Information Collection

Generic Clearance for Notice of Loss and Proof of Loss

IC 264452 under ICR 202403-1660-006 · OMB 1660-0159.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1660-0159 can be found here:

2024-04-05 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FEMA Form FF-104-F Generic Clearance for Notice of Loss and Proof of Loss	Form
Form FEMA Form FF-104-F Generic Clearance for Notice of Loss and Proof of Loss	Form
FEMA Form FF-104-F #1 Proof of Loss (English) FEMA Form FF-104-FY-22-231_V2_DRAFT.pdf	Form
FEMA Form FF-104-F #1 Proof of Loss (English) FEMA Form FF-104-FY-22-231_V2_DRAFT.pdf	Form
FEMA Forn FF-104-F #1 Proof of Loss (Spanish) FEMA Form FF-104-FY-22-231-A_V2_DRAFT.pdf	Form
FEMA Forn FF-104-F #1 Proof of Loss (Spanish) FEMA Form FF-104-FY-22-231-A_V2_DRAFT.pdf	Form
FEMA Form FF-104-F #2 Release and Certification (Individual/Household)- Par FEMA Form FF-104-FY-22-252_DRAFT.pdf	Form
FEMA Form FF-104-F #2 Release and Certification (Individual/Household)- Par FEMA Form FF-104-FY-22-252_DRAFT.pdf	Form
FEMA Form FF-104-F #2 Release and Certification (Individual/Household)- Par FEMA Form FF-104-FY-22-252-A_DRAFT.pdf	Form
FEMA Form FF-104-F #2 Release and Certification (Individual/Household)- Par FEMA Form FF-104-FY-22-252-A_DRAFT.pdf	Form
FEMA Form FF-104-F #3 Release and Certification (Entity)- Partial Payment ( FEMA Form FF-104-FY-22-253_DRAFT.pdf	Form
FEMA Form FF-104-F #3 Release and Certification (Entity)- Partial Payment ( FEMA Form FF-104-FY-22-253_DRAFT.pdf	Form
FEMA Form FF-104-F #3 Release and Certification (Entity)- Partial Payment ( FEMA Form FF-104-FY-22-253-A_DRAFT.pdf	Form
FEMA Form FF-104-F #3 Release and Certification (Entity)- Partial Payment ( FEMA Form FF-104-FY-22-253-A_DRAFT.pdf	Form
FEMA Form FF-104-F #4 Notice of Loss (English) FEMA Form FF-104-FY-22-230_DRAFT.pdf	Form
FEMA Form FF-104-F #4 Notice of Loss (English) FEMA Form FF-104-FY-22-230_DRAFT.pdf	Form
FEMA Form FF-104-F #4 Notice of Loss (Spanish) FEMA Form FF-104-FY-22-230-A_DRAFT.pdf	Form
FEMA Form FF-104-F #4 Notice of Loss (Spanish) FEMA Form FF-104-FY-22-230-A_DRAFT.pdf	Form
FEMA Form FF-104-F #5 Request to Supplement Claim (English) FEMA Form FF-104-FY-22-254_DRAFT.pdf	Form
FEMA Form FF-104-F #5 Request to Supplement Claim (English) FEMA Form FF-104-FY-22-254_DRAFT.pdf	Form
FEMA Form FF-104-F #5 Request to Supplement Claim (Spanish) FEMA Form FF-104-FY-22-254-A_DRAFT.pdf	Form
FEMA Form FF-104-F #5 Request to Supplement Claim (Spanish) FEMA Form FF-104-FY-22-254-A_DRAFT.pdf	Form
FEMA Form FF-104-F Banking Information Form (English) FEMA Form FF-104-FY-22-251_DRAFT.pdf	Form
FEMA Form FF-104-F Banking Information Form (English) FEMA Form FF-104-FY-22-251_DRAFT.pdf	Form
FEMA Form FF-104-F Banking Information Form (Spanish) FEMA Form FF-104-FY-22-251-A_DRAFT.pdf	Form
FEMA Form FF-104-F Banking Information Form (Spanish) FEMA Form FF-104-FY-22-251-A_DRAFT.pdf	Form
1660-0159 Generic Application POL-11-2023_Signed.pdf #1 Generic Application- Proof of Loss	IC Document
1660-0159 Generic Application POL-11-2023_Signed.pdf #1 Generic Application- Proof of Loss	IC Document
1660-0159 - Gen App FF-104-FY-22-252 (RC-House).pdf #2 Generic Application- Release and Certification (Indivivual/Household))	IC Document
1660-0159 - Gen App FF-104-FY-22-252 (RC-House).pdf #2 Generic Application- Release and Certification (Indivivual/Household))	IC Document
1660-0159 - Gen App FF-104-FY-22-253 (RC Entity).pdf #3 Generic Application- Release and Certification (Entity)	IC Document
1660-0159 - Gen App FF-104-FY-22-253 (RC Entity).pdf #3 Generic Application- Release and Certification (Entity)	IC Document
1660-0159 - Gen App FF-104-FY-22-230 (NOL).pdf #4 Generic Application-Notice of Loss	IC Document
1660-0159 - Gen App FF-104-FY-22-230 (NOL).pdf #4 Generic Application-Notice of Loss	IC Document
1660-0159 - Gen App FF-104-FY-22-254 (Supplement).pdf #5 Generic Application- Request to Supplement Claim	IC Document
1660-0159 - Gen App FF-104-FY-22-254 (Supplement).pdf #5 Generic Application- Request to Supplement Claim	IC Document
1660-0159 - Gen App FF-104-FY-22-251 (Bank Info).pdf #6 Generic Application- Banking Information Form	IC Document
1660-0159 - Gen App FF-104-FY-22-251 (Bank Info).pdf #6 Generic Application- Banking Information Form	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Generic Clearance for Notice of Loss and Proof of Loss

