Fuel Geyser Incident Reporting Form

DOI Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1090-0011 can be found here:

Documents and Forms

Document Name Document Type
OS FT-104 Fuel Geyser Incident Reporting Form.pdf Other-Web Form
OS FT-104 DI-4011 Fuel Geyser Reporting Form.pdf Request for Approval IC Document

Information Collection (IC) Details

IC Title:	Fuel Geyser Incident Reporting Form	Agency IC Tracking Number:	2018-OS-FT38

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Web Form			OS FT-104 Fuel Geyser Incident Reporting Form.pdf		Yes	Yes	Fillable Fileable

Line of Business: Disaster Management

Subfunction: Disaster Preparedness and Planning

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	17	17
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Approval	OS FT-104 DI-4011 Fuel Geyser Reporting Form.pdf	10/30/2018

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.