Second Batch of Hermits Peak Instruments (Revised)

Generic Clearance for Notice of Loss and Proof of Loss

OMB: 1660-0159

IC ID: 266617

Documents and Forms
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Information Collection (IC) Details

View Information Collection (IC)

Second Batch of Hermits Peak Instruments (Revised)
 
New
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form FEMA Form FF-104-FY-22-230 Notice of Loss FEMA Form FF-104-FY-22-230_NEW.pdf Yes Yes Fillable Fileable
Form FEMA Form FF-104-FY-22-230-A Formulario de Notificacion de Perdida FEMA Form FF-104-FY-22-230-A_DRAFT.pdf Yes Yes Fillable Fileable
Form FEMA Form FF-104-FY-22-231 Proof of Loss FEMA Form FF-104-FY-22-231_DRAFT.pdf Yes Yes Fillable Fileable
Form FEMA Form FF-104-FY-22-231-A Comprobante de Perdida - Incendio en Hermit's Peak/Calf Canyon FEMA Form FF-104-FY-22-231-A_DRAFT.pdf Yes Yes Fillable Fileable
Form FEMA Form FF-104-FY-22-251 Banking Information Form FEMA Form FF-104-FY-22-251_DRAFT.pdf Yes Yes Fillable Fileable
Form FEMA Form FF-104-FY-22-251-A Formulario de Informacion Bancaria FEMA Form FF-104-FY-22-251-A_DRAFT.pdf Yes Yes Fillable Fileable
Form FEMA Form FF-104-FY-22-252 Release and Certification (Individual/Household) - Partial FEMA Form FF-104-FY-22-252_DRAFT.pdf Yes Yes Fillable Fileable
Form FEMA Form FF-104-FY-22-253 Release and Certification (Entity) - Partial Payment FEMA Form FF-104-FY-22-253_DRAFT.pdf Yes Yes Fillable Fileable

Disaster Management Disaster Repair and Restore

 

143,625 0
   
Private Sector Businesses or other for-profits
 
   0 %

  Approved 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 143,625 0 143,625 0 0 0
Annual IC Time Burden (Hours) 691,799 0 691,799 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Generic Application - Notice of Loss 1660-0159 Generic Application NOL- 03-2024.docx 04/09/2024
Generic Application - Proof of Loss 1660-0159 Generic Application POL-04-2024.docx 04/09/2024
Generic Application - Banking Information 1660-0159 Generic Application Banking Info - 11-2023_Signed.docx 04/09/2024
Generic Application - Release and Certification (I/H) 1660-0159 Generic Application Partial RC (I-H)-04-2024.docx 04/09/2024
Generic Application - Release and Certification (Entity) 1660-0159 Generic Application Partial RC (entity)-04-2024.docx 04/09/2024
Worksheet - Burden and Opportunity Costs 1660-0159 - Burden and Opportunity Costs for 2nd Batch BMOPRA-1111.xlsx 04/09/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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