Information Collection

Request to Supplement Claim - State, Local and Tribal Governments

IC 258472 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 Request to Supplement Claim - State, Local and Tribal Governments	Form and Instruction
Form FEMA Form FF-104-F Requeset to Supplement Claim Request to Supplement Claim - State, Local and Tribal Governments	Form and Instruction
Form FEMA Form FF-104-F Request to Supplement Claim (Spanish) Request to Supplement Claim - State, Local and Tribal Governments	Form and Instruction
FEMA Form FF-104-F Requeset to Supplement Claim FEMA Form FF-104-FY-22-254_DRAFT.pdf www.fema.gov/hermits-peak	Form and Instruction
FEMA Form FF-104-F Requeset to Supplement Claim FEMA Form FF-104-FY-22-254_DRAFT.pdf www.fema.gov/hermits-peak	Form and Instruction
FEMA Form FF-104-F Request to Supplement Claim (Spanish) FEMA Form FF-104-FY-22-254-A_DRAFT.pdf www.fema.gov/hermits-peak	Form and Instruction
FEMA Form FF-104-F Request to Supplement Claim (Spanish) FEMA Form FF-104-FY-22-254-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-22-254	Requeset to Supplement Claim	FEMA Form FF-104-FY-22-254_DRAFT.pdf	https://www.fema.gov/hermits-peak	Yes	Yes	Fillable Fileable Signable
Form and Instruction	FEMA Form FF-104-FY-22-254-A	Request to Supplement Claim (Spanish)	FEMA Form FF-104-FY-22-254-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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	287	287
Annual IC Time Burden (Hours)	49	49
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.