Generic Clearance for Notice of Loss and Proof of Loss

Forms and Documents

Document Name	Status
Form FEMA Form FF-104-F Generic Clearance for Notice of Loss and Proof of Loss Form	New
1660-NW163 - Supporting Statement A - 2023 08 11 clean.docx Supporting Statement A	2023-08-11
1660-NW163 - Published 30-Day New Generic FRN - 2023 08 11.pdf Supplementary Document	2023-08-11
1660-NW163 - Published 60-Day New Generic FRN - 2023 05 05.pdf Supplementary Document	2023-05-12
PLAW-117publ103.pdf Supplementary Document	2023-05-12
USCODE-2021-title42-chap68.pdf Supplementary Document	2023-05-12

IC Document Collections

IC ID	Document Title	Status
264452	Generic Clearance for Notice of Loss and Proof of Loss Form	New

ICR Details

OMB Control No:	ICR Reference No: 202305-1660-002
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: DHS/FEMA	Agency Tracking No: 1660-NW163
Title: Generic Clearance for Notice of Loss and Proof of Loss
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 08/28/2023

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	287,250	0
Time Burden (Hours)	732,490	0
Cost Burden (Dollars)	31,606,900	0

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Abstract: The Federal Emergency Management Agency (FEMA) will use the collected information to commence the process and procedures for claimants to seek compensation for injury or loss of property resulting from the Hermit’s Peak/Calf Canyon Fire and other fires that meet the criteria. Affected state, local and Tribal governments, private sector businesses, not-for-profit organizations, and individuals and households that suffered injuries resulting from fires will be eligible to apply for compensation. Claimants will submit a Notice of Loss to the Agency, meet with a FEMA Claims Reviewer, obtain documentation needed to substantiate claims, sign a Proof of Loss, and complete and return a Release and Certification form.

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Authorizing Statute(s): US Code: 42 USC 5121-5207 Name of Law: Stafford Act
   PL: Pub.L. 117 - 180 Division G Name of Law: Hermit's Peak/Calf Canyon Fire Assistance Act
  

Citations for New Statutory Requirements: PL: Pub.L. 117 - 180 Division G Name of Law: Hermit's Peak/Calf Canyon Fire Assistance Act

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 29144	05/05/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 54632	08/11/2023
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 0

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ICR Summary of Burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	287,250	0	287,250	0	0	0
Annual Time Burden (Hours)	732,490	0	732,490	0	0	0
Annual Cost Burden (Dollars)	31,606,900	0	31,606,900	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new generic collection.

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Annual Cost to Federal Government: $65,103,002

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 08/28/2023

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