Public Assistance Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form FEMA Form FF-104-F Request for Public Assistance	Form and Instruction	Unchanged	Available
Form FEMA Form FF-104-F Request for Public Assistance	Form and Instruction	Unchanged	Repair queued
Form FEMA Form FF-104-F Tribal Administrative Plan	Form and Instruction	Unchanged	Available
Form FEMA Form FF-104-F Tribe Administrative Plan	Form and Instruction	Unchanged	Repair queued
Form FEMA Form FF-104-F Time Extension	Form and Instruction	Unchanged	Available
Form FEMA Form FF-104-F Time Extension Request	Form and Instruction	Unchanged	Repair queued
Form FEMA Form FF-104-F Damage Information	Form and Instruction	Unchanged	Available
Form FEMA Form FF-104-F Damage Information	Form and Instruction	Unchanged	Repair queued
Form FEMA Form FF-104-F Project Application for Management Costs	Form and Instruction	Unchanged	Available
Form FEMA Form FF-104-F Project Application for Management Costs	Form and Instruction	Unchanged	Repair queued
Form FEMA Form FF-104-F Project Application for Building Code and Floodplain Management Administration and Enforcement	Form and Instruction	Unchanged	Available
Form FEMA Form FF-104-F Project Application for Building Code and Floodplain Management and Enforcement	Form and Instruction	Unchanged	Repair queued
Form FEMA Form FF-104-F Project Application for Infrastructure Restoration	Form and Instruction	Unchanged	Available
Form FEMA Form FF-104-F Project Application for Infrastructure Restoration	Form and Instruction	Unchanged	Repair queued
Form FEMA Form FF-104-F Project Application for COVID-19	Form and Instruction	Unchanged	Available
Form FEMA Form FF-104-F Project Application for COVID-19	Form and Instruction	Unchanged	Repair queued
Form FEMA Form FF-104-F Project Application for Emergency Protective Measures	Form and Instruction	Unchanged	Available
Form FEMA Form FF-104-F Project Application for Emergency Protective Measures	Form and Instruction	Unchanged	Repair queued
Form FEMA Form FF-104-F Project Application for Debris Removal	Form and Instruction	Unchanged	Available
Form FEMA Form FF-104-F Project Application for Debris Removal	Form and Instruction	Unchanged	Repair queued
Form FEMA Form FF-104-F Pre-Approval Request	Form and Instruction	Modified	Available
Form FEMA Form FF-104-F Pre-Approval Request	Form and Instruction	Modified	Repair queued
Form FEMA Form FF-104-F Donated Labor Sign-in	Form and Instruction	Unchanged	Available
Form FEMA Form FF-104-F Donated Labor Sign-in	Form and Instruction	Unchanged	Repair queued
Form FEMA Form FF-104-F Impact List	Form and Instruction	Unchanged	Available
Form FEMA Form FF-104-F Impact List	Form and Instruction	Unchanged	Repair queued
Form FEMA Form FF-104-F Applicant Impact Survey	Form and Instruction	Unchanged	Available
Form FEMA Form FF-104-F Applicant Impact Survey	Form and Instruction	Unchanged	Repair queued
Form FEMA Form FF-104-F Recipient Incident Information	Form and Instruction	Unchanged	Available
Form FEMA Form FF-104-F Recipient Incident Information	Form and Instruction	Unchanged	Repair queued
Form FEMA Form FF-104-F Organization Profile	Form and Instruction	Unchanged	Available
Form FEMA Form FF-104-F Organization Profile	Form and Instruction	Unchanged	Repair queued
Form FEMA Template 104- Equitable Vaccine Response and Recovery: Vaccine Administration Information	Form and Instruction	Unchanged	Available
Form FEMA Template 104- Equitable Vaccine Administration Information Submission Template	Form and Instruction	Unchanged	Repair queued
Form FEMA Form FF-104-F State Administrative Plan	Form and Instruction	Unchanged	Available
Form FEMA Form FF-104-F State Administrative Plan	Form and Instruction	Unchanged	Repair queued
Form FEMA Form FF-104-F Force Account Equipment Summary Record	Form and Instruction	Unchanged	Available
Form FEMA Form FF-104-F Force Account Equipment Summary	Form and Instruction	Unchanged	Repair queued
Form FEMA Form FF-104-F Contract Work Summary	Form and Instruction	Unchanged	Available
Form FEMA Form FF-104-F Contract Work Summary	Form and Instruction	Unchanged	Repair queued
Form FEMA Form FF-104-F Rented Equipment Summary Record	Form and Instruction	Unchanged	Available
Form FEMA Form FF-104-F Rented Equipment Summary	Form and Instruction	Unchanged	Repair queued
Form FEMA Form FF-104-F Materials Summary Record	Form and Instruction	Unchanged	Available
Form FEMA Form FF-104-F Materials Summary	Form and Instruction	Unchanged	Repair queued
Form FEMA Form FF-104-F Force Account Labor Summary Record	Form and Instruction	Unchanged	Available
Form FEMA Form FF-104-F Force Account Labor Summary Record	Form and Instruction	Unchanged	Repair queued
Form FEMA Form FF-104-F Applicant's Benefits Calculation Worksheet	Form and Instruction	Unchanged	Available
Form FEMA Form FF-104-F Applicant's Benefits Calculation Worksheet	Form and Instruction	Unchanged	Repair queued
Form FEMA Form FF-104-F Quarterly Progress Report	Form and Instruction	Unchanged	Available
Form FEMA Form FF-104-F Quarterly Progress Report	Form and Instruction	Unchanged	Repair queued
1660-0017 - Emergency Supporting Statement A - 2023 11 02 clean.docx	Supporting Statement A	Uploaded 2023-11-02	Repair queued
1660-0017 Emergency Justification Memo - 11022023.pdf	Supplementary Document	Uploaded 2023-11-02	Repair queued
