Public Assistance Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form FEMA Form FF-104-F Request for Public Assistance	Form and Instruction	Modified	Available
Form FEMA Form FF-104-F Request for Public Assistance	Form and Instruction	Modified	Repair queued
Form FEMA Form FF-104-F Tribal Administrative Plan	Form and Instruction	New	Available
Form FEMA Form FF-104-F Tribe Administrative Plan	Form and Instruction	New	Repair queued
Form FEMA Form FF-104-F Time Extension	Form and Instruction	New	Available
Form FEMA Form FF-104-F Time Extension Request	Form and Instruction	New	Repair queued
Form FEMA Form FF-104-F Damage Information	Form and Instruction	New	Available
Form FEMA Form FF-104-F Damage Information	Form and Instruction	New	Repair queued
Form FEMA Form FF-104-F Project Application for Management Costs	Form and Instruction	New	Available
Form FEMA Form FF-104-F Project Application for Management Costs	Form and Instruction	New	Repair queued
Form FEMA Form FF-104-F Project Application for Building Code and Floodplain Management Administration and Enforcement	Form and Instruction	New	Available
Form FEMA Form FF-104-F Project Application for Building Code and Floodplain Management and Enforcement	Form and Instruction	New	Repair queued
Form FEMA Form FF-104-F Project Application for Infrastructure Restoration	Form and Instruction	New	Available
Form FEMA Form FF-104-F Project Application for Infrastructure Restoration	Form and Instruction	New	Repair queued
Form FEMA Form FF-104-F Project Application for COVID-19	Form and Instruction	New	Available
Form FEMA Form FF-104-F Project Application for COVID-19	Form and Instruction	New	Repair queued
Form FEMA Form FF-104-F Project Application for Emergency Protective Measures	Form and Instruction	New	Available
Form FEMA Form FF-104-F Project Application for Emergency Protective Measures	Form and Instruction	New	Repair queued
Form FEMA Form FF-104-F Project Application for Debris Removal	Form and Instruction	New	Available
Form FEMA Form FF-104-F Project Application for Debris Removal	Form and Instruction	New	Repair queued
Form FEMA Form FF-104-F Pre-Approval Request	Form and Instruction	New	Available
Form FEMA Form FF-104-F Pre-Approval Request	Form and Instruction	New	Repair queued
Form FEMA Form FF-104-F Donated Labor Sign-in	Form and Instruction	New	Available
Form FEMA Form FF-104-F Donated Labor Sign-in	Form and Instruction	New	Repair queued
Form FEMA Form FF-104-F Impact List	Form and Instruction	New	Available
Form FEMA Form FF-104-F Impact List	Form and Instruction	New	Repair queued
Form FEMA Form FF-104-F Applicant Impact Survey	Form and Instruction	New	Available
Form FEMA Form FF-104-F Applicant Impact Survey	Form and Instruction	New	Repair queued
Form FEMA Form FF-104-F Recipient Incident Information	Form and Instruction	New	Available
Form FEMA Form FF-104-F Recipient Incident Information	Form and Instruction	New	Repair queued
Form FEMA Form FF-104-F Organization Profile	Form and Instruction	New	Available
Form FEMA Form FF-104-F Organization Profile	Form and Instruction	New	Repair queued
Form FEMA Template 104- Equitable Vaccine Response and Recovery: Vaccine Administration Information	Form and Instruction	Modified	Available
