OMB control number

Generic Clearance for Notice of Loss and Proof of Loss

OMB 1660-0159 · DHS/FEMA.

OMB 1660-0159

The Federal Emergency Management Agency (FEMA) will use the collected information to commence the process and procedures for claimants to seek compensation for injury or loss of property resulting from the Hermit’s Peak/Calf Canyon Fire and other fires that meet the criteria. Affected state, local and Tribal governments, private sector businesses, not-for-profit organizations, and individuals and households that suffered injuries resulting from fires will be eligible to apply for compensation. Claimants will submit a Notice of Loss to the Agency, meet with a FEMA Claims Reviewer, obtain documentation needed to substantiate claims, sign a Proof of Loss, and complete and return a Release and Certification form.

The latest form for Generic Clearance for Notice of Loss and Proof of Loss expires 2026-11-30 and is listed under ICR 202404-1660-002.

View the official OMB control history on Reginfo.gov.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form FEMA Form FF-104-F Banking Information Form (Entity) Spanish (document unavailable)Form
Form FEMA Form FF-104-F Banking Information Form (Entity) (document unavailable)Form
Form FEMA Form FF-104-F Notice of Request for Arbitration Form (Spanish) (document unavailable)Form
Form FF-104-FY-25-100 Notice of Request for Arbitration Form (English) (document unavailable)Form
Form FF-104-FY-24-117-E Smoke & Ash Cleaning Form (Spanish Version) (document unavailable)Form
Form FF-104-FY-24-121-E Risk Reduction Proposal Form (Spanish Version) (document unavailable)Form
Form FF-104-FY-24-122-E Notice of Appeal (Spanish Version) (document unavailable)Form
Form FF-104-FY-24-116-A Flood Insurance Assessment (Spanish Version) (document unavailable)Form
Form FF-104-FY-24-115-E Evacuee Hosting (Spanish Version) (document unavailable)Form
Form FF-104-FY-24-114-E Evacuation Information Worksheet (Spanish Version) (document unavailable)Form
Form FEMA Form FF-104-F Proof of Loss (Spanish) (document unavailable)Form
Form FEMA Form FF-104-F Release and Certifications (Individuals and Households) - Partial Payment (Spanish) (document unavailable)Form
Form FEMA Form FF-104-F Release and Certifications (Entity) - Partial Payment (Spanish) (document unavailable)Form
Form Form FF-104-FY-22- Notice of Loss (Spanish) (document unavailable)Form
Form FEMA Form FF-104-F Banking Information Form (Spanish) (document unavailable)Form
Form FF-104-FY-24-122 Notice of Appeal Request Form (document unavailable)Form
Form FEMA Form FF-104-F Risk Reduction ProposalForm
Form FEMA Form FF-104-F Smoke & Ash CleaningForm
Form FEMA Form FF-104-F Flood Insurance AssessmentForm
Form FEMA Form FF-104-F Evacuee HostingForm
Form FEMA Form FF-104-F Evacuation Information WorksheetForm
Form FEMA Form FF-104-F Release and Certification (Entity) - Partial PaymentForm
Form FEMA Form FF-104-F Release and Certification (Individual/Household) - PartialForm
Form FEMA Form FF-104-F Formulario de Informacion BancariaForm
Form FEMA Form FF-104-F Banking Information FormForm
Form FEMA Form FF-104-F Comprobante de Perdida - Incendio en Hermit's Peak/Calf CanyonForm
Form FEMA Form FF-104-F Proof of LossForm
Form FEMA Form FF-104-F Formulario de Notificacion de PerdidaForm
Form FEMA Form FF-104-F Notice of LossForm
Form FEMA Form FF-104-F Banking Information Form (Spanish)Form
Form FEMA Form FF-104-F Banking Information Form (English)Form
Form FEMA Form FF-104-F #5 Request to Supplement Claim (Spanish)Form
Form FEMA Form FF-104-F #5 Request to Supplement Claim (English)Form
Form FEMA Form FF-104-F #4 Notice of Loss (Spanish)Form
Form FEMA Form FF-104-F #4 Notice of Loss (English)Form
Form FEMA Form FF-104-F #3 Release and Certification (Entity)- Partial Payment (Spanish)Form
Form FEMA Form FF-104-F #3 Release and Certification (Entity)- Partial Payment (English)Form
Form FEMA Form FF-104-F #2 Release and Certification (Individual/Household)- Partial Payment (Spanish)Form
Form FEMA Form FF-104-F #2 Release and Certification (Individual/Household)- Partial Payment (English)Form
Form FEMA Forn FF-104-F #1 Proof of Loss (Spanish)Form
Form FEMA Form FF-104-F #1 Proof of Loss (English)Form
1660-0159 - Supporting Statement A - 2024 03 29.docxSupporting Statement A
1660-0159 Signed Change Request - 2024 03 27.pdf Justification for No Material/Nonsubstantive Change
1660-NW163 - Published 30-Day New Generic FRN - 2023 08 11.pdf Supplementary Document
1660-NW163 - Published 60-Day New Generic FRN - 2023 05 05.pdf Supplementary Document
PLAW-117publ103.pdf Supplementary Document
USCODE-2021-title42-chap68.pdf Supplementary Document
8th Batch of Hermit's Peak Instruments (New) Form
8th Batch of Hermit's Peak Instruments (New) Form
7th Batch of Hermit's Peak Instruments (New) Form
7th Batch of Hermit's Peak Instruments (New) Form
6th Batch of Hermit's Peak Instruments (New) Form
6th Batch of Hermit's Peak Instruments (New) Form
6th Batch of Hermit's Peak Instruments (New) Form
6th Batch of Hermit's Peak Instruments (New) Form
6th Batch of Hermit's Peak Instruments (New) Form
6th Batch of Hermit's Peak Instruments (New) Form
5th Batch of Hermit's Peak Instruments (Revised) Form
5th Batch of Hermit's Peak Instruments (Revised) Form
5th Batch of Hermit's Peak Instruments (Revised) Form
5th Batch of Hermit's Peak Instruments (Revised) Form
5th Batch of Hermit's Peak Instruments (Revised) Form
4th Batch of Hermit's Peak Instrument (New) Form
Third Batch of Hermits Peak Instruments (New) Form
Third Batch of Hermits Peak Instruments (New) Form
Third Batch of Hermits Peak Instruments (New) Form
Third Batch of Hermits Peak Instruments (New) Form
Third Batch of Hermits Peak Instruments (New) Form
Second Batch of Hermits Peak Instruments (Revised) Form
Second Batch of Hermits Peak Instruments (Revised) Form
Second Batch of Hermits Peak Instruments (Revised) Form
Second Batch of Hermits Peak Instruments (Revised) Form
Second Batch of Hermits Peak Instruments (Revised) Form
Second Batch of Hermits Peak Instruments (Revised) Form
Second Batch of Hermits Peak Instruments (Revised) Form
Second Batch of Hermits Peak Instruments (Revised) Form
Generic Clearance for Notice of Loss and Proof of Loss Form
Generic Clearance for Notice of Loss and Proof of Loss Form
Generic Clearance for Notice of Loss and Proof of Loss Form
Generic Clearance for Notice of Loss and Proof of Loss Form
Generic Clearance for Notice of Loss and Proof of Loss Form
Generic Clearance for Notice of Loss and Proof of Loss Form
Generic Clearance for Notice of Loss and Proof of Loss Form
Generic Clearance for Notice of Loss and Proof of Loss Form
Generic Clearance for Notice of Loss and Proof of Loss Form
Generic Clearance for Notice of Loss and Proof of Loss Form
Generic Clearance for Notice of Loss and Proof of Loss Form
Generic Clearance for Notice of Loss and Proof of Loss Form

