Information Collection

USVSST Application

IC 222379 under ICR 202210-1123-001 · OMB 1123-0013.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1123-0013 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1123-0013 USVSST Application	Form and Instruction
1123-0013 USVSST Application USVSSTF 11.27.2019.pdf www.usvsst.com	Form and Instruction
1123-0013 USVSST Application USVSSTF 11.27.2019.pdf www.usvsst.com	Form and Instruction

IC Title:

USVSST Application

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 10609

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1123-0013	USVSST Application	USVSSTF 11.27.2019.pdf	http://www.usvsst.com	Yes	Yes	Fillable Fileable

Line of Business: Disaster Management

Subfunction: Disaster Repair and Restore

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 700

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 85 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	700	0	700
Annual IC Time Burden (Hours)	875	-525	1,400
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.