Information Collection

Individuals and Households Program (IHP) - Other Needs Assistance Administrative Option Selection

IC 21141 under ICR 202212-1660-013 · OMB 1660-0061.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1660-0061 can be found here:

Documents and Forms

Document Name Document Type
Form FEMA Form FF-104-F Individuals and Households Program (IHP) - Other Needs Assistance Administrative Option Selection Form
FEMA Form FF-104-F Individuals and Households Program (IHP) - Other Needs A FEMA Form FF-104-FY-21-114 (formerly 010-0-11).pdf Form
FEMA Form FF-104-F Individuals and Households Program (IHP) - Other Needs A FEMA Form FF-104-FY-21-114 (formerly 010-0-11).pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Individuals and Households Program (IHP) - Other Needs Assistance Administrative Option Selection	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 44 CFR 206

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	FEMA Form FF-104-FY-21-114 (formerly 010-0-11)	Individuals and Households Program (IHP) - Other Needs Assistance Administrative Option Selection	FEMA Form FF-104-FY-21-114 (formerly 010-0-11).pdf		Yes	No	Fillable Printable

Line of Business: Disaster Management

Subfunction: Disaster Repair and Restore

Privacy Act System of Records
Title: Individuals and Households Program (IHP) Other	FR Citation: 78 FR 25282

Number of Respondents: 629	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	629	74	555
Annual IC Time Burden (Hours)	692	81	611
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.