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pdfPAPERWORK REDUCTION ACT
CHANGE WORKSHEET
Agency/Subagency
OMB control number
DHS/FEMA
1
6
6
0
0
0
0
2
Enter only items that change
Current record
New record
Agency form number(s)
FT-104-FY-22-104
FT-104-FY-22-104
Annual reporting and recordkeeping hour
burden
Number of respondents
52,000
53,667
Total annual responses
52,000
53,667
Percent of these responses
collected electronically
Total annual hours
100 %
100 %
8,668
8,946
-278
Difference
Explanation of difference
Program change
Adjustment
Annual reporting and recordkeeping cost
burden (in thousands of dollars)
Total annualized Capital/Startup costs
0.00
0.00
Total annual costs (O&M)
0.00
0.00
Total annualized cost requested
0.00
0.00
0.00
Difference
Explanation of difference
Program change
0.00
Adjustment
0.00
Other changes**
For the 1660-0002 collection, updating Supporting Statement A due to a burden hour increase for the Request for Information (RFI) (Medical,
Dental, Disability-Accessibility-Related Items) form.
Signature of Senior Official or designee:
Date:
For OIRA Use
6/13/2024
**This form cannot be used to extend an expiration date.
OMB FORM 83-C, 10/95
Reset
Adobe Professional 7.0
File Type | application/pdf |
File Title | OMB Form 83-C, Paperwork Reduction Act Change Worksheet, October 1995 |
Author | WHS/ESD/IMD |
File Modified | 2024-06-13 |
File Created | 2007-08-09 |