1600-0017 - Published 30-Day BRI FRN - 2023 03 03.pdf	Supplementary Document	Uploaded 2023-03-03	Repair queued
1600-0017 - Published 60-Day BRI FRN - 2022 12 14.pdf	Supplementary Document	Uploaded 2022-12-30	Repair queued
privacy-pia-fema-hmgp.pdf	Supplementary Document	Uploaded 2022-12-30	Repair queued
privacy_pia_FEMA_GrantManagementPrograms_February2015.pdf	Supplementary Document	Uploaded 2022-12-30	Repair queued
SORN, DHS-FEMA-009 HMA, PA, and CDL SORN (78 FR 16015, 2014 03 24).pdf	Supplementary Document	Uploaded 2022-12-30	Repair queued
stafford_act.pdf	Supplementary Document	Uploaded 2016-09-02	Repair queued
CFR-2011-title44-vol1-part206.pdf	Supplementary Document	Uploaded 2016-09-01	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
41294	Request for Public Assistance	Form and Instruction	Unchanged	Request for Public Assistance
41294	Request for Public Assistance	Form and Instruction	Unchanged
257686	Tribe Administrative Plan	Form and Instruction	Unchanged	Tribal Administrative Plan
257686	Tribe Administrative Plan	Form and Instruction	Unchanged
257685	Time Extension Request	Form and Instruction	Unchanged	Time Extension
257685	Time Extension Request	Form and Instruction	Unchanged
257682	Damage Information	Form and Instruction	Unchanged	Damage Information
257682	Damage Information	Form and Instruction	Unchanged
257681	Project Application for Management Costs	Form and Instruction	Unchanged	Project Application for Management Costs
257681	Project Application for Management Costs	Form and Instruction	Unchanged
257680	Project Application for Building Code and Floodplain Management and Enforcement	Form and Instruction	Unchanged	Project Application for Building Code and Floodplain Management Administration and Enforcement
257680	Project Application for Building Code and Floodplain Management and Enforcement	Form and Instruction	Unchanged
257679	Project Application for Infrastructure Restoration	Form and Instruction	Unchanged	Project Application for Infrastructure Restoration
257679	Project Application for Infrastructure Restoration	Form and Instruction	Unchanged
257678	Project Application for COVID-19	Form and Instruction	Unchanged	Project Application for COVID-19
257678	Project Application for COVID-19	Form and Instruction	Unchanged
257677	Project Application for Emergency Protective Measures	Form and Instruction	Unchanged	Project Application for Emergency Protective Measures
257677	Project Application for Emergency Protective Measures	Form and Instruction	Unchanged
257676	Project Application for Debris Removal	Form and Instruction	Unchanged	Project Application for Debris Removal
257676	Project Application for Debris Removal	Form and Instruction	Unchanged
257675	Pre-Approval Request	Form and Instruction	Modified	Pre-Approval Request
257675	Pre-Approval Request	Form and Instruction	Modified
257674	Donated Labor Sign-in	Form and Instruction	Unchanged	Donated Labor Sign-in
257674	Donated Labor Sign-in	Form and Instruction	Unchanged
257673	Impact List	Form and Instruction	Unchanged	Impact List
257673	Impact List	Form and Instruction	Unchanged
257672	Applicant Impact Survey	Form and Instruction	Unchanged	Applicant Impact Survey
257672	Applicant Impact Survey	Form and Instruction	Unchanged
257671	Recipient Incident Information	Form and Instruction	Unchanged	Recipient Incident Information
257671	Recipient Incident Information	Form and Instruction	Unchanged
257670	Organization Profile	Form and Instruction	Unchanged	Organization Profile
257670	Organization Profile	Form and Instruction	Unchanged
247457	Equitable Vaccine Administration Information Submission Template	Form and Instruction	Unchanged	Equitable Vaccine Response and Recovery: Vaccine Administration Information
247457	Equitable Vaccine Administration Information Submission Template	Form and Instruction	Unchanged
191941	State Administrative Plan	Form and Instruction	Unchanged	State Administrative Plan
191941	State Administrative Plan	Form and Instruction	Unchanged
190424	Request for Arbitration and Recommendation from Hurricanes Katrina or Rita		Unchanged
190419	Request for Appeals and Recommendation		Unchanged
185911	Force Account Equipment Summary	Form and Instruction	Unchanged	Force Account Equipment Summary Record
185911	Force Account Equipment Summary	Form and Instruction	Unchanged
185910	Contract Work Summary	Form and Instruction	Unchanged	Contract Work Summary
185910	Contract Work Summary	Form and Instruction	Unchanged
185909	Rented Equipment Summary	Form and Instruction	Unchanged	Rented Equipment Summary Record
185909	Rented Equipment Summary	Form and Instruction	Unchanged
185908	Materials Summary	Form and Instruction	Unchanged	Materials Summary Record
185908	Materials Summary	Form and Instruction	Unchanged
185907	Force Account Labor Summary Record	Form and Instruction	Unchanged	Force Account Labor Summary Record
185907	Force Account Labor Summary Record	Form and Instruction	Unchanged
185903	Applicant's Benefits Calculation Worksheet	Form and Instruction	Unchanged	Applicant's Benefits Calculation Worksheet
185903	Applicant's Benefits Calculation Worksheet	Form and Instruction	Unchanged
185897	Quarterly Progress Report	Form and Instruction	Unchanged	Quarterly Progress Report
185897	Quarterly Progress Report	Form and Instruction	Unchanged