Form FEMA Template 104- Equitable Vaccine Administration Information Submission Template	Form and Instruction	Modified	Repair queued
Form 009-0-141 FAC-TRAX System	Form	Removed	Available
Form 009-0-141 FAC-TRAX System	Form	Removed	Repair queued
Form FEMA Form 009-0-91 Project Worksheet-Photo Sheet	Form	Removed	Available
Form FEMA Form 009-0-91 Project Worksheet Photo Sheet	Form	Removed	Repair queued
Form FEMA Form 009-0-91 Project Worksheet - Maps and Sketches Sheet	Form	Removed	Available
Form FEMA Form 009-0-91 Project Worksheet Maps and Sketches Sheet	Form	Removed	Repair queued
Form FEMA Form 009-0-91 Project Worksheet-Cost Estimate Continuation Sheet	Form	Removed	Available
Form FEMA Form 009-0-91 Project Worksheet Cost Estimate Continuation Sheet and Cost Overruns	Form	Removed	Repair queued
Form FEMA Form 009-0-91 Project Worksheet - Damage Description and Scope of Work Continuation Sheet	Form	Removed	Available
Form FEMA Form 009-0-91 Project Work Sheet Damage Description and Scope of Work	Form	Removed	Repair queued
Form FEMA Form FF-104-F State Administrative Plan	Form and Instruction	Modified	Available
Form FEMA Form FF-104-F State Administrative Plan	Form and Instruction	Modified	Repair queued
Form FEMA Form FF-104-F Force Account Equipment Summary Record	Form and Instruction	Modified	Available
Form FEMA Form FF-104-F Force Account Equipment Summary	Form and Instruction	Modified	Repair queued
Form FEMA Form FF-104-F Contract Work Summary	Form and Instruction	Modified	Available
Form FEMA Form FF-104-F Contract Work Summary	Form and Instruction	Modified	Repair queued
Form FEMA Form FF-104-F Rented Equipment Summary Record	Form and Instruction	Modified	Available
Form FEMA Form FF-104-F Rented Equipment Summary	Form and Instruction	Modified	Repair queued
Form FEMA Form FF-104-F Materials Summary Record	Form and Instruction	Modified	Available
Form FEMA Form FF-104-F Materials Summary	Form and Instruction	Modified	Repair queued
Form FEMA Form FF-104-F Force Account Labor Summary Record	Form and Instruction	Modified	Available
Form FEMA Form FF-104-F Force Account Labor Summary Record	Form and Instruction	Modified	Repair queued
Form FEMA Form 009-0-12 PNP Facility Questionaire	Form	Removed	Available
Form FEMA Form 009-0-12 PNP Facility Questionnaire	Form	Removed	Repair queued
Form FEMA Form FF-104-F Applicant's Benefits Calculation Worksheet	Form and Instruction	Modified	Available
Form FEMA Form FF-104-F Applicant's Benefits Calculation Worksheet	Form and Instruction	Modified	Repair queued
Form FEMA Form 009-0-12 Special Consideration Questions	Form	Removed	Available
Form FEMA Form 009-0-12 Special Considerations Questions	Form	Removed	Repair queued
Form FEMA Form 009-0-91 Project Worksheet	Form and Instruction	Removed	Available
Form FEMA Form 009-0-91 Project Worksheet	Form and Instruction	Removed	Repair queued
Form FEMA Form FF-104-F Quarterly Progress Report	Form and Instruction	Modified	Available
Form FEMA Form FF-104-F Quarterly Progress Report	Form and Instruction	Modified	Repair queued
FF-104-FY-22-247_Hazard Mitigation Addendum_Final.docx	Supplementary Document	Uploaded 2023-03-09	Repair queued
FF-104-FY-22-246_Environmental and Historic Preservation Info_Final.docx	Supplementary Document	Uploaded 2023-03-09	Repair queued