Agency IC Tracking Number:

Instruments #1-#6

IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 44 CFR Part 269 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form	FEMA Form FF-104-FY-22-231	#1 Proof of Loss (English)	FEMA Form FF-104-FY-22-231_V2_DRAFT.pdf	No	Printable Only
Form	FEMA Forn FF-104-FY-22-231-A	#1 Proof of Loss (Spanish)	FEMA Form FF-104-FY-22-231-A_V2_DRAFT.pdf	No	Printable Only
Form	FEMA Form FF-104-FY-22-252	#2 Release and Certification (Individual/Household)- Partial Payment (English)	FEMA Form FF-104-FY-22-252_DRAFT.pdf	No	Printable Only
Form	FEMA Form FF-104-FY-22-252-A	#2 Release and Certification (Individual/Household)- Partial Payment (Spanish)	FEMA Form FF-104-FY-22-252-A_DRAFT.pdf	No	Printable Only
Form	FEMA Form FF-104-FY-22-253	#3 Release and Certification (Entity)- Partial Payment (English)	FEMA Form FF-104-FY-22-253_DRAFT.pdf	No	Printable Only
Form	FEMA Form FF-104-FY-22-253-A	#3 Release and Certification (Entity)- Partial Payment (Spanish)	FEMA Form FF-104-FY-22-253-A_DRAFT.pdf	No	Printable Only
Form	FEMA Form FF-104-FY-22-230	#4 Notice of Loss (English)	FEMA Form FF-104-FY-22-230_DRAFT.pdf	No	Printable Only
Form	FEMA Form FF-104-FY-22-230-A	#4 Notice of Loss (Spanish)	FEMA Form FF-104-FY-22-230-A_DRAFT.pdf	No	Printable Only
Form	FEMA Form FF-104-FY-22-254	#5 Request to Supplement Claim (English)	FEMA Form FF-104-FY-22-254_DRAFT.pdf	No	Printable Only
Form	FEMA Form FF-104-FY-22-254-A	#5 Request to Supplement Claim (Spanish)	FEMA Form FF-104-FY-22-254-A_DRAFT.pdf	No	Printable Only
Form	FEMA Form FF-104-FY-22-251	Banking Information Form (English)	FEMA Form FF-104-FY-22-251_DRAFT.pdf	No	Printable Only
Form	FEMA Form FF-104-FY-22-251-A	Banking Information Form (Spanish)	FEMA Form FF-104-FY-22-251-A_DRAFT.pdf	No	Printable Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Disaster Management

Subfunction: Disaster Repair and Restore

Privacy Act System of Records

Title: DHS/ALL-013 Department of Homeland Security Claims Records

FR Citation: 73 FR 63987

Number of Respondents: 28,725

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	28,725	28,725
Annual IC Time Burden (Hours)	696,581	696,581
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
#1 Generic Application- Proof of Loss	1660-0159 Generic Application POL-11-2023_Signed.pdf	01/17/2024
#2 Generic Application- Release and Certification (Indivivual/Household))	1660-0159 - Gen App FF-104-FY-22-252 (RC-House).pdf	01/17/2024
#3 Generic Application- Release and Certification (Entity)	1660-0159 - Gen App FF-104-FY-22-253 (RC Entity).pdf	01/17/2024
#4 Generic Application-Notice of Loss	1660-0159 - Gen App FF-104-FY-22-230 (NOL).pdf	01/17/2024
#5 Generic Application- Request to Supplement Claim	1660-0159 - Gen App FF-104-FY-22-254 (Supplement).pdf	01/17/2024
#6 Generic Application- Banking Information Form	1660-0159 - Gen App FF-104-FY-22-251 (Bank Info).pdf	01/17/2024

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.