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202404-1660-002 No material or nonsubstantive change to a currently approved collection 2024-04-05 Approved without change
202403-1660-006 No material or nonsubstantive change to a currently approved collection 2024-04-04 Approved without change
202305-1660-002 New collection (Request for a new OMB Control Number) 2023-08-28 Approved without change

OMB Details

Generic Clearance for Notice of Loss and Proof of Loss

Federal Enterprise Architecture: Disaster Management - Disaster Repair and Restore

Information collection instruments
FormNameElectronic accessType
Form FEMA Form FF-104-FY-22-252-A#2 Release and Certification (Individual/Household)- Partial Payment (Spanish)Printable OnlyForm
Form FEMA Form FF-104-FY-22-251-ABanking Information Form (Spanish)Printable OnlyForm
Form FEMA Form FF-104-FY-22-251Banking Information Form (English)Printable OnlyForm
Form FEMA Form FF-104-FY-22-254-A#5 Request to Supplement Claim (Spanish)Printable OnlyForm
Form FEMA Form FF-104-FY-22-252#2 Release and Certification (Individual/Household)- Partial Payment (English)Printable OnlyForm
Form FEMA Form FF-104-FY-22-254#5 Request to Supplement Claim (English)Printable OnlyForm
Form FEMA Form FF-104-FY-22-230-A#4 Notice of Loss (Spanish)Printable OnlyForm
Form FEMA Form FF-104-FY-22-230#4 Notice of Loss (English)Printable OnlyForm
Form FEMA Form FF-104-FY-22-253-A#3 Release and Certification (Entity)- Partial Payment (Spanish)Printable OnlyForm
Form FEMA Form FF-104-FY-22-253#3 Release and Certification (Entity)- Partial Payment (English)Printable OnlyForm
Form FEMA Form FF-104-FY-22-231#1 Proof of Loss (English)Printable OnlyForm
Form FEMA Forn FF-104-FY-22-231-A#1 Proof of Loss (Spanish)Printable OnlyForm

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.