Information Collection

Assessment Survey - Electronic

IC 226850 under ICR 202212-1660-009 · OMB 1660-0143.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1660-0143 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FEMA Form FF-104-F Assessment Survey - Electronic	Form and Instruction
FEMA Form FF-104-F Assessment Survey - Electronic FEMA Form FF-104-FY-21-164 (formerly 519-0-41) Assessment Survey-Electronic.docx	Form and Instruction
FEMA Form FF-104-F Assessment Survey - Electronic FEMA Form FF-104-FY-21-164 (formerly 519-0-41) Assessment Survey-Electronic.docx	Form and Instruction

IC Title:

Assessment Survey - Electronic

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 44 CFR 206.101

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-21-164 (formerly 519-0-41)	Assessment Survey - Electronic	FEMA Form FF-104-FY-21-164 (formerly 519-0-41) Assessment Survey-Electronic.docx		Yes	Yes	Fillable Fileable

Line of Business: Disaster Management

Subfunction: Disaster Preparedness and Planning

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,856

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	5,856	1,824	4,032
Annual IC Time Burden (Hours)	586	-220	806
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.