20160825 FEMA FACTRAX Screenshots.pdf	Supplementary Document	Uploaded 2023-03-09	Repair queued
1600-0017 - Published 30-Day BRI FRN - 2023 03 03.pdf	Supplementary Document	Uploaded 2023-03-03	Repair queued
1600-0017 - Published 60-Day BRI FRN - 2022 12 14.pdf	Supplementary Document	Uploaded 2022-12-30	Repair queued
privacy-pia-fema-hmgp.pdf	Supplementary Document	Uploaded 2022-12-30	Repair queued
privacy_pia_FEMA_GrantManagementPrograms_February2015.pdf	Supplementary Document	Uploaded 2022-12-30	Repair queued
SORN, DHS-FEMA-009 HMA, PA, and CDL SORN (78 FR 16015, 2014 03 24).pdf	Supplementary Document	Uploaded 2022-12-30	Repair queued
1660-0017 - BRI Supporting Statement A - 2023 03 09 clean.docx	Supporting Statement A	Uploaded 2023-03-09	Missing upstream
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 and Instruction	Modified	Request for Public Assistance
41294	Request for Public Assistance	Form and Instruction	Modified
257686	Tribe Administrative Plan	Form and Instruction	New	Tribal Administrative Plan
257686	Tribe Administrative Plan	Form and Instruction	New
257685	Time Extension Request	Form and Instruction	New	Time Extension
257685	Time Extension Request	Form and Instruction	New
257682	Damage Information	Form and Instruction	New	Damage Information
257682	Damage Information	Form and Instruction	New
257681	Project Application for Management Costs	Form and Instruction	New	Project Application for Management Costs
257681	Project Application for Management Costs	Form and Instruction	New
257680	Project Application for Building Code and Floodplain Management and Enforcement	Form and Instruction	New	Project Application for Building Code and Floodplain Management Administration and Enforcement
257680	Project Application for Building Code and Floodplain Management and Enforcement	Form and Instruction	New
257679	Project Application for Infrastructure Restoration	Form and Instruction	New	Project Application for Infrastructure Restoration
257679	Project Application for Infrastructure Restoration	Form and Instruction	New
257678	Project Application for COVID-19	Form and Instruction	New	Project Application for COVID-19
257678	Project Application for COVID-19	Form and Instruction	New
257677	Project Application for Emergency Protective Measures	Form and Instruction	New	Project Application for Emergency Protective Measures
257677	Project Application for Emergency Protective Measures	Form and Instruction	New
257676	Project Application for Debris Removal	Form and Instruction	New	Project Application for Debris Removal
257676	Project Application for Debris Removal	Form and Instruction	New
257675	Pre-Approval Request	Form and Instruction	New	Pre-Approval Request
257675	Pre-Approval Request	Form and Instruction	New
257674	Donated Labor Sign-in	Form and Instruction	New	Donated Labor Sign-in
257674	Donated Labor Sign-in	Form and Instruction	New
257673	Impact List	Form and Instruction	New	Impact List
257673	Impact List	Form and Instruction	New
257672	Applicant Impact Survey	Form and Instruction	New	Applicant Impact Survey
257672	Applicant Impact Survey	Form and Instruction	New
257671	Recipient Incident Information	Form and Instruction	New	Recipient Incident Information
