Declaration and Release

Disaster Assistance Registration

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1660-0002 can be found here:

Documents and Forms

Document Name Document Type
Form FF-104-FY-21-128 ( Declaration and Release Form
FF-104-FY-21-128 ( Declaration and Release Form (English) FEMA Form FF-104-FY-21-128 (formerly 009-0-3) (English).pdf Form
FF-104-FY-21-128 ( Declaration and Release Form (English) FEMA Form FF-104-FY-21-128 (formerly 009-0-3) (English).pdf Form
FF-104-FY-21-128-A Declaration and Release Form (Spanish) FEMA Form FF-104-FY-21-128-A (formerly 009-0-4) (Spanish).pdf Form
FF-104-FY-21-128-A Declaration and Release Form (Spanish) FEMA Form FF-104-FY-21-128-A (formerly 009-0-4) (Spanish).pdf Form

Information Collection (IC) Details

IC Title:	Declaration and Release	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 44 CFR Part 206 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	FF-104-FY-21-128 (formerly 009-0-3)	Declaration and Release Form (English)	FEMA Form FF-104-FY-21-128 (formerly 009-0-3) (English).pdf		No		Paper Only
Form	FF-104-FY-21-128-A (formerly 009-0-4)	Declaration and Release Form (Spanish)	FEMA Form FF-104-FY-21-128-A (formerly 009-0-4) (Spanish).pdf		No		Paper Only

Line of Business: Disaster Management

Subfunction: Emergency Response

Privacy Act System of Records
Title: Disaster Recovery Assistance Files System of Records	FR Citation: 78 FR 25282

Number of Respondents: 2,300	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	2,300	2,300
Annual IC Time Burden (Hours)	77	77
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.