General Admissions Application (Long and Short) and Stipend Forms

Forms and Documents

Document Name	Status
Form 119-25-1 General Admissions Application (Long) Form Form	Modified
Form 119-25-4 Student Stipend Agreement (Amendment) Form	Unchanged
Form 119-25-5 Executive Fire Officer program Application for Admission Form	Unchanged
Form 119-25-3 Student Stipend Agreement Form	Unchanged
Form 119-25-1 (automate General Admissions Application - Automated Form and Instruction	Modified
Form 119-25-2 General Admissions Application - Short Form Form	Modified
83C 1660-0100 signed 3-11-12.pdf Justification for No Material/Nonsubstantive Change	2012-04-04

IC Document Collections

IC ID	Document Title	Status
21048	General Admissions Application (Long) Form Form	Modified
192798	Student Stipend Agreement (Amendment) Form	Unchanged
178881	Executive Fire Officer program Application for Admission Form	Unchanged
178878	Student Stipend Agreement Form	Unchanged
178877	General Admissions Application - Automated Form and Instruction	Modified
178874	General Admissions Application - Short Form Form	Modified

ICR Details

OMB Control No: 1660-0100	ICR Reference No: 201203-1660-004
Status: Historical Active	Previous ICR Reference No: 201005-1660-001
Agency/Subagency: DHS/FEMA	Agency Tracking No:
Title: General Admissions Application (Long and Short) and Stipend Forms
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 07/29/2012
	Date Received in OIRA: 04/13/2012
Terms of Clearance: DHS has appropriately applied OMB guidelines on Race and Ethnicity reporting.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2013	08/31/2013	08/31/2013
Responses	109,400	0	109,400
Time Burden (Hours)	11,783	0	11,783
Cost Burden (Dollars)	0	0	0

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Abstract: FEMA is responsible for providing training to meet the needs of disaster preparedness requirements set forth by regulation. To facilitate meeting these requirements, FEMA collects applicant information necessary to register for courses and to receive stipends for the courses. FEMA uses the application forms to admit applicants to courses and programs offered at National Emergency Training Center (NETC), the Noble Training Facility (NTF), and various locations throughout the United States.

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Authorizing Statute(s): EO: EO 12148 Name/Subject of EO: Federal Emergency Management
   EO: EO 12127 Name/Subject of EO: Federal Emergency Management Agency
   US Code: 42 USC 5121-5207 Name of Law: Robert T. Stafford Disaster Relief and Emergency Assistance Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 8376	02/24/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 74222	05/05/2010
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 6

IC Title	Form No.	Form Name
Student Stipend Agreement (Amendment)	119-25-4	Student Stipend Agreement (Amendment)
General Admissions Application - Short Form	119-25-2	General Admissions Application Short Form
Student Stipend Agreement	119-25-3	Student Stipend Agreement
Executive Fire Officer program Application for Admission	119-25-5	National Fire Academy Executive Fire Officer Program Application Admission
General Admissions Application - Automated	119-25-1 (automated)	General Admissions Application
General Admissions Application (Long) Form	119-25-1	General Admissions Application

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	109,400	109,400	0	0	0	0
Annual Time Burden (Hours)	11,783	11,783	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: FEMA Form 119-25-1 (formerly 75-5) has combined the paper and electronic submission methods previously listed due to the single method currently available to submit the information. This results in an increase of 1,500 hours for non-electronic submission and a decrease of 1,333 for elimination of the former electronic submission option. The annual hour burden for the collection activity has an overall net increase of 167 hours. FEMA Form 119-25-2 (formerly 75-5A) has combined the paper and electronic submission methods previously listed due to the single method currently available to submit the information. This results in an increase of 1,500 hours for non-electronic submission and a decrease of 1,250 for elimination of the former electronic submission. The annual hour burden for the collection activity has an overall net increase of 250 hours. FEMA Form 119-25-5 (formerly FEMA Form 95-22) has an increase in annual hour burden due to the addition of the 67 annual hours burden approved in this collection to the 333 annual hours burden approved in collection OMB Control Number 1660-0021. The annual hour burden for the collection activity has an overall net increase of 333 hours. “Additional Documentation: Letter of Intent, Resume, Letter of Recommendation, Diploma Photocopy, Organization Chart” is a collection activity added to this collection due to the requirement for this information in combination with FEMA Form 119-25-5. This results in an increase in 400 annual burden hours. FEMA Form 119-25-4 (Student Stipend Amendment, formerly FEMA Form 75-3A) has increased by 33 annual hours burden. The annual hour burden was inadvertently not added into the last collection request and is now reported.

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Annual Cost to Federal Government: $307,500

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 04/13/2012

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