Applicant Impact Survey

Public Assistance Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1660-0017 can be found here:

Documents and Forms

Document Name Document Type
Form FEMA Form FF-104-F Applicant Impact Survey Form and Instruction
FEMA Form FF-104-F Applicant Impact Survey FF-104-FY-22-235_Applicant Impact Survey_Final.docx portal.fema.gov Form and Instruction
FEMA Form FF-104-F Applicant Impact Survey FF-104-FY-22-235_Applicant Impact Survey_Final.docx portal.fema.gov Form and Instruction

Information Collection (IC) Details

IC Title:	Applicant Impact Survey	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 206

Information Collection Instruments:

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-22-235	Applicant Impact Survey	FF-104-FY-22-235_Applicant Impact Survey_Final.docx	https://portal.fema.gov	Yes	Yes	Fillable Fileable

Line of Business: Disaster Management

Subfunction: Disaster Repair and Restore

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 60	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	60,000	60,000
Annual IC Time Burden (Hours)	7,002	7,002
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.