General Admissions Application (Long and Short) and Stipend Forms

Forms and Documents

Document Name	Status
Form FEMA Form 119-25-0 General Admissions Application Short Form Form and Instruction	New
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 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	Removed
Published 30 Day FRN.pdf Supplementary Document	2016-10-17
Published 60 Day FRN.pdf Supplementary Document	2016-10-17
Supporting Statement 1660-0100 Part A Final .docx Supporting Statement A	2016-11-30
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

IC Document Collections

IC ID	Document Title	Status
223957	General Admissions Application Short Form Form and Instruction	New
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
178877	Student Stipend Agreement Form and Instruction	Modified
178874	General Admissions Application - Short Form Form and Instruction	Removed

ICR Details

OMB Control No: 1660-0100	ICR Reference No: 201610-1660-001
Status: Historical Active	Previous ICR Reference No: 201307-1660-009
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: 04/28/2017
	Date Received in OIRA: 11/30/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2020	36 Months From Approved	04/30/2017
Responses	111,800	0	112,800
Time Burden (Hours)	24,400	0	12,900
Cost Burden (Dollars)	0	0	0

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Abstract: FEMA provides training to advance the professional development of personnel engaged in fire prevention and control and emergency management activities through its Center for Domestic Preparedness, Emergency Management Institute, National Fire Academy, National Training and Education Division, National Domestic Preparedness Consortium, and Rural Domestic Preparedness Consortium.

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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:
	81 FR 4330	01/26/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 24850	04/27/2016
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	FEMA Form 119-25-3	Studen Stipend Agreement
General Admissions Application	FEMA Form 119-25-1	General Admissions Application
General Admissions Application Short Form	FEMA Form 119-25-0-6	Training Registration Form
General Admissions Application - Short Form	FEMA Form 119-25-2	General Admissions Application - Short Form
Student Stipend Agreement (Amendment)	FEMA Form 119-25-4	Student Stipend Agreement (Amendment)
Executive Fire Officer program Application for Admission	FEMA Form 119-25-5	National Fire Academy Executive Fire Officer Program Application for Admission

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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	111,800	112,800	0	-1,000	0	0
Annual Time Burden (Hours)	24,400	12,900	0	11,500	0	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: FEMA Form 119-25-0-1 has an increase in the number of respondents from 25,000 to 52,000 (+27,000) because FEMA is replacing the existing General Admissions Application (FEMA Form 119-25-1) and General Admissions Application Short Form (FEMA Form 119-25-2) forms with a single FEMA-wide form which will be submitted as a paper version or using an on-line application process. There was also an adjustment increase from 3,750 hours to 7,800 (+4,050) hours. The FEMA Form 119-25-0-6 (General Admissions Application Short Form Scannable Version) has been created for those courses where less information is required from the respondent. It is expected that 154,500 respondents will used this form requiring 15,450 burden hours. The FEMA Form 119-25-2 (reduction of 80,000 respondents and 8,000 burden hours) is being eliminated and being replaced by the FEMA Form 119-25-0-1.

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Annual Cost to Federal Government: $2,063,978

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: 11/30/2016

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