option Selection / FF-104-FY-21-114 (formerly 010-0-11)	555	1	555	1.1	611	$97.90	$59,817
State, Local, or Tribal Government	Development of State/Tribal Administrative Plan for Other Needs Provision of IHP / No Form	4	1	4	2	8	$97.90	$783
Individuals or Households	Individual and Households Program Application for Continued Temporary Housing Assistance / FF-104-FY-21-115 (formerly 010-0-12)	13,110	4	52,440	1	52,440	$39.25	$2,058,270
Individuals or Households	Programa de Individuos y Familias Solicitud para Continuar la Asistencia de Vivienda Temporera / FF-104-FY-21-115-A (formerly 010-0-12S)	1,658	4	6,632	1	6,632	$39.25	$260,306
Individuals or Households	Request for Approval of Late Registration / No Form	4,405	1	4,405	0.8	3,524	$39.25	$138,317
Individuals or Households	Appeal of Program Decision / No Form	43,591	1	43,591	0.8	34,873	$39.25	$1,368,765
Individuals or Households	Request for Advance Disaster Assistance / FF-104-FY-21-116 (formerly 009-0-95)	381	1	381	0.2	76	$39.25	$2,983
Individuals or Households	Solicitud de Adelanto de la Asistencia por Desastre / FF-104-FY-21-116-A (formerly 009-0-95S)	52	1	52	0.2	10	$39.25	$393
Individuals or Households	Request to Stop Payment and Reissue Disaster Assistance Check / FF-104-FY-21-117 (009-0-96)	2,922	1	2,922	0.1	292	$39.25	$11,461
Individuals or Households	Solicitud para Detener el Pago y Reemitir el Cheque de Asistencia por Desastre / FF-104-FY-21-117 (formerly 009-0-96S)	780	1	780	0.1	78	$39.25	$3,062
Individuals or Households	Authorization for the Release of Information Under the Privacy Act / FF-104-FY-21-118 – English (formerly 140-003d-1)	231	1	231	0.2	46	$39.25	$1,806
Individuals or Households	96 / FF-104-FY-21-118-A – Spanish (formerly 140-003d-1S)	96	1	96	0.2	19	$39.25	$746
Total		67,785		112,089		98,609		$3,906,709

Instruction for Wage-rate category multiplier: Take each non-loaded “Avg. Hourly Wage Rate” from the BLS website table and multiply that number by 1.45¹. For example, a non-loaded BLS table wage rate of $42.51 would be multiplied by 1.45, and the entry for the “Avg. Hourly Wage Rate” would be $61.64.

The wage rate for All Occupations (SOC 00-0000) is $27.07. Including the wage rate multiplier of 1.45, the fully-loaded wage rate is $39.25 per hour.² Therefore, the annual burden hour cost is $2,904,186 annually ($39.25 x 73,992 hours). The wage rate for Management Occupations (SOC 11-0000) is $60.81. Including the wage rate multiplier of 1.61³, the fully-loaded wage rate is $97.90 per hour.⁴ Therefore, the annual burden hour cost is $60,600 (=$97.90 x 619 hours). The total estimated burden hour cost for this collection is $3,906,709 ((=$39.25 x 97,990 hours) + $60,600 + $1 due to rounding) annually.⁵

13. Provide an estimate of the total annual cost burden to respondents or recordkeepers resulting from the collection of information. The cost of purchasing or contracting out information collection services should be a part of this cost burden estimate. (Do not include the cost of any hour burden shown in Items 12 and 14.)

The cost estimates should be split into two components:

a. Operation and Maintenance and purchase of services component. These estimates should take into account cost associated with generating, maintaining, and disclosing or providing information. Include descriptions of methods used to estimate major cost factors including system and technology acquisition, expected useful life of capital equipment, the discount rate(s), and the time period over which costs will be incurred.

b. Capital and Start-up-Cost should include, among other items, preparations for collecting information such as purchasing computers and software, monitoring sampling, drilling and testing equipment, and record storage facilities.

