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Federal forms, ICRs, and supporting documents

Information Collection Request

Subrogration Notice and Proff of Loss - Cerro Grande Fire Assistance Act

ICR 200103-3067-004 · OMB 3067-0284 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
32105 Subrogration Notice and Proff of Loss - Cerro Grande Fire Assistance Act Form Migrated
ICR Details
3067-0284 200103-3067-004
Historical Active 200010-3067-001
FEMA
Subrogration Notice and Proff of Loss - Cerro Grande Fire Assistance Act
Extension without change of a currently approved collection   No
Regular
Approved without change 05/16/2001
Retrieve Notice of Action (NOA) 03/20/2001
  Inventory as of this Action Requested Previously Approved
05/31/2004 05/31/2004 05/31/2001
12 0 5,000
18,000 0 20,000
0 0 0
Claimants presenting subrogation claims are required to complete the Subrogation Notice and Proof of Loss form. FEMA will use the information to evaluate the claim and determine if compensation is due to the claimant under the Cerro Grande Fire Assistance Act The information may also be used by others to prevent duplication of benefits which are prohibited by the CGFAA, and for other authorized uses.
None
None
No
1
IC Title Form No. Form Name
Subrogration Notice and Proff of Loss - Cerro Grande Fire Assistance Act CG-3
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 12 5,000 0 -4,988 0 0
Annual Time Burden (Hours) 18,000 20,000 0 -2,000 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes
$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
03/20/2001