ICR Details

OMB Control No: 1660-0017	ICR Reference No: 202311-1660-001
Status: Historical Active	Previous ICR Reference No: 202212-1660-015
Agency/Subagency: DHS/FEMA	Agency Tracking No: Emergency - Non-Congregate Sheltering
Title: Public Assistance Program
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 11/03/2023
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/03/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/02/2023
Terms of Clearance: This request is approved pursuant to 5 CFR 1320.13 due to emergency situation that emerged as a result of the wildfires in Hawaii. This approval is limited to the collections use in that emergency. The agency is reminded that the collection of information should not begin until official approval is provided by OIRA upon review of the emergency justification. The previous terms of clearance are still in effect.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2024	6 Months From Approved	08/31/2026
Responses	635,269	0	635,269
Time Burden (Hours)	341,635	0	341,635
Cost Burden (Dollars)	0	0	0

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Abstract: The information collected is required for the Public Assistance (PA) Program eligibility determinations, grants management, and compliance with other Federal laws and regulations. The Robert T. Stafford Disaster Relief and Emergency Assistance Act, 42 U.S.C. § 5121-5207 (the Stafford Act), authorizes grants to assist State, Tribal, and local governments and certain private non-profit entities with the response to and recovery from disasters following Presidentially declared major disasters and emergencies.