257671	Recipient Incident Information	Form and Instruction	New
257670	Organization Profile	Form and Instruction	New	Organization Profile
257670	Organization Profile	Form and Instruction	New
247457	Equitable Vaccine Administration Information Submission Template	Form and Instruction	Modified	Equitable Vaccine Response and Recovery: Vaccine Administration Information
247457	Equitable Vaccine Administration Information Submission Template	Form and Instruction	Modified
223320	FAC-TRAX System	Form	Removed	FAC-TRAX System
223320	FAC-TRAX System	Form	Removed
206469	Project Worksheet Photo Sheet	Form	Removed	Project Worksheet-Photo Sheet
206469	Project Worksheet Photo Sheet	Form	Removed
206468	Project Worksheet Maps and Sketches Sheet	Form	Removed	Project Worksheet - Maps and Sketches Sheet
206468	Project Worksheet Maps and Sketches Sheet	Form	Removed
206467	Project Worksheet Cost Estimate Continuation Sheet and Cost Overruns	Form	Removed	Project Worksheet-Cost Estimate Continuation Sheet
206467	Project Worksheet Cost Estimate Continuation Sheet and Cost Overruns	Form	Removed
206466	Project Work Sheet Damage Description and Scope of Work	Form	Removed	Project Worksheet - Damage Description and Scope of Work Continuation Sheet
206466	Project Work Sheet Damage Description and Scope of Work	Form	Removed
191941	State Administrative Plan	Form and Instruction	Modified	State Administrative Plan
191941	State Administrative Plan	Form and Instruction	Modified
190424	Request for Arbitration and Recommendation from Hurricanes Katrina or Rita		Unchanged
190419	Request for Appeals and Recommendation		Unchanged
185911	Force Account Equipment Summary	Form and Instruction	Modified	Force Account Equipment Summary Record
185911	Force Account Equipment Summary	Form and Instruction	Modified
185910	Contract Work Summary	Form and Instruction	Modified	Contract Work Summary
185910	Contract Work Summary	Form and Instruction	Modified
185909	Rented Equipment Summary	Form and Instruction	Modified	Rented Equipment Summary Record
185909	Rented Equipment Summary	Form and Instruction	Modified
185908	Materials Summary	Form and Instruction	Modified	Materials Summary Record
185908	Materials Summary	Form and Instruction	Modified
185907	Force Account Labor Summary Record	Form and Instruction	Modified	Force Account Labor Summary Record
185907	Force Account Labor Summary Record	Form and Instruction	Modified
185906	PNP Facility Questionnaire	Form	Removed	PNP Facility Questionaire
185906	PNP Facility Questionnaire	Form	Removed
185906	PNP Facility Questionnaire	Instruction	Removed
185903	Applicant's Benefits Calculation Worksheet	Form and Instruction	Modified	Applicant's Benefits Calculation Worksheet
185903	Applicant's Benefits Calculation Worksheet	Form and Instruction	Modified
185901	Special Considerations Questions	Form	Removed	Special Consideration Questions
185901	Special Considerations Questions	Form	Removed
185900	Project Worksheet	Form and Instruction	Removed	Project Worksheet
185900	Project Worksheet	Form and Instruction	Removed
185897	Quarterly Progress Report	Form and Instruction	Modified	Quarterly Progress Report
185897	Quarterly Progress Report	Form and Instruction	Modified

