Public Assistance Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form FEMA Form 009-0-49 Request for Public Assistance	Form	Modified	Available
Form FEMA Form 009-0-49 Request for Public Assistance	Form	Modified	Repair queued
Form FEMA Template 104- Equitable Vaccine Administration Information Submission	Form and Instruction	Modified	Available
Form FEMA Template 104- FEMA Template 104-FY-21-100 Equitable COVID-19 Response and Recovery: Vaccine Administration Information	Form and Instruction	Modified	Repair queued
Form 009-0-141 FAC-TRAX System	Form	Modified	Available
Form 009-0-141 FAC-TRAX System	Form	Modified	Repair queued
Form FEMA Form 009-0-91 Project Worksheet-Photo Sheet	Form	Modified	Available
Form FEMA Form 009-0-91 Project Worksheet Photo Sheet	Form	Modified	Missing upstream
Form FEMA Form 009-0-91 Project Worksheet - Maps and Sketches Sheet	Form	Modified	Available
Form FEMA Form 009-0-91 Project Worksheet Maps and Sketches Sheet	Form	Modified	Repair queued
Form FEMA Form 009-0-91 Project Worksheet-Cost Estimate Continuation Sheet	Form	Modified	Available
Form FEMA Form 009-0-91 Project Worksheet Cost Estimate Continuation Sheet and Cost Overruns	Form	Modified	Repair queued
Form FEMA Form 009-0-91 Project Worksheet - Damage Description and Scope of Work Continuation Sheet	Form	Modified	Available
Form FEMA Form 009-0-91 Project Work Sheet Damage Description and Scope of Work	Form	Modified	Repair queued
Form FEMA Form 009-0-12 Force Account Equipment Summary Record	Form	Modified	Available
Form FEMA Form 009-0-12 Force Account Equipment Summary Record	Form	Modified	Missing upstream
Form FEMA Form 009-0-12 Contract Work Summary Record	Form	Modified	Available
Form FEMA Form 009-0-12 Contract Work Summary Record	Form	Modified	Repair queued
Form FEMA Form 009-0-12 Rented Equipment Summary Record	Form	Modified	Available
Form FEMA Form 009-0-12 Rented Equipment Summary Record	Form	Modified	Repair queued
Form FEMA Form 009-0-12 Materials Summary Record	Form	Modified	Available
Form FEMA Form 009-0-12 Materials Summary Record	Form	Modified	Repair queued
Form FEMA Form 009-0-12 Force Account Labor Summary Record	Form	Modified	Available
Form FEMA Form 009-0-12 Force Account Labor Summary	Form	Modified	Repair queued
Form FEMA Form 009-0-12 PNP Facility Questionaire	Form	Modified	Available
Form FEMA Form 009-0-12 PNP Facility Questionnaire	Form	Modified	Repair queued
Form FEMA Form 009-0-12 Applicant's Benefits Calculation Worksheet	Form	Modified	Repair queued
Form FEMA Form 009-0-12 Applicant's Benefits Calculation Worksheet	Form	Modified	Repair queued
Form FEMA Form 009-0-12 Special Consideration Questions	Form	Modified	Available
Form FEMA Form 009-0-12 Special Considerations Questions	Form	Modified	Repair queued
Form FEMA Form 009-0-91 Project Worksheet	Form and Instruction	Modified	Available
Form FEMA Form 009-0-91 Project Worksheet	Form and Instruction	Modified	Repair queued
Form FEMA Form 009-0-11 Quarterly Progress Report	Form and Instruction	Modified	Available
Form FEMA Form 009-0-11 Progress Report	Form and Instruction	Modified	Missing upstream
Simplified Procedures Final Rule_FR Published.pdf	Supplementary Document	Uploaded 2022-08-08	Repair queued
1660-0017 Final Rule Supporting Statement A 20220803.docx	Supporting Statement A	Uploaded 2022-08-08	Repair queued
stafford_act.pdf	Supplementary Document	Uploaded 2016-09-02	Repair queued
CFR-2011-title44-vol1-part206.pdf	Supplementary Document	Uploaded 2016-09-01	Repair queued

IC Document Collections

Information collection document groups

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

ICR Details

OMB Control No: 1660-0017	ICR Reference No: 202208-1660-001
Status: Historical Active	Previous ICR Reference No: 202109-1660-002
Agency/Subagency: DHS/FEMA	Agency Tracking No: Final Rule - Simplified Procedures
Title: Public Assistance Program
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 09/13/2022
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/30/2022
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/13/2022
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2023	6 Months From Approved	03/31/2025
Responses	431,720	0	449,084
Time Burden (Hours)	484,189	0	491,533
Cost Burden (Dollars)	0	0	0

---

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: This workflow is based on the publication of the Final Rule on 8/3/2022 with effective date also of 8/3/2022.

---

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

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
1660-AB10	Final or interim final rulemaking	87 FR 47359	08/03/2022

---

Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 20

table that charts list of burden

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

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	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	431,720	449,084	0	-17,364	0	0
Annual Time Burden (Hours)	484,189	491,533	0	-7,344	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Changing Regulations

Short Statement: These changes are due to a decrease in the number of responses for FEMA Forms 009-0-123, 009-0-124, 009-0-125, 009-0-126, and 009-0-127 and for the number of respondents for FEMA Form 009-0-111. FEMA requires that recipients of large projects fill out these supplemental forms to account for the actual costs for reconciliation purposes. These forms are not required for small projects. The final rule revising this collection updates FEMA’s regulations governing the Public Assistance program at 44 CFR 206.203(c) to increase the monetary threshold for when FEMA will process an application using “simplified procedures” to $1,000,000. The decrease in the number of large projects as a result of the increase in the large project threshold means fewer applicants submitting these forms or submitting fewer of them. Changes in costs result from changes in the fully loaded average hourly wage from $56.65 to $55.95, and from the changes to response and respondent numbers for certain forms, noted above.

---

Annual Cost to Federal Government: $1,957,204

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

---

Common Form ICR:  No

---

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: 09/13/2022

---