Information Collection

Impact List

IC 257673 under ICR 202212-1660-015 · OMB 1660-0017.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1660-0017 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FEMA Form FF-104-F Impact List	Form and Instruction
FEMA Form FF-104-F Impact List FF-104-FY-22-236_Impact List_Final .docx portal.fema.gov	Form and Instruction
FEMA Form FF-104-F Impact List FF-104-FY-22-236_Impact List_Final .docx portal.fema.gov	Form and Instruction

IC Title:

Impact List

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

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-22-236	Impact List	FF-104-FY-22-236_Impact List_Final .docx	https://portal.fema.gov	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: 60

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	60,000	60,000
Annual IC Time Burden (Hours)	30,000	30,000
Annual IC Cost Burden (Dollars)	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.