ICR Details

OMB Control No: 1660-0017	ICR Reference No: 202212-1660-015
Status: Historical Active	Previous ICR Reference No: 202208-1660-001
Agency/Subagency: DHS/FEMA	Agency Tracking No: BRI
Title: Public Assistance Program
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 08/17/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/14/2023
Terms of Clearance: The agency shall complete usability testing on the collection before launch. By Nov 30, the agency shall meet with OMB to discuss their usability testing plan and will provide periodic updates until launch. The agency will provide to OMB any user feedback that highlights particular burdens associated with policy, regulatory or statutory requirements. The agency may use the previously approved version of the forms until the new online platform is launch.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2026	36 Months From Approved	08/31/2023
Responses	635,269	0	431,720
Time Burden (Hours)	341,635	0	484,189
Cost Burden (Dollars)	0	0	0

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Abstract: The information collected is required for the Public Assistance (PA) Program eligibility determinations, grants management, and compliance with other Federal laws and regulations. The Robert T. Stafford Disaster Relief and Emergency Assistance Act, 42 U.S.C. § 5121-5207 (the Stafford Act), authorizes grants to assist State, Tribal, and local governments and certain private non-profit entities with the response to and recovery from disasters following Presidentially declared major disasters and emergencies.

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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

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 76499	12/14/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 13456	03/03/2023
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 27

table that charts list of burden

IC Title	Form No.	Form Name
Applicant Impact Survey	FEMA Form FF-104-FY-22-235	Applicant Impact Survey
Applicant's Benefits Calculation Worksheet	FEMA Form FF-104-FY-21-135 (formerly 009-0-128)	Applicant's Benefits Calculation Worksheet
Contract Work Summary	FEMA Form FF-104-FY-21-140 (formerly 009-0-126)	Contract Work Summary
Damage Information	FEMA Form FF-104-FY-22-245	Damage Information
Donated Labor Sign-in	FEMA Form FF-104-FY-22-237	Donated Labor Sign-in
Equitable Vaccine Administration Information Submission Template	FEMA Template 104-FY-21-100	Equitable Vaccine Response and Recovery: Vaccine Administration Information
FAC-TRAX System	009-0-141	FAC-TRAX System
Force Account Equipment Summary	FEMA Form FF-104-FY-21-141 (formerly 009-0-127)	Force Account Equipment Summary Record
Force Account Labor Summary Record	FEMA Form FF-104-FY-21-137 (formerly 009-0-123)	Force Account Labor Summary Record
Impact List	FEMA Form FF-104-FY-22-236	Impact List
Materials Summary	FEMA Form FF-104-FY-21-138 (formerly 009-0-124)	Materials Summary Record
Organization Profile	FEMA Form FF-104-FY-22-233	Organization Profile
PNP Facility Questionnaire	FEMA Form 009-0-121	PNP Facility Questionaire
Pre-Approval Request	FEMA Form FF-104-FY-22-238	Pre-Approval Request
Project Application for Building Code and Floodplain Management and Enforcement	FEMA Form FF-104-FY-22-243	Project Application for Building Code and Floodplain Management Administration and Enforcement
Project Application for COVID-19	FEMA Form FF-104-FY-22-241	Project Application for COVID-19
Project Application for Debris Removal	FEMA Form FF-104-FY-22-239	Project Application for Debris Removal
Project Application for Emergency Protective Measures	FEMA Form FF-104-FY-22-240	Project Application for Emergency Protective Measures
Project Application for Infrastructure Restoration	FEMA Form FF-104-FY-22-242	Project Application for Infrastructure Restoration
Project Application for Management Costs	FEMA Form FF-104-FY-22-244	Project Application for Management Costs
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
Quarterly Progress Report	FEMA Form FF-104-FY-21-132 (formerly 009-0-111)	Quarterly Progress Report
Recipient Incident Information	FEMA Form FF-104-FY-22-234	Recipient Incident Information
Rented Equipment Summary	FEMA Form FF-104-FY-21-139 (formerly 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 FF-104-FY-21-131 (formerly 009-0-49)	Request for Public Assistance
Special Considerations Questions	FEMA Form 009-0-120	Special Consideration Questions
State Administrative Plan	FEMA Form FF-104-FY-22-249	State Administrative Plan
Time Extension Request	FEMA Form FF-104-FY-22-248	Time Extension
Tribe Administrative Plan	FEMA Form FF-104-FY-22-250	Tribal Administrative Plan

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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	635,269	431,720	0	254,677	-51,128	0
Annual Time Burden (Hours)	341,635	484,189	0	-78,644	-63,910	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to: Cutting Redundancy

Short Statement: FEMA has spent the last 18 months working with internal and external stakeholders to identify ways to improve their experience requesting Public Assistance and providing their damage and impact details needed to provide necessary funding to survivors and communities recovering from disasters. The changes to PA’s information collection reflects the improvements needed to simplify and streamline the information collection process. FEMA challenged itself to remove barriers and use technology to reduce the administrative burden. The result is a significant reduction in burden hours despite there being an increase in severe weather events and biological disasters. FEMA has spent the last 18 months working with internal and external stakeholders to identify ways to improve their experience requesting Public Assistance and providing their damage and impact details needed to provide necessary funding to survivors and communities recovering from disasters. The changes to PA’s information collection reflects the improvements needed to simplify and streamline the information collection process. FEMA challenged itself to remove barriers and use technology to reduce the administrative burden. The result is a significant reduction in burden hours despite there being an increase in severe weather events and biological disasters. The reduction in burden hours translates to a significant reduction in cost.

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Annual Cost to Federal Government: $2,001,955

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

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Common Form ICR:  No

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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: 03/14/2023

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