Information Collection

Hermits Peak/Calf Canyon Claims Office Customer Satisfaction Surveys

IC 276678 under ICR 202412-1660-003 · OMB 1660-0130.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FEMA Form-104-FY-2 Proof of Loss Survey -Phone Hermits Peak/Calf Canyon Claims Office Customer Satisfaction Surveys	Form and Instruction
Form FEMA Form FF-104-F Assessment Survey - Phone Hermits Peak/Calf Canyon Claims Office Customer Satisfaction Surveys	Form and Instruction
Form FEMA Form FF-104-F Acknowledgement Survey – Phone Hermits Peak/Calf Canyon Claims Office Customer Satisfaction Surveys	Form and Instruction
FEMA Form-104-FY-2 Proof of Loss Survey -Phone FF-104-FY-24-118_POL_2025.docx	Form and Instruction
FEMA Form FF-104-F Assessment Survey - Phone FF-104-FY-24-119_Assessment_2025.docx	Form and Instruction
FEMA Form FF-104-F Acknowledgement Survey – Phone FF-104-FY-24-120_Acknowledgement_2025.docx	Form and Instruction
1660-0130_HPCC_Surveys_08042025.pdf Generic Application	IC Document

IC Title:

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Electronic Capability
Form and Instruction	FEMA Form-104-FY-24-118	No	Fillable Printable
Form and Instruction	FEMA Form FF-104-FY-24-119	No	Fillable Printable
Form and Instruction	FEMA Form FF-104-FY-24-120	No	Fillable Printable

Line of Business: Disaster Management

Subfunction: Disaster Preparedness and Planning

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 7,400

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	7,400	7,400
Annual IC Time Burden (Hours)	1,335	1,335
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic Application		08/05/2025

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

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