THE BASIC REQUIREMENT FOR THIS FORM
STEMS FROM THE DISASTER RELIEF ACT '74, PL 93-288, AND FEDERAL
DISASTER ASSISTANCE REGULATIONS, TITLE 44, PART 205. THIS FORM IS
USED IN CONJUNCTION WITH THE DAMAGE SURVEY REPORT PREPARED FOR EACH
DAMAGED FACILITY. CERTAIN DSR'S REQUIRE SUPPLEMENTAL DATA WHICH MAY
BE CONVENIENTLY RECORDED ON THIS SPECIAL FORM.
On behalf of this Federal agency, I certify that
the collection of information encompassed by this request complies
with 5 CFR 1320.9 and the related provisions of 5 CFR
1320.8(b)(3).
The following is a summary of the topics, regarding
the proposed collection of information, that the certification
covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a
benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control
number;
If you are unable to certify compliance with any of
these provisions, identify the item by leaving the box unchecked
and explain the reason in the Supporting Statement.