Information Collection

Environmental and Historic Preservation Screening Form

IC 193035 under ICR 202212-1660-001 · OMB 1660-0115.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1660-0115 can be found here:

Documents and Forms

Document Name Document Type
Form FEMA Form FF-119-F Environmental and Historic Preservation Screening Form Form and Instruction
FEMA Form FF-119-F Environmental and Historic Preservation Screening Form FEMA Form FF-119-FY-21-105 GPD EHP.pdf www.fema.gov/grants/preparedness/preparedness-grants-ehp-compliance Form and Instruction
FEMA Form FF-119-F Environmental and Historic Preservation Screening Form FEMA Form FF-119-FY-21-105 GPD EHP.pdf www.fema.gov/grants/preparedness/preparedness-grants-ehp-compliance Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Environmental and Historic Preservation Screening Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	FEMA Form FF-119-FY-21-105 (formerly 024-0-1)	Environmental and Historic Preservation Screening Form	FEMA Form FF-119-FY-21-105 GPD EHP.pdf	https://www.fema.gov/grants/preparedness/preparedness-grants-ehp-compliance	Yes	Yes	Fillable Fileable

Line of Business: Disaster Management

Subfunction: Disaster Preparedness and Planning

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,000	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,000	200	1,800
Annual IC Time Burden (Hours)	14,567	167	14,400
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.