There are no record keeping, capital, start-up or maintenance costs associated with this information collection.

Annual Cost Burden to Respondents or Recordkeepers
Data Collection Activity/Instrument	*Annual Capital Start-Up Cost (investments in overhead, equipment, and other one-time expenditures	*Annual Operations and Maintenance Costs (such as recordkeeping, technical/professional services, etc.)	Annual Non-Labor Cost (expenditures on training, travel, and other resources)	Total Annual Cost to Respondents
N/A	N/A	N/A	N/A	N/A
Total	$0	$0	$0	$0

14. Provide estimates of annualized cost to the federal government. Also, provide a description of the method used to estimate cost, which should include quantification of hours, operational expenses (such as equipment, overhead, printing and support staff), and any other expense that would have been incurred without this collection of information. You may also aggregate cost estimates for Items 12, 13, and 14 in a single table.

Annual Cost to the Federal Government
Item	Cost ($)
Contract Costs: N/A	$0
Staff Salaries1 [85 of GS 9 Step 5 employees spending approximately 10% of time annually processing information received from 140,194 disaster survivors. 12 GS 14 Step 5 employees spending approximately 8.2% of time annually reviewing information from 555 States, Territories, and Tribal governments. (85 x $68,146 x 0.1 x 1.452 = $839,899) + (12 x $138,866 x .082 x 1.45 = $198,134) = $1,038,033]	$1,038,033
Facilities [cost for renting, overhead, etc. for data collection activity]	$0
Computer Hardware and Software [cost of equipment annual lifecycle]	$0
Equipment Maintenance [cost of annual maintenance/service agreements for equipment]	$0
Printing [Cost to print approximately 63,534 forms (245,212 pages total) to send to disaster survivors via postal mail at $.015 per page] 245,212 x .015	$3,678
Postage [Cost of mailing approximately 63,534 forms to disaster survivors] 63,534 x .583	$36,850
Travel	$0
Total	$1,078,561
1 Office of Personnel Management 2021 Pay and Leave Tables for the Washington-Baltimore-Arlington, DC-MD-VA-WV-PA locality. Available online at https://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/salary-tables/pdf/2021/DCB.pdf. Accessed November 18, 2021. 2 Wage rate includes a 1.45 multiplier to reflect the fully-loaded wage rate. 3 United States Postal Service first-class postage rate. Available online at https://www.usps.com/business/prices.htm. Accessed November 18, 2021.

 15. Explain the reasons for any program changes or adjustments reported in Items 13 or 14 of the OMB Form 83-I in a narrative form. Present the itemized changes in hour burden and cost burden according to program changes or adjustments in Table 5. Denote a program increase as a positive number, and a program decrease as a negative number.

Program decrease for the Appeal of Program Decision / No Form instrument due to a decrease in the number of years included in review period. Previously, annual burden hours and cost burden reflected a 15-year review period (2005 - 2019). In particular, the number of appeals submitted in years 2005 and 2006 were disproportionately high due to Hurricane Katrina. However, estimates in this renewal are based on a 10-year review period (2010 - 2019).

Increases in annual burden hours for other instruments are due to rounding. For example, the average burden per response (in hours) for Other Needs Assistance Administrative Option Selection / FF-104-FY-21-114 is 1.1 hours (66 minutes) in this renewal compared to 1.08 hours (approximately 65 minutes) for the previous renewal. Of the 98,609 total annual burden hours included in this renewal, 2,507.74 are due to rounding.⁶ FEMA estimates that rounding adjustments accounted for $99,080 (= (11.10 hours x $97.90) + (2,496.64 hours x $39.25)) of Total Annual Respondent Cost.⁷

A “Program increase” is an additional burden resulting from a federal government regulatory action or directive. (e.g., an increase in sample size or coverage, amount of information, reporting frequency, or expanded use of an existing form). This also includes previously in-use and unapproved information collections discovered during the ICB process, or during the fiscal year, which will be in use during the next fiscal year.

