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Information Collection

Generic Clearance for Notice of Loss and Proof of Loss

IC 264452 under ICR 202404-1660-002 · OMB 1660-0159.

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Generic Clearance for Notice of Loss and Proof of Loss Instruments #1-#6
 
Unchanged
 
Required to Obtain or Retain Benefits
 
44 CFR Part 269  (To search for a specific CFR, visit the Code of Federal Regulations.)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form FEMA Form FF-104-FY-22-231 #1 Proof of Loss (English) FEMA Form FF-104-FY-22-231_V2_DRAFT.pdf No   Printable Only
Form FEMA Forn FF-104-FY-22-231-A #1 Proof of Loss (Spanish) FEMA Form FF-104-FY-22-231-A_V2_DRAFT.pdf No   Printable Only
Form FEMA Form FF-104-FY-22-252 #2 Release and Certification (Individual/Household)- Partial Payment (English) FEMA Form FF-104-FY-22-252_DRAFT.pdf No   Printable Only
Form FEMA Form FF-104-FY-22-252-A #2 Release and Certification (Individual/Household)- Partial Payment (Spanish) FEMA Form FF-104-FY-22-252-A_DRAFT.pdf No   Printable Only
Form FEMA Form FF-104-FY-22-253 #3 Release and Certification (Entity)- Partial Payment (English) FEMA Form FF-104-FY-22-253_DRAFT.pdf No   Printable Only
Form FEMA Form FF-104-FY-22-253-A #3 Release and Certification (Entity)- Partial Payment (Spanish) FEMA Form FF-104-FY-22-253-A_DRAFT.pdf No   Printable Only
Form FEMA Form FF-104-FY-22-230 #4 Notice of Loss (English) FEMA Form FF-104-FY-22-230_DRAFT.pdf No   Printable Only
Form FEMA Form FF-104-FY-22-230-A #4 Notice of Loss (Spanish) FEMA Form FF-104-FY-22-230-A_DRAFT.pdf No   Printable Only
Form FEMA Form FF-104-FY-22-254 #5 Request to Supplement Claim (English) FEMA Form FF-104-FY-22-254_DRAFT.pdf No   Printable Only
Form FEMA Form FF-104-FY-22-254-A #5 Request to Supplement Claim (Spanish) FEMA Form FF-104-FY-22-254-A_DRAFT.pdf No   Printable Only
Form FEMA Form FF-104-FY-22-251 Banking Information Form (English) FEMA Form FF-104-FY-22-251_DRAFT.pdf No   Printable Only
Form FEMA Form FF-104-FY-22-251-A Banking Information Form (Spanish) FEMA Form FF-104-FY-22-251-A_DRAFT.pdf No   Printable Only

Disaster Management Disaster Repair and Restore

DHS/ALL-013 Department of Homeland Security Claims Records  73 FR 63987

28,725 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   0 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 28,725 0 0 0 0 28,725
Annual IC Time Burden (Hours) 696,581 0 0 0 0 696,581
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
#1 Generic Application- Proof of Loss 1660-0159 Generic Application POL-11-2023_Signed.pdf 01/17/2024
#2 Generic Application- Release and Certification (Indivivual/Household)) 1660-0159 - Gen App FF-104-FY-22-252 (RC-House).pdf 01/17/2024
#3 Generic Application- Release and Certification (Entity) 1660-0159 - Gen App FF-104-FY-22-253 (RC Entity).pdf 01/17/2024
#4 Generic Application-Notice of Loss 1660-0159 - Gen App FF-104-FY-22-230 (NOL).pdf 01/17/2024
#5 Generic Application- Request to Supplement Claim 1660-0159 - Gen App FF-104-FY-22-254 (Supplement).pdf 01/17/2024
#6 Generic Application- Banking Information Form 1660-0159 - Gen App FF-104-FY-22-251 (Bank Info).pdf 01/17/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.