Information Collection

Proof of Loss - State, Local, and Tribal Governments

IC 256768 under ICR 202302-1660-001 · OMB 1660-0155.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FEMA Form FF-204-F Proof of Loss - State, Local, and Tribal Governments	Form and Instruction
Form FEMA Form FF-204-F Proof of Loss - State, Local, and Tribal Governments	Form and Instruction
FEMA Form FF-204-F Proof of Loss FEMA Form FF-104-FY-22-231_DRAFT.pdf www.fema.gov/hermits-peak	Form and Instruction
FEMA Form FF-204-F Proof of Loss FEMA Form FF-104-FY-22-231_DRAFT.pdf www.fema.gov/hermits-peak	Form and Instruction
FEMA Form FF-204-F Proof of Loss (Spanish) FEMA Form FF-104-FY-22-231-A_DRAFT.pdf www.fema.gov/hermits-peak	Form and Instruction
FEMA Form FF-204-F Proof of Loss (Spanish) FEMA Form FF-104-FY-22-231-A_DRAFT.pdf www.fema.gov/hermits-peak	Form and Instruction

IC Title:

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 Part 296 (To search for a specific CFR, visit the Code of Federal Regulations.)

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-204-FY-22-231	Proof of Loss	FEMA Form FF-104-FY-22-231_DRAFT.pdf	https://www.fema.gov/hermits-peak	Yes	Yes	Fillable Fileable Signable
Form and Instruction	FEMA Form FF-204-FY-22-231-A	Proof of Loss (Spanish)	FEMA Form FF-104-FY-22-231-A_DRAFT.pdf	https://www.fema.gov/hermits-peak	Yes	Yes	Fillable Fileable Signable

Line of Business: Disaster Management

Subfunction: Disaster Repair and Restore

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 287

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	Previously Approved
Annual Number of Responses for this IC	287	287
Annual IC Time Burden (Hours)	6,458	6,458
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.