Signed OMB 83-C Change Request

PAPERWORK REDUCTION ACT
CHANGE WORKSHEET
Agency/Subagency

OMB control number

Department of Homeland Security (DHS) /
Federal Emergency Management Agency (FEMA)

1

6

6

0

0

1

1

5

Enter only items that change
Current record
New record
Agency form number(s)

FEMA Form FF-119-FY-21-105
(formerly 024-0-1)

FEMA Form FF-207-FY-21-100
(formerly 024-0-1)

Annual reporting and recordkeeping hour
burden
Number of respondents
Total annual responses
Percent of these responses
collected electronically

%

%

Total annual hours

0

Difference
Explanation of difference
Program change
Adjustment
Annual reporting and recordkeeping cost
burden (in thousands of dollars)
Total annualized Capital/Startup costs
Total annual costs (O&M)

0.00

Total annualized cost requested

0.00
0.00

Difference
Explanation of difference
Program change
Adjustment
Other changes**

FEMA requests the opportunity to correct the document uploaded as the instrument in ROCIS for this collection, and correct any references to the
FEMA Form number of the instrument in ROCIS and the Supporting Statement A. All burden and cost number remain the same.
Signature of Senior Official or designee:

Date:

For OIRA Use

6/06/2023
**This form cannot be used to extend an expiration date.
OMB FORM 83-C, 10/95

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