Information Collection

CCP/ISP Crisis Counseling Assistance and Training Program, Immediate Services Program Application

IC 21184 under ICR 202211-1660-004 · OMB 1660-0085.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1660-0085 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FEMA Form FF-104-F CCP/ISP Crisis Counseling Assistance and Training Program, Immediate Services Program Application	Form and Instruction
Form FEMA Form FF-104-F CCP/ISP Crisis Counseling Assistance and Training Program, Immediate Services Program Application CCP/ISP Crisis Counseling Assistance and Training Program, Immediate Services Program Application	Form and Instruction
FEMA Form FF-104-F CCP/ISP Crisis Counseling Assistance and Training Progra FF-104-FY-21-148 ISP Application 60 adjudication.docx www.samhsa.gov/dtac/ccp-toolkit	Form and Instruction
FEMA Form FF-104-F CCP/ISP Crisis Counseling Assistance and Training Progra FF-104-FY-21-148 ISP Application 60 adjudication.docx www.samhsa.gov/dtac/ccp-toolkit	Form and Instruction

IC Title:

CCP/ISP Crisis Counseling Assistance and Training Program, Immediate Services Program 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: 44 CFR 206.171

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	FEMA Form FF-104-FY-21-148 (formerly 003-0-1)	CCP/ISP Crisis Counseling Assistance and Training Program, Immediate Services Program Application	FF-104-FY-21-148 ISP Application 60 adjudication.docx	https://www.samhsa.gov/dtac/ccp-toolkit	Yes	Yes	Fillable Fileable

Line of Business: Disaster Management

Subfunction: Disaster Preparedness and Planning

Privacy Act System of Records

Title: DHS/FEMA-009 â Hazard Mitigation Assistance Grant Programs

FR Citation: 77 FR 17783

Number of Respondents: 18

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	18	3	15
Annual IC Time Burden (Hours)	144	24	120
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.