Request to Supplement Claim - Individuals and Households

Notice of Loss and Proof of Loss

OMB: 1660-0155

IC ID: 258474

Information Collection (IC) Details

View Information Collection (IC)

Request to Supplement Claim - Individuals and Households
 
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-22-254 Request 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

Disaster Management Disaster Repair and Restore

 

9,479 0
   
Individuals or Households
 
   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 9,479 0 9,479 0 0 0
Annual IC Time Burden (Hours) 1,611 0 1,611 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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