Information Collection

Second Batch of Hermits Peak Instruments (Revised)

IC 266617 under ICR 202404-1660-002 · OMB 1660-0159.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FEMA Form FF-104-F Second Batch of Hermits Peak Instruments (Revised)	Form
FEMA Form FF-104-F Notice of Loss FEMA Form FF-104-FY-22-230_NEW.pdf	Form
FEMA Form FF-104-F Formulario de Notificacion de Perdida FEMA Form FF-104-FY-22-230-A_DRAFT.pdf	Form
FEMA Form FF-104-F Proof of Loss FEMA Form FF-104-FY-22-231_DRAFT.pdf	Form
FEMA Form FF-104-F Comprobante de Perdida - Incendio en Hermit's Peak/Calf FEMA Form FF-104-FY-22-231-A_DRAFT.pdf	Form
FEMA Form FF-104-F Banking Information Form FEMA Form FF-104-FY-22-251_DRAFT.pdf	Form
FEMA Form FF-104-F Formulario de Informacion Bancaria FEMA Form FF-104-FY-22-251-A_DRAFT.pdf	Form
FEMA Form FF-104-F Release and Certification (Individual/Household) - Parti FEMA Form FF-104-FY-22-252_DRAFT.pdf	Form
FEMA Form FF-104-F Release and Certification (Entity) - Partial Payment FEMA Form FF-104-FY-22-253_DRAFT.pdf	Form
1660-0159 Generic Application NOL- 03-2024.docx Generic Application - Notice of Loss	IC Document
1660-0159 Generic Application POL-04-2024.docx Generic Application - Proof of Loss	IC Document
1660-0159 Generic Application Banking Info - 11-2023_Signed.docx Generic Application - Banking Information	IC Document
1660-0159 Generic Application Partial RC (I-H)-04-2024.docx Generic Application - Release and Certification (I/H)	IC Document
1660-0159 Generic Application Partial RC (entity)-04-2024.docx Generic Application - Release and Certification (Entity)	IC Document
1660-0159 - Burden and Opportunity Costs for 2nd Batch BMOPRA-1111.xlsx Worksheet - Burden and Opportunity Costs	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Second Batch of Hermits Peak Instruments (Revised)

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	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

Federal Enterprise Architecture Business Reference Module

Line of Business: Disaster Management

Subfunction: Disaster Repair and Restore

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 143,625

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	143,625	143,625
Annual IC Time Burden (Hours)	691,799	691,799
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.