Partial Payment Release and Certification Form (Entity) - Private Sector

Notice of Loss and Proof of Loss

OMB: 1660-0155

IC ID: 258469

Information Collection (IC) Details

View Information Collection (IC)

Partial Payment Release and Certification Form (Entity) - Private Sector
 
No New
 
Required to Obtain or Retain Benefits
 

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-22-253 Partial Payment Release and Certification Form (Entity) FEMA Form FF-104-FY-22-253_DRAFT.pdf https://www.fema.gov/hermits-peak Yes Yes Fillable Fileable Signable
Form and Instruction FEMA Form FF-104-FY-22-253-A Partial Payment Release and Certification Form (Entity) (Spanish) FEMA Form FF-104-FY-22-253-A_DRAFT.pdf https://www.fema.gov/hermits-peak Yes Yes Fillable Fileable Signable

Disaster Management Disaster Repair and Restore

 

18,959 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 18,959 0 18,959 0 0 0
Annual IC Time Burden (Hours) 4,740 0 4,740 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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