Emergency Justfication: State, local, tribal, and territorial (SLTT) governments can request sheltering support services after receiving an emergency or major disaster declaration authorizing PA emergency protective measures. FEMA provides PA funding to SLTT governments for costs related to emergency sheltering for disaster survivors. Typically, sheltering occurs in facilities with large open spaces, such as schools, churches, community centers, or other similar facilities. However, there are situations when the need arises to support survivors in non-congregate shelters, which are locations where each individual or household has living space that offers some level of privacy such as hotels, motels, or dormitories. To ensure FEMA can track individuals and households transitioned into more permanent housing solutions and the successful reimbursement to the state for the cost of sheltering survivors, additional information needs to be collected to support non-congregate sheltering in Hawaii. The following questions should be included into PA’s information collection 1660-0017: Number of rooms Check in date Check out date Person ID Site ID for shelter With the escalating demand for sheltering services and the recognition that sheltering periods are likely to extend in the face of mounting housing crises, FEMA should make this data collection change not only for Hawaii but as a standard practice for future disaster scenarios. This will better equip FEMA to meet the evolving needs of survivors and communities during these challenging times. It is vital that FEMA implement the revision to PA’s information collection as soon as possible.

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Authorizing Statute(s): PL: Pub.L. 93 - 288 406-407 Name of Law: Robert T. Stafford Disaster Relief and Emergency Assistance Act
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 5 601 Name of Law: American Recovery and Reinvestment Act of 2009

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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

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 27

table that charts list of burden

IC Title	Form No.	Form Name
Applicant Impact Survey	FEMA Form FF-104-FY-22-235	Applicant Impact Survey
Applicant's Benefits Calculation Worksheet	FEMA Form FF-104-FY-21-135 (formerly 009-0-128)	Applicant's Benefits Calculation Worksheet
Contract Work Summary	FEMA Form FF-104-FY-21-140 (formerly 009-0-126)	Contract Work Summary
Damage Information	FEMA Form FF-104-FY-22-245	Damage Information
Donated Labor Sign-in	FEMA Form FF-104-FY-22-237	Donated Labor Sign-in
Equitable Vaccine Administration Information Submission Template	FEMA Template 104-FY-21-100	Equitable Vaccine Response and Recovery: Vaccine Administration Information
Force Account Equipment Summary	FEMA Form FF-104-FY-21-141 (formerly 009-0-127)	Force Account Equipment Summary Record
Force Account Labor Summary Record	FEMA Form FF-104-FY-21-137 (formerly 009-0-123)	Force Account Labor Summary Record
Impact List	FEMA Form FF-104-FY-22-236	Impact List
Materials Summary	FEMA Form FF-104-FY-21-138 (formerly 009-0-124)	Materials Summary Record
Organization Profile	FEMA Form FF-104-FY-22-233	Organization Profile
Pre-Approval Request	FEMA Form FF-104-FY-22-238	Pre-Approval Request
Project Application for Building Code and Floodplain Management and Enforcement	FEMA Form FF-104-FY-22-243	Project Application for Building Code and Floodplain Management Administration and Enforcement
Project Application for COVID-19	FEMA Form FF-104-FY-22-241	Project Application for COVID-19
Project Application for Debris Removal	FEMA Form FF-104-FY-22-239	Project Application for Debris Removal
Project Application for Emergency Protective Measures	FEMA Form FF-104-FY-22-240	Project Application for Emergency Protective Measures
Project Application for Infrastructure Restoration	FEMA Form FF-104-FY-22-242	Project Application for Infrastructure Restoration
Project Application for Management Costs	FEMA Form FF-104-FY-22-244	Project Application for Management Costs
Quarterly Progress Report	FEMA Form FF-104-FY-21-132 (formerly 009-0-111)	Quarterly Progress Report
Recipient Incident Information	FEMA Form FF-104-FY-22-234	Recipient Incident Information
Rented Equipment Summary	FEMA Form FF-104-FY-21-139 (formerly 009-0-125)	Rented Equipment Summary Record
Request for Appeals and Recommendation
Request for Arbitration and Recommendation from Hurricanes Katrina or Rita
Request for Public Assistance	FEMA Form FF-104-FY-21-131 (formerly 009-0-49)	Request for Public Assistance
State Administrative Plan	FEMA Form FF-104-FY-22-249	State Administrative Plan
Time Extension Request	FEMA Form FF-104-FY-22-248	Time Extension
Tribe Administrative Plan	FEMA Form FF-104-FY-22-250	Tribal Administrative Plan

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ICR Summary of Burden

table that charts list of burden

	Total Approved	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	635,269	635,269	0	0	0	0
Annual Time Burden (Hours)	341,635	341,635	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	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:

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Annual Cost to Federal Government: $2,001,955

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.     Yes

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.     Yes

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? Yes

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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: 11/02/2023

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