General Admissions Application (Long and Short) and Stipend Forms

Forms and Documents

Document Name	Status
Form FEMA Form 119-25-1 General Admissions Application Form and Instruction	Modified
Form FEMA Form 119-25-4 Student Stipend Agreement (Amendment) Form and Instruction	Modified
Form FEMA Form 119-25-5 Executive Fire Officer program Application for Admission Form and Instruction	Modified
Form 119-25-3 Student Stipend Agreement Form	Removed
Form FEMA Form 119-25-3 Student Stipend Agreement Form and Instruction	Modified
Form FEMA Form 119-25-2 General Admissions Application - Short Form Form and Instruction	Modified
Supporting Statement 1660-0100 07242013.docx Supporting Statement A	2013-07-25
Public Law 93-498.pdf Supplementary Document	2013-07-12
PIA 1660-0100 03292012.pdf Supplementary Document	2013-07-12
SORN 1660-0100 04062011.pdf Supplementary Document	2013-07-12
Pub 30 Day FRN 16600100 06252013.pdf Supplementary Document	2013-07-12
Pub. 60 Day FRN 1660100.pdf Supplementary Document	2013-07-12

IC Document Collections

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

ICR Details

OMB Control No: 1660-0100	ICR Reference No: 201307-1660-009
Status: Historical Active	Previous ICR Reference No: 201209-1660-003
Agency/Subagency: DHS/FEMA	Agency Tracking No:
Title: General Admissions Application (Long and Short) and Stipend Forms
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/15/2013
	Date Received in OIRA: 08/01/2013
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2016	36 Months From Approved	11/30/2013
Responses	112,800	0	109,400
Time Burden (Hours)	12,900	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 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
   EO: EO 12148 Name/Subject of EO: Federal Emergency Management
  

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:
	78 FR 20330	04/04/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 38067	06/25/2013
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 5

IC Title	Form No.	Form Name
Student Stipend Agreement	119-25-3	Student Stipend Agreement
Student Stipend Agreement (Amendment)	FEMA Form 119-25-4	Studen Stipend Agreement (Amendment)
General Admissions Application - Short Form	FEMA Form 119-25-2	General Admissions Application - Short Form
Executive Fire Officer program Application for Admission	FEMA Form 119-25-5	National Fire Academy Executive Fire Officer Program Application Admissions
Student Stipend Agreement	FEMA Form 119-25-3	Studen Stipend Agreement
General Admissions Application	FEMA 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	112,800	109,400	0	0	3,400	0
Annual Time Burden (Hours)	12,900	11,783	0	500	617	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: FEMA Form 119-25-1 has an increase in the number of respondents from 15,000 to 25,000 (+10,000) because FEMA Form 119-25-1 (automated) was not put into use due to problems with the computerized system that was being used to collect the input and the system not being put into operation. The individuals who were expected to use the FEMA Form 119-25-1 (automated) are using the FEMA Form 119-25-1. There was also an adjustment increase from 2,250 hours to 3,750 (+1,500) hours. Part of this is related to the 1,333 hours that were estimated for the FEMA Form 119-25-1 (automated) that was not being utilized. The additional 167 hours is due to the increase time (8 minutes to 9) to complete the FEMA Form 119-25-1 as compared to the FEMA Form 119-25.1 (automated). FEMA Form 119-25-1 (automated) is no longer being used and the FEMA Forms 119-25-1 is being used for this purpose. This has resulted in a reduction of 10,000 respondents and a decrease of 1,333 burden hours for the FEMA Form 119-25-1 (automated). FEMA Form 119-25-2 has a burden increase from 75,000 respondents to 80,000 respondents (+5,000) and a corresponding increase in burden hours from 7,500 to 8,000 (+500) due to the increased usage of this form. The number of respondents using this form has been steadily increasing since the last information collection budget submission. This is due to a an increase in the number of off-campus course deliveries. FEMA Form 119-25-3 has a burden decrease of 1,000 respondents to 7,000 respondents . This decrease is due to a reduction in the number respondents submitting requests for student stipend reimbursements. The burden hours for this collection has a decrease from 267 to 233 (-34) hours due to a reduction in the use of this form. FEMA Form 119-25-3 was mistakenly entered into the ROCIS system twice with an estimation of 8000 respondents and 267 burden hours. The burden estimates were removed from this collection. FEMA Form 119-25-4 has a decrease in respondents from 1000 to 500. The decrease is due to a reduction in the number of respondents submitting amendments to the student stipend reimbursement form (FEMA Form 119-25-3). The burden hours for this collection have an adjustment decrease from 33 to 17 (-16) hours due to a reduction in the number of respondents submitting stipend amendments. FEMA Form 119-25-5 have a decrease from 400 to 300 (-100) respondents due to a reduction in the number of annual respondents applying for the Executive Fire Officer Program. The burden hours for this collection have an adjustment of 900 hours from 400 (+500) hours due to the amount of additional time required to assemble and complete the FEMA Form 119-25-5 and the required supplemental documentation (responses to the questions on the form, letter of intent, resume, letters of recommendation, copies of diplomas, organizational chart, and a short essay).

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Annual Cost to Federal Government: $184,106

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: 08/01/2013

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