Information Collection

Governor's Request for Disaster Declaration

IC 35675 under ICR 202011-3245-001 · OMB 3245-0121.

Documents and Forms

Document Name Document Type
3245-0121 Economic Injury Worksheet Final Template 11-20-2020.pdf Other-Economic Injury Worksheet
3245-0121 Economic Injury Worksheet Final Template 11-20-2020.pdf Other-Economic Injury Worksheet

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Governor's Request for Disaster Declaration	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 13 CFR 123.3

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Economic Injury Worksheet			3245-0121 Economic Injury Worksheet Final Template 11-20-2020.pdf		Yes	No	Paper Only

Line of Business: Disaster Management

Subfunction: Disaster Monitoring and Prediction

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 56	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	56	-5	61
Annual IC Time Burden (Hours)	1,200	-20	1,220
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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