Information Collection Request

Notice of Loss and Proof of Loss

ICR 202302-1660-001 · OMB 1660-0155 · Active

Forms and Documents

Document	Type	Status	Availability
Form FEMA Form FF-104-F Request to Supplement Claim - Individuals and Households	Form and Instruction	New	Available
Form FEMA Form FF-104-F Request to Supplement Claim - Individuals and Households	Form and Instruction	New	Missing upstream
Form FEMA Form FF-104-F Request to Supplement Claim - Private Sector	Form and Instruction	New	Available
Form FEMA Form FF-104-F Request to Supplement Claim - Private Sector	Form and Instruction	New	Repair queued
Form FEMA Form FF-104-F Request to Supplement Claim - State, Local and Tribal Governments	Form and Instruction	New	Available
Form FEMA Form FF-104-F Request to Supplement Claim - State, Local and Tribal Governments	Form and Instruction	New	Repair queued
Form FEMA Form FF-104-F Partial Payment Release and Certification Form - Individuals and Households	Form and Instruction	New	Available
Form FEMA Form FF-104-F Partial Payment Release and Certification Form - Individuals and Households	Form and Instruction	New	Missing upstream
Form FEMA Form FF-104-F Partial Payment Release and Certification Form (Entity) - Private Sector	Form and Instruction	New	Available
Form FEMA Form FF-104-F Partial Payment Release and Certification Form (Entity) - Private Sector	Form and Instruction	New	Repair queued
Form FEMA Form FF-104-F Partial Payment Release and Certification Form (Entity) - State, Local and Tribal Governments	Form and Instruction	New	Available
Form FEMA Form FF-104-F Partial Payment Release and Certification Form (Entity) - State, Local and Tribal Governments	Form and Instruction	New	Repair queued
Form FEMA Form FF-104-F Banking Information - Individuals and Households	Form and Instruction	New	Available
Form FEMA Form FF-104-F Banking Information - Individuals and Households	Form and Instruction	New	Repair queued
Form FEMA Form FF-104-F Banking Information - Private Sector	Form and Instruction	New	Repair queued
Form FEMA Form FF-104-F Banking Information - Private Sector	Form and Instruction	New	Repair queued
Form FEMA Form FF-104-F Banking Information - State, Local & Tribal Governement	Form and Instruction	New	Repair queued
Form FEMA Form FF-104-F Banking Information - State, Local & Tribal Governement	Form and Instruction	New	Repair queued
Form FEMA Form FF-104-F Proof of Loss - Individuals and Households	Form and Instruction	Modified	Available
Form FEMA Form FF-104-F Proof of Loss - Individuals and Households	Form and Instruction	Modified	Repair queued
Form FEMA Form FF-104-F Notice of Loss - Individuals and Households	Form and Instruction	Modified	Available
Form FEMA Form FF-104-F Notice of Loss - Individuals and Households	Form and Instruction	Modified	Repair queued
Form FEMA Form FF-104-F Proof of Loss - Private Sector	Form and Instruction	Modified	Available
Form FEMA Form FF-104-F Proof of Loss - Private Sector	Form and Instruction	Modified	Missing upstream
Form FEMA Form FF-104-F Notice of Loss - Private Sector	Form and Instruction	Modified	Repair queued
Form FEMA Form FF-104-F Notice of Loss - Private Sector	Form and Instruction	Modified	Repair queued
Form FEMA Form FF-204-F Proof of Loss - State, Local, and Tribal Governments	Form and Instruction	Modified	Available
Form FEMA Form FF-204-F Proof of Loss - State, Local, and Tribal Governments	Form and Instruction	Modified	Repair queued
Form FEMA Form FF-104-F Notice of Loss - State, Local, and Tribal Governments	Form and Instruction	Modified	Available
Form FEMA Form FF-104-F Notice of Loss - State, Local, and Tribal Governments	Form and Instruction	Modified	Repair queued
FEMA_IFR Hermits Peak.pdf	Supplementary Document	Uploaded 2022-11-14	Available
FEMA_IFR Hermits Peak.pdf	Supplementary Document	Uploaded 2022-11-14	Repair queued
1660-0155_Emergency Justification Memo_Hermits Peak Notice of Loss_ 02.8.2023.pdf	Supplementary Document	Uploaded 2023-02-14	Available
1660-0155_Emergency Justification Memo_Hermits Peak Notice of Loss_ 02.8.2023.pdf	Supplementary Document	Uploaded 2023-02-14	Repair queued
1660-0155 - Supporting Statement A - 2023 02 10 clean.docx	Supporting Statement A	Uploaded 2023-02-10	Available
1660-0155 - Supporting Statement A - 2023 02 10 clean.docx	Supporting Statement A	Uploaded 2023-02-10	Repair queued

IC Document Collections

IC ID	Collection	Type	Status
258474	Request to Supplement Claim - Individuals and Households	Form and Instruction	New
258474	Request to Supplement Claim - Individuals and Households	Form and Instruction	New
258473	Request to Supplement Claim - Private Sector	Form and Instruction	New
258473	Request to Supplement Claim - Private Sector	Form and Instruction	New
258472	Request to Supplement Claim - State, Local and Tribal Governments	Form and Instruction	New
258472	Request to Supplement Claim - State, Local and Tribal Governments	Form and Instruction	New
258470	Partial Payment Release and Certification Form - Individuals and Households	Form and Instruction	New
258470	Partial Payment Release and Certification Form - Individuals and Households	Form and Instruction	New
258469	Partial Payment Release and Certification Form (Entity) - Private Sector	Form and Instruction	New
258469	Partial Payment Release and Certification Form (Entity) - Private Sector	Form and Instruction	New
258466	Partial Payment Release and Certification Form (Entity) - State, Local and Tribal Governments	Form and Instruction	New
258466	Partial Payment Release and Certification Form (Entity) - State, Local and Tribal Governments	Form and Instruction	New
258464	Banking Information - Individuals and Households	Form and Instruction	New
258464	Banking Information - Individuals and Households	Form and Instruction	New
258463	Banking Information - Private Sector	Form and Instruction	New
258463	Banking Information - Private Sector	Form and Instruction	New
258462	Banking Information - State, Local & Tribal Governement	Form and Instruction	New
258462	Banking Information - State, Local & Tribal Governement	Form and Instruction	New
256772	Proof of Loss - Individuals and Households	Form and Instruction	Modified
256772	Proof of Loss - Individuals and Households	Form and Instruction	Modified
256771	Notice of Loss - Individuals and Households	Form and Instruction	Modified
256771	Notice of Loss - Individuals and Households	Form and Instruction	Modified
256770	Proof of Loss - Private Sector	Form and Instruction	Modified
256770	Proof of Loss - Private Sector	Form and Instruction	Modified
256769	Notice of Loss - Private Sector	Form and Instruction	Modified
256769	Notice of Loss - Private Sector	Form and Instruction	Modified
256768	Proof of Loss - State, Local, and Tribal Governments	Form and Instruction	Modified
256768	Proof of Loss - State, Local, and Tribal Governments	Form and Instruction	Modified
256767	Notice of Loss - State, Local, and Tribal Governments	Form and Instruction	Modified
256767	Notice of Loss - State, Local, and Tribal Governments	Form and Instruction	Modified

ICR Details

Status	Active
Agency/Subagency	DHS/FEMA
OMB Control No	1660-0155
Type of Information Collection	Revision of a currently approved collection
Previous ICR Reference No	202211-1660-001
Agency Tracking No	Second Emergency (Hermit's Peak)
Date Submitted to OIRA	2023-02-15
Requested Expiration Date	2023-02-15