OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Generic Clearance for Notice of Loss and Proof of Loss

IC 264452 under ICR 202404-1660-002 · OMB 1660-0159.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
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 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-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-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 (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 (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 (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 - 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-22-230 (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-22-251 (Bank Info).pdf
#6 Generic Application- Banking Information Form		IC Document

Information Collection (IC) Details

View Information Collection (IC)

layout table

Information Collection Instruments:
table that charts list of instruments
Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted 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


table that charts list of burden
  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 28,725 0 0 0 0 28,725
Annual IC Time Burden (Hours) 696,581 0 0 0 0 696,581
Annual IC Cost Burden (Dollars) 0 0 0 0 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.