A “Program decrease”, is a reduction in burden because of: (1) the discontinuation of an information collection; or (2) a change in an existing information collection by a Federal agency (e.g., the use of sampling (or smaller samples), a decrease in the amount of information requested (fewer questions), or a decrease in reporting frequency).

“Adjustment” denotes a change in burden hours due to factors over which the government has no control, such as population growth, or in factors which do not affect what information the government collects or changes in the methods used to estimate burden or correction of errors in burden estimates.

Itemized Changes in Annual Burden Hours
Data Collection Activity/Instrument	Program Change (hours currently on OMB inventory)	Program Change (new)	Difference	Adjustment (hours currently on OMB inventory)	Adjustment (new)	Difference
Appeal of Program Decision / No Form	87,419	34,873	-52,546	N/A	N/A	N/A
Total	87,419	34,873	-52,546	0	0	0

Explain: The decrease in annual cost burden for the Appeal of Program Decision / No Form instrument is due to a decrease in the number of years included in review period.

Itemized Changes in Annual Cost Burden
Data Collection Activity/Instrument	Program Change (cost currently on OMB inventory)	Program Change (new)	Difference	Adjustment (cost currently on OMB inventory)	Adjustment (new)	Difference
Appeal of Program Decision / No Form	$3,282,583	$1,368,765	-$1,913,818	N/A	N/A	N/A
Total	$3,282,583	$1,368,765	-$1,913,818	$0	$0	$0

Explain: The decrease in annual cost burden for the Appeal of Program Decision / No Form instrument is due to a decrease in the number of years included in review period.

16. For collections of information whose results will be published, outline plans for tabulation and publication. Address any complex analytical techniques that will be used. Provide the time schedule for the entire project, including beginning and ending dates of the collection of information, completion of report, publication dates, and other actions.

FEMA does not intend to employ the use of statistics or the publication thereof for this information collection.

17. If seeking approval not to display the expiration date for OMB approval of the information collection, explain reasons that display would be inappropriate.

FEMA will display the expiration date for the OMB approval of this information collection.

18. Explain each exception to the certification statement identified in Item 19 “Certification for Paperwork Reduction Act Submissions,” of OMB Form 83-I.

This collection does not seek exception to “Certification for Paperwork Reduction Act Submissions”.

1 Bureau of Labor Statistics, Employer Costs for Employee Compensation, Table 1. “Employer costs per hour worked for employee compensation and costs as a percent of total compensation: Civilian workers, by major occupational and industry group, June 2021.” Available at https://www.bls.gov/news.release/archives/ecec_09162021.pdf. Accessed November 17, 2021. The wage multiplier is calculated by dividing total compensation for all workers of $38.91 by wages and salaries for all workers of $26.85 per hour yielding a benefits multiplier of approximately 1.45.

2 Information on the mean wage rate from the U.S. Department of Labor, Bureau of Labor Statistics is available online at: https://www.bls.gov/oes/2020/may/oes_nat.htm#00-0000. Accessed November 18, 2021.

3 State and local government wage multiplier: Bureau of Labor Statistics, Employer Costs for Employee Compensation, Table 1. Available at https://www.bls.gov/news.release/archives/ecec_12162021.pdf . Accessed December 17, 2021. The wage multiplier is calculated by dividing total compensation for State and local government workers of $54.46 by Wages and salaries for State and local government workers of $33.76 per hour yielding a benefits multiplier of approximately 1.61

4 Information on the mean wage rate from the U.S. Department of Labor, Bureau of Labor Statistics is available online at: https://www.bls.gov/oes/2020/may/oes_nat.htm#11-0000. Accessed November 18, 2021.

5 Total Annual Respondent Cost reflects a difference of $1 due to rounding.

6 Estimated Annualized Burden Hours and Costs Table.

7 Rounding accounts for 2.5 percent (= $99,080 / $3,906,709) of Total Annual Respondent Cost estimate.

4