Information Collection

Partial Payment Release and Certification Form - Individuals and Households

IC 258470 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-104-F Partial Payment Release and Certification Form - Individuals and Households	Form and Instruction
Form FEMA Form FF-104-F Partial Payment Release and Certification Form Partial Payment Release and Certification Form - Individuals and Households	Form and Instruction
Form FEMA Form FF-104-F Partial Payment Release and Certification Form (Spanish) Partial Payment Release and Certification Form - Individuals and Households	Form and Instruction
FEMA Form FF-104-F Partial Payment Release and Certification Form FEMA Form FF-104-FY-22-252_DRAFT.pdf www.fema.gov/hermits-peak	Form and Instruction
FEMA Form FF-104-F Partial Payment Release and Certification Form FEMA Form FF-104-FY-22-252_DRAFT.pdf www.fema.gov/hermits-peak	Form and Instruction
FEMA Form FF-104-F Partial Payment Release and Certification Form (Spanish) FEMA Form FF-104-FY-22-252-A_DRAFT.pdf www.fema.gov/hermits-peak	Form and Instruction
FEMA Form FF-104-F Partial Payment Release and Certification Form (Spanish) FEMA Form FF-104-FY-22-252-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: 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-22-252	Partial Payment Release and Certification Form	FEMA Form FF-104-FY-22-252_DRAFT.pdf	https://www.fema.gov/hermits-peak	Yes	Yes	Fillable Fileable Signable
Form and Instruction	FEMA Form FF-104-FY-22-252-A	Partial Payment Release and Certification Form (Spanish)	FEMA Form FF-104-FY-22-252-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: 9,479

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	9,479	9,479
Annual IC Time Burden (Hours)	2,370	2,370
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.