Assessment Survey - Electronic

Federal Emergency Management Agency Individual Assistance Customer Satisfaction Surveys

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.