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pdfPAPERWORK REDUCTION ACT
CHANGE WORKSHEET
Agency/Subagency
OMB control number
DHS/FEMA
1
6
6
0
0
0
6
1
Enter only items that change
Current record
New record
Agency form number(s)
FF-104-FY-21-114
FF-104-FY-21-114
Annual reporting and recordkeeping hour
burden
Number of respondents
0
0
Total annual responses
0
0
0 %
0%
0
0
Percent of these responses
collected electronically
Total annual hours
0
Difference
Explanation of difference
Program change
0
Adjustment
0
Annual reporting and recordkeeping cost
burden (in thousands of dollars)
Total annualized Capital/Startup costs
0.00
0.00
Total annual costs (O&M)
0.00
0.00
Total annualized cost requested
0.00
0.00
0.00
Difference
Explanation of difference
Program change
0.00
Adjustment
0.00
Other changes**
IHP made non substantive changes to the Other Needs Assistance Administrative Option Selection form.
Signature of Senior Official or designee:
Date:
For OIRA Use
3/17/2025
**This form cannot be used to extend an expiration date.
OMB FORM 83-C, 10/95
Reset
Adobe Professional 7.0
| File Type | application/pdf |
| File Title | OMB Form 83-C, Paperwork Reduction Act Change Worksheet, October 1995 |
| Author | WHS/ESD/IMD |
| File Modified | 2025-03-17 |
| File Created | 